— For poor people, living in an affluent area can be a health hazard. That is the provocative conclusion of a study of the death records of more than 8000 people living in four US cities.
The ill effects of being poor or living in economically disadvantaged areas have been demonstrated before, but it is unusual to consider both factors in the same study. When Marilyn Winkleby and colleagues at Stanford University in California did so, they were surprised to find that death rates in four Californian cities were highest for poor people living in the richest neighbourhoods (American Journal of Public Health, DOI: 10.2105/AJPH.2004.060970).
They offer two possible explanations: poor people living in rich areas may have to pay more for housing and other services, magnifying the effect of poverty; alternatively, their health may suffer from stress caused by continually being reminded that they are at the bottom of the economic pile. I dont think the two are mutually exclusive, says team member Catherine Cubbin, now at the University of California, San Francisco.
Richard Wilkinson, who studies health inequalities at the University of Nottingham, UK, suspects that stress is largely to blame. With Kate Pickett of the University of York he has reviewed more than 150 studies and concluded that health is generally poorer in societies where differences in income are larger (Social Science & Medicine, vol 62, p 1768). The basic picture seems to be that low social status is stigmatising, Wilkinson says.