Michael R. Veall

Background Prior studies have shown a positive relationship between income inequality and population-level mortality. This study investigates whether the relationship between US state-level income inequality and all-cause mortality persisted from 1989 to 2019 and whether changes in income inequality were correlated with changes in mortality rates. Methods We perform repeated cross-sectional regressions of mortality on state-level inequality measures (Gini coefficients) at 10-year intervals. We also estimate the correlation between within-state changes in income inequality and changes in mortality rates using two time-series models, one with state- and year-fixed effects and one with a lagged dependent variable. Our primary regressions control for median income and are weighted by population. Main outcome measures The two primary outcomes are male and female age-adjusted mortality rates for the working-age (25–64) population in each state. The secondary outcome is all-age mortality. Results There is a strong positive correlation between Gini and mortality in 1989. A 0.01 increase in Gini is associated with more deaths: 9.6/100 000 (95% CI 5.7, 13.5, pConclusion The absence or reversal of correlation after 1989 and the presence of an inverse correlation between change in inequality and change in all-cause mortality represents a significant reversal from the findings of a number of other studies. It also raises questions about the conditions under which income inequality may be an important policy target for improving population health.

According to Canadian taxfiler data, over the last thirty years there has been a surge in the income shares of the top 1%, top 0.1% and top 0.01% of income recipients, even with longitudinal smoothing by individual using three‐ or five‐year moving averages. Top shares fell in 2008 and 2009, but only by a fraction of the overall surge. Alberta, British Columbia, and Ontario have much more pronounced surges than other provinces. Part of the Canadian surge is likely attributable to U.S. factors, but a comprehensive explanation remains elusive. Even so, I draw implications for policies that might achieve some support from across the political spectrum, including the elimination of tax preferences that favour those with high incomes, the promotion of shareholder democracy and, to maintain Canada's relatively high intergenerational mobility, continued wide accessibility to healthcare and education.

About 6 percent of seniors in Canada have family incomes below the Low Income Measure (LIM), a definition of relative poverty that sets the line at 50 percent of the median household income adjusted for family size. The Canadian senior below-LIM rate has fallen sharply in the last 35 years and is low compared to that in other countries, to the general Canadian population, and to Canadian families with children. Canadian income tax data show that below-LIM seniors are overrepresented among recent immigrants, females, the unmarried, and those supporting dependent children (possibly grandchildren). Age does not appear to be of great importance. While there are no uncontestable cases for additional targeting of transfer income, there is a strong argument for assistance to the small number of seniors with dependent children.

The paper explores whether the responses to household food insecurity questions in cycles two and three of the Canadian National Population Health Survey help explain the links between socioeconomic status and health at the individual level. Short-term transitions in food insecurity status are correlated with changes in health status. There is some evidence for females but not for males that conditional on current health, current household food insecurity can lead to lower future health status, even in the short run. There is stronger evidence for both males and females that conditional on current household food insecurity status, lower current health status can lead to an increased probability of future household food insecurity.