Life expectancy and disease rates in the United States differ starkly among Americans depending on their demographic characteristics and where they live. Although health care systems are taking important steps to reduce inequities, meaningful progress requires interventions outside the clinic, in sectors such as employment, housing, transportation, and public safety. Inequities exist in each of these sectors, and barriers to educational attainment, higher-income jobs, and social mobility limit the opportunity of disadvantaged people to improve their circumstances.
Poverty has long been recognized as a contributor to death and disease, but several recent trends have generated an increased focus on the link between income and health. First, income inequality in the United States has increased dramatically in recent decades, while health indicators have plateaued, and life expectancy differences by income have grown. Second, there is growing scholarly and public recognition that many nonclinical factors—education, employment, race, ethnicity, and geography—influence health outcomes.
The water crisis in Flint, Michigan, revealed systemic government malfeasance that exposed an entire city population to lead-contaminated water. It also alerted the nation to the fact that lead poisoning remains endemic and threatens the livelihood of children across the country. The problem extends beyond Flint—a recent report identified more than 2,600 areas in the United States that have lead poisoning rates at least double those recorded during the peak of the Flint crisis.