CHAPTER 4

Income, Income Inequality, Wealth, and Health

Multiple Choice Questions

1. When several predictive variables are highly correlated with one another, making it difficult to ascertain the relative importance of each, the problem is referred to as ________.
   1. the Preston curve
   2. conflict theory
   3. the problem of scale
   4. collinearity
2. The Preston curve shows that ________.
   1. redistributing income within poor countries will improve life expectancy
   2. redistributing income within rich countries will improve life expectancy
   3. absolute income matters but its distribution in a population does not
   4. social inequality is the result of poor education
3. Neo-materialist theorists brought ________.
   1. income inequality into the theoretical framework
   2. income threshold effects and neighbourhood variables into the analysis
   3. psychosocial variables together with materialist ones
   4. attention to the fact that Canada is more unequal than the United States
4. Preston found that ________ with significant income inequality have ________.
   1. poor countries; poorer health outcomes
   2. poor countries; better health outcomes
   3. affluent countries; poorer health outcomes
   4. affluent countries; better health outcomes
5. In his theorizing, Richard Wilkinson drew from the research of ________.
   1. primatologists
   2. neonatologists
   3. immunologists
   4. anthropologists

1. All of the following are identified as weaknesses in Wilkinson’s synthesis, EXCEPT ________.
   1. problem of scale
   2. problem of inconsistent correlation
   3. problem with animal models
   4. problem with plausible biological pathway
2. ________ is NOT one of the features of neo-liberalism.
   1. Government deregulation
   2. Pressure to lower taxes
   3. Push towards privatization
   4. Expansion of government spending
3. The following statement regarding income inequalities in Canada is TRUE: ________.
   1. In Canada, income inequalities between the rich and the poor are smaller than in most rich countries
   2. In Canada, income inequalities between the rich and the poor got bigger between 1990 and 2010 but are now stable (or slightly shrinking)
   3. In Canada, income inequalities between the rich and the poor have remained stable for decades
   4. In Canada, there are no sizeable income inequalities between the rich and the poor
4. The Preston curve shows a ________.
   1. curvilinear relationship between income and life expectancy
   2. linear relationship between income and life expectancy
   3. linear relationship between mortality and morbidity
   4. curvilinear relationship between mortality and morbidity
5. The works of Dr Gerry Rodgers (1979) showed ________.
   1. correlation between infant mortality rates and the country-level income inequality measures
   2. correlation between stress and social cohesion
   3. that gender is an important social determinant of health
   4. that reduction in inequality correlates with longer disability-free lifespans for older adults
6. Progressive income taxes ________.
   1. increase the income for richer people and decrease income and other resources for poorer people
   2. change the social status of people in society and their social ranking
   3. reduce the income of richer people and increase income and other resources for poorer ones
   4. change social rank order
7. Canadian researchers Hou and Myles (2005) found ________.
   1. that poorer people living among richer people benefit from inequality at the local level
   2. that poorer people living among richer people experience poorer health because bigger gaps exist between richer and poorer
   3. a strong association between neighbourhood inequality and health
   4. no association between household income and health
8. A new government proposes changes to the tax system. Under the new system, the government will take the same per cent of everyone’s income. This form of taxation is known as ________.
   1. straightforward tax
   2. flat tax
   3. progressive tax
   4. ultimate tax
9. A new government proposes changes to the tax system. Under the new system, the government will take a larger proportion of a higher income than of a lower one. This form of taxation is known as ________.
   1. straightforward tax
   2. flat tax
   3. progressive tax
   4. ultimate tax
10. The following statement regarding liberal regime countries is FALSE: ________.
    1. Compared to other liberal regime countries, the United States has a poor record in providing access to affordable health care services to its population
    2. Compared to other liberal regime countries, Canada has the most progressive policies for redistribution of income and reduction of income inequalities among its population
    3. The social democratic regime countries if Northern Europe are more successful in redistributing income and other health-relevant resources than liberal regime countries
    4. Many taxes and benefits provided by liberal regime governments are not progressive
11. A measure of income inequality in which 0 represents perfect equality and 1 represents perfect inequality is called the ________.
    1. Robin Hood index
    2. LICO index
    3. GNP index
    4. GINI index
12. In Canada, ________ have the highest child poverty rates.
    1. female sole-support households
    2. male sole-support households
    3. immigrant families
    4. two-parent households
13. Residualism implies that ________.
    1. the government should be closely involved in the matters of private citizens
    2. residual income should be distributed evenly across the population
    3. the intervention of government in the matters of private citizens should be as limited as possible
    4. voluntary organizations and religious groups require government regulation
14. The neo-materialist position ________.
    1. focuses on individuals’ perceptions of social inequalities
    2. is a multi-level perspective that analyzes the impact of social structures, processes, and public goods distribution on health of individuals
    3. is based on Wilkinson’s arguments
    4. relies heavily on recent findings in primatology and neurology
15. According to the psychosocial perspective, the pathway from income inequality starts from ________ and ends in ________.
    1. negative emotions; chronic stress
    2. antisocial behaviour; chronic stress
    3. perception of place in social hierarchy; poor health
    4. poor health; antisocial behaviour

True or False Questions

1. The health gradient is a universal feature of affluent societies.
2. According to Wilkinson, stress is primarily an emotional response with few significant physiological effects.
3. From his findings, Preston (1975) concluded that total income and average income matter most in poorer places but the distribution of available income matters more in affluent ones.
4. While a materialist theorist would probably argue that health inequities will decrease under a more progressive tax system, a scholar working under psychosocial framework may contend that such a taxation system will not make much difference.
5. In Canada, the United Kingdom, Australia, and the United States, income taxes are progressive, albeit more so in Canada than in the US.
6. Among the liberal regime countries, taxation and the distribution of benefits through public programs is most progressive in the United States.
7. A score of 1 in a GINI coefficient means that income is perfectly and evenly distributed among the population.
8. Overall, psychosocial theories, at least at the population level, do not square well with the available evidence.
   
9. Residualism arises from underlying liberal values of individualism, personal liberty, respect for private property, non-interference, and personal responsibility for one’s own life.
   
10. According to the text, the rates of low income and poverty over the past 30 years have decreased for families of young children, young single adults, and people with limited education and job skills.

Short Answer Questions

1. What is the Preston curve and what does it represent?
2. What are the major differences between psychosocial and materialist theories in explaining health inequalities?
3. What is the most commonly used measure of inequality? What does it say about inequality in OECD countries and Canada?
4. The problem of scale has been identified as one of the weaknesses in Wilkinson argument. What does this mean?
5. What is residualism? Describe and give an example.

Essay Questions

1. How well supported by the evidence is the inequality hypothesis? In your answer, summarize the works of the key scholars, the major assumptions of the hypothesis, and the criticisms levelled against it.
2. Compare and contrast materialist, neo-materialist, and psychosocial theories of social inequalities in health. Using specific examples, explain how they would go about explaining health inequalities.
3. Why is income a powerful predictor of health inequalities? Describe the specific mechanisms through which income becomes a determinant of health.