Executive Summary: “Relative Deprivation, Poor Health Habits and Mortality” by Christine Eibner and William N. Evans

Beginning in the early 1990s, a number of authors began to detect a strong statistical link between income inequality and measures of group health. Cross-country and cross-state models found that areas with higher income inequalities tended to have higher mortality and poorer measures of health status. This work has since been widely criticized and a number of more recent studies leave the inequality/healthy hypothesis in doubt. 

Authors of the original studies referenced above argued that the statistical relationship between income and mortality was due in part to the impact of “relative deprivation” which argues that individuals are adversely affected when they perceive themselves to be economically deprived relative to their peers. These papers hypothesize that relative deprivation influences health primarily through psychosocial pathways. Individuals who feel they are economically disadvantaged compared to their peers may be depressed and disgruntled, conditions that affect health both directly (via heart disease, high blood pressure, and suicide) and indirectly (via increased smoking, poor eating habits, and alcohol abuse).

What’s interesting about the appeals to relative deprivation in the context of the income inequality/health literature is that inequality and relative deprivation are two fundamentally different phenomena. Clearly these two variables are related, but income inequality is a group measure while relative deprivation is specific to the individual. Two people living in the same state or country are exposed to the same measure of group inequality, yet these two people can have vastly different measures of relative deprivation.

Although recent studies cast doubt on the relationship between income inequality and health, to date, few studies look specifically at the relative deprivation hypothesis. In this paper, we use detailed data at the individual level to test directly whether measures of relative deprivation are predictive of poor health. 

In the first part of this paper, we use restricted-use micro-level data from the National Health Interview Survey Multiple Cause of Death Files (NHIS/MCOD) to investigate the relative deprivation/mortality link. We focus exclusively on males aged 21-64, and our primary measure of relative deprivation is based on work by Yitzhaki. This measure takes into consideration not only a respondent’s percentile rank in income within their reference group but also the average incomes of people who make more than the respondent. We define reference groups using a combination of characteristics including state of residence, age, race, and education.

Our results indicate that, even after controlling for reference group effects and individual income, relative deprivation is positively associated with an individual’s probability of death. Relative deprivation is also positively linked to cause-specific mortality, notably for deaths due to tobacco-related cancers and coronary heart disease (CHD). In the second part of this paper, we use data from the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS) to explore whether relative deprivation is associated with morbidity and health-compromising behavior. Using a number of outcomes including self-reported health status, limited activity days, smoking, seatbelt use, body mass index, and propensity to exercise, we find that relative deprivation in the sense of Yitzhaki is consistently linked to the probability that an individual engages is in poor health and engages in risky behaviors.