This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related article  • Related letter  • Similar articles in JAMA  Topic Collections  • Health Policy  • Public Health, Other  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: The Commentary by Dr Woolf¹ considers possible future health consequences of the current decline in US household income. However, declining incomes among the middle class and increasing income inequality might not, in and of themselves, have future health consequences.

Income inequalities may instead be symptoms of broader social problems that are in turn responsible for poor health outcomes. For example, the association between income inequality and health in cross-national studies disappears when controlling for educational attainment.² This suggests that problems with schools, not income inequality, may drive the association.

In addition, the burden of disease in the bottom 80% of income earners in the United States—amounting to 17.4 million quality-adjusted life-years lost annually relative to the top 20%—has little to do with purchasing power.³ This lower 80% of US residents ranks second worldwide in terms of purchasing power but has a life expectancy below that of the . . . [Full Text of this Article]

Peter Muennig, MD, MPH
pm124@columbia.edu
Mailman School of Public Health
Columbia University
New York, New York

RELATED ARTICLE

Future Health Consequences of the Current Decline in US Household Income
Steven H. Woolf
JAMA. 2007;298(16):1931-1933.
EXTRACT | FULL TEXT  

RELATED LETTER

Health Consequences of Declining Incomes—Reply
Steven H. Woolf
JAMA. 2008;299(6):633-634.
EXTRACT | FULL TEXT