Inequality and the social environment: a reply to Lynch et al.

The paper by Lynch et al is intended to cast doubt on the importance to health of social capital, relative income and psychosocial pathways, and to gain support for a view of the continued importance of absolute income and of “neomaterial” factors. Before answering specific points I should draw attention to two new studies that support the importance of relative income over absolute income in richer countries. Firstly, data for 21 regions of Taiwan showed that, as living standards rose during the course of rapid economic growth, income inequality replaced absolute median income as the best predictor of mortality. Secondly, in an analysis of infant mortality in relation to income distribution and gross national product per capita (GNPpc) in three sets of data covering richer and poorer countries, Hales et al showed that income distribution was more important than GNPpc except in the poorer countries.