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Evidence based public health policy and practice
The politics of preventable deaths: local spending, income inequality, and premature mortality in US cities
  1. C R Ronzio1,
  2. E Pamuk2,
  3. G D Squires3
  1. 1Department of Pediatrics, Children’s National Medical Center (The George Washington University), Research Center VI, Washington, USA
  2. 2National Center for Health Statistics, Centers for Disease Control and Prevention, USA
  3. 3Department of Sociology, The George Washington University, USA
  1. Correspondence to:
 Dr C R Ronzio
 Department of Pediatrics, Children’s National Medical Center (The George Washington University), Research Center VI (Room 6103), 111 Michigan Avenue, NW, Washington, DC 20010-2970, USA; cronziocnmc.org

Abstract

Objective: To examine the association between (1) local political party, (2) urban policies, measured by spending on local programmes, and (3) income inequality with premature mortality in large US cities.

Design: Cross sectional ecological study.

Outcome measures: All cause death rates and death rates attributable to preventable or immediate causes for people under age 75.

Predictor measures: Income inequality, city spending, and social factors.

Setting: All central cities in the US with population equal to or greater than 100 000.

Results: Income inequality is the most significant social variable associated with preventable or immediate death rates, and the relation is very strong: a unit increase in the Gini coefficient is associated with 37% higher death rates. Spending on police is associated with 23% higher preventable death rates compared with 14% lower death rates in cities with high spending on roads.

Conclusions: Cities with high income inequality and poverty are so far unable to reduce their mortality through local expenditures on public goods, regardless of the mayoral party. Longitudinal data are necessary to determine if city spending on social programmes reduces mortality over time.

  • expenditures
  • city
  • inequality
  • mortality
  • policy

https://doi.org/10.1136/jech.2003.008672

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    Footnotes

    • Funding: Dr Ronzio completed some of this work as an Association of Schools of Public Health fellow and also was supported by grant number CCCS 900 18A 81 0711 from the Health Resources and Services Administration.

    • Conflicts of interest: none declared.

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