Income inequality and health: expanding the debate

The causes and consequences of health inequalities (and their implications for research and practice) have not, it is fair to say, been a notable feature of the body of work that we refer to as social pharmacy. By contrast, the previous three decades have witnessed a burgeoning number of empirical studies, numerous reviews, and growing political awareness about the social determinants of health inequalities. The field of epidemiology and public health, focusing on health inequalities, has risen in prominence with a finding that an individual's social position (whether this is measured by social class, education, or deprivation) profoundly shapes their health outcomes. To illustrate this using deprivation as a marker of social position, the recent Global Burden of Disease study showed that males who lived in the most deprived areas of England in 2013 could expect to have a life expectancy which was 8.2 years shorter than those living in the least deprived areas. If we were to look at social class or education, we would also see wide differences in health outcomes. There are, of course, huge inequalities in health outcomes when we compare health outcomes within and between different countries. For those who want to know more about this literature, there are numerous reviews.

This paper develops a proposed research agenda in order to highlight how corporate governance, accounting and company law are relevant to the consideration of income inequality and wider social health. To illustrate this proposed research agenda, this paper draws on corporate governance research in the law and finance tradition, as well as macro-level studies in accounting concerned with the wider corporate governance context, in order to consider the association between shareholder protection, income inequality and child mortality. Under 5 child mortality is an objective indication of a country’s ability to nurture its children. In an influential body of work, La Porta et al. (1997a, 1997b, 1998, 2008) concluded that a common law legal system which protected the interests of shareholders gave rise to better economic and social outcomes. However, drawing on corporate governance and accounting literature we contend that such a conclusion is flawed. The findings of this paper suggest that common law countries (i.e. those with the greater legal protection for investors) have worse social outcomes in terms of under-5 child mortality.

Social environmental injustice could directly influence children's physical activity and weight, but also indirectly through changing their psychosocial processes. This study aims to assess spatially continuous physical and social environments and to examine the impact of psychosocial stress on the complex interaction between children and obesogenic environments in three Eastern Alabama counties. The obesogenic environment is defined with particular physical, social, and economic characteristics, causing higher risk of being overweight or obese. Survey questionnaires were collected for 690 children in grades K-6 at six schools to measure children's weight, height, socio-demographics, and home locations. Physical activity, psychosocial stress, and family environment were further gathered from a subsample of children aged 8–13 (n = 65) through extended surveys. GIS and statistical methods were used to assess multilevel environments at family, community, and school levels. The associations between children's physical activity, stress, weight, and physical and social environments were examined by a series of multi-level regression models. Of the sample, 42.3% of the participants were measured as overweight or obese, much higher than the national rate of 31.8%. High weight clusters were observed in a variety of block groups with diverse physical and social environments. Community physical and social environments exhibited inconsistent even opposite spatial patterns (r = −0.18; p < 0.05). The results of multi-level regression models demonstrated the bidirectional causal interactions of physical activity, psychosocial stress, and weight. We also found that family (p < 0.01) and school environments (p < 0.01) were more influential to children's participation in physical activity, psychological wellbeing, and weight status compared to community environments.