A new study found that American health equity is declining as income inequality worsens.

Using data from more than 5.4 million respondents to the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System, the study, published by Jama Network Open, found that the black-white gap from 1993 to 2017 had noticeable improvement, but showed health equity and health justice along with income disparities declining over time.

Respondents to the survey, ages 18-64, were asked questions about their overall health during a one-month period, which were then compared to trends in health equity based on race, gender and income level.

“Improving health equity often figures as an important goal for communities, thought leaders, and policy makers in public health,” the report reads. “Yet, this analysis suggests that across the past 25 years, the promise of improving health equity has not been met. Greater or different efforts than those tried in the past will have to be mustered if health equity is to improve.”

Research from the National Academy of Medicine states that “health care accounts for only 10% to 20% of overall health outcomes,” where social determinants such as living conditions, education and income account for the remaining 80% to 90%. One example of these findings shows low education is attributable to the same number of deaths as heart attacks. 

Another study conducted by Jama Network Open in 2016 found average life expectancy of U.S. men in the bottom 1% of income distribution is roughly equivalent to the life expectancy of someone in Sudan or Pakistan, compared to men in the top 1% of income outliving the average man in all other countries. 

“The results of this study show a worrisome lack of progress on health equity during the past 25 years in the United States,” the researchers write in the report. “Achieving widely shared goals of improving health equity will require greater effort from public health policy makers, along with their partners in medicine and the sectors that contribute to the social determinants of health.”

The authors conclude that effective policy solutions to reduce poverty would be a “clear starting point to improving health equity.”

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