Clinical Abstracts
With Comments by Adriane Fugh-Berman, MD
Correlation Between Health and Wealth
July 2000; Volume 2; 55-56
Source: Connor J, et al. Randomised studies of income supplementation: A lost opportunity to assess health outcomes. J Epidemiol Community Health 1999;53:725-730.
Objective: A systematic review of randomized studies of income supplementation, with particular reference to health outcomes.
Design/Setting/Method: An extensive search of electronic databases and contact with previous authors yielded 10 relevant studies, all conducted in North America. Trials were not considered eligible if payment was explicitly linked to behavior modification; if payment could only be spent a certain way; if the control group had some other intervention; if there was allocation to services that usually cost money; or if there was allocation to interventions that potentially increased future income. Five trials assessed the effects of income supplementation on work force participation, and randomized 10,000 families to 3-5 years of various combinations of minimum income guarantees and reduced tax rates. Two trials randomized 2,400 released prisoners to 3-6 months of benefits. One trial randomized 3,500 families to three years of income supplements; another assessed the health effects of one-year income supplementation in 54 people with severe mental illness. One study compared three groups of state lottery winners. Very few health outcomes data were collected or reported. In the New Jersey-Pennsylvania negative income tax experiments, health and medical care outcomes for the 55% of participants in stable families who completed the whole experiment revealed no significant treatment effect on health status indicators, chronic illnesses, hospital days, work days lost, or physician visits; a possible increase in doctors visits for children early in the experiment was noted. The final report from the rural income maintenance experiment revealed no significant effects for medical care utilization or health status.
In the Gary income maintenance experiment, there was a statistically significant higher birth weight among women with three risk factors for low birth weight (and in some subgroups with two risk factors) compared to controls. Oddly, there also was a significant decrease in the birth weight of subjects in the group considered to be lowest risk.
The only study primarily designed to assess the connection between poverty and health was a Canadian study of 54 people with serious mental illness living below the poverty line. Twenty-six participants were randomized to receive allowances and forgettable loans for one year (all participants chose a sponsor and an adviser from supporting agencies). Compared with baseline, both groups experienced significantly decreased hospitalization rates and improved quality of life in terms of finances, and mental and physical health. Several studies have been done of lottery winners; however, health outcome data were not collected.
Funding: Health Research Council of New Zealand.
Comments: Will an infusion of money improve health status? Now there’s an understudied alternative therapy! The correlations between socioeconomic status and health are well-documented, and it is a fascinating idea to study whether an infusion of money improves health. The authors point out that lotteries provide a great opportunity (although to date not utilized) to study this question; lottery winners can easily be compared with non-winning ticket buyers because, if winning is by chance, lottery players have been naturally randomized. Most of the studies surveyed in this paper involved relatively small income supplements to poor populations and would not be expected to cause long-term socioeconomic status to change. But a jump in socioeconomic status from big lottery winnings or a good day on "Who Wants to be a Millionaire" could provide interesting fodder to answer this question.
July 2000; Volume 2; 55-56
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content