Global variations in health: Evaluating Wilkinson's income inequality hypothesis using the World Values Survey

This international comparative study analyses individual-level data derived from the World Values
Survey to evaluate Wilkinson’s [(1996). Unhealthy societies: The afflictions of inequality. London: Routledge;
(1998). Mortality and distribution of income. Low relative income affects mortality [letter;
comment]. British Medical Journal, 316, 1611–1612] income inequality hypothesis regarding variations in
health status. Random-coefficient, multilevel modelling provides a direct test of Wilkinson’s hypothesis
using micro-data on individuals and macro-data on income inequalities analysed simultaneously. This
overcomes the ecological fallacy that has troubled previous research into links between individual selfrated
health, individual income, country income and income inequality data. Logic regression analysis
reveals that there are substantial differences between countries in self-rated health after taking account
of age and gender, and individual income has a clear effect in that poorer people report experiencing
worse health. The Wilkinson hypothesis is not supported, however, since there is no significant
relationship between health and income inequality when individual factors are taken into account.
Substantial differences between countries remain even after taking account of micro- and macrovariables;
in particular the former communist countries report high levels of poor health.