| The relationship between income inequality and health is the subject of intense debate in social epidemiology. The income inequality hypothesis asserts that ecological income inequality is detrimental for health due to reduced social or material resources. Relatedly, the relative position hypothesis suggests lower hierarchical position of individuals is associated with negative emotions and stress, with consequences for health and social cohesion. Debate centers on both the relevance of these theories as they apply to health and the appropriate mechanism(s) underlying the relationship.;I draw from Wilkinson's (1992) paper that suggests that the distribution of income is more important in predicting health in wealthy nations due to relationships between relative deprivation, negative emotions, and decreased social cohesion and contrast its utility with Wilson's (1996) theory of the benefits of affluence that posits economic heterogeneity is beneficial, particularly in otherwise poor neighborhoods, because affluent residents model mainstream norms and uphold neighborhood institutions.;Some scholars argue that inequality is not important in smaller units of analysis, such as neighborhoods. But these assertions are based primarily on studies outside the U.S. and have little theoretical basis. Moreover, tests of this theory in U.S. neighborhoods, where effects of inequality have typically been strongest, are rare. Further, though it is reasonable to expect that inequality is more problematic for those at the lower end of the hierarchy, and that neighborhood inequality may be differentially important across raceethnicity, the literature is largely absent on this topic. Finally, the relationship between relative position and health at the neighborhood level, and the way in which local context may be associated with it, is not fully understood.;I use hierarchical multilevel Poisson and logistic regression models on data from the Los Angeles Family and Neighborhood Survey, the Los Angeles County Health Department, and the decennial census to address these gaps in the literature by systematically testing the strong and weak versions of the income inequality hypothesis at the neighborhood level on local age-specific and race-ethnic-specific mortality rates, and in multilevel models on individual morbidity. Then, I test the relative position hypothesis within neighborhoods on three morbidity outcomes; hypertension, obesity, and self-rated health. Due to commonalities across theory, collective efficacy, a local social resource based on cohesion, trust, and likelihood of intervention for the common good, is tested as a mediator of the relationship between economic structure and health.;Results regularly suggest neighborhood context matters for both mortality and morbidity. Neighborhood economic well-being is especially relevant for mortality across race-ethnicity, while inequality was not important for all cause mortality among blacks or Latinos, but was detrimental for Whites in low income neighborhoods. The strong and weak versions of the income inequality hypothesis are disputed in multilevel models. Instead, results indicate economic heterogeneity is actually beneficial on average for hypertension, obesity, and self-rated health. Effects of inequality did not vary across individual income.;Some race-ethnic differences were found wherein whites benefit more so than other groups from economic heterogeneity. Collective efficacy, as expected by Wilson, mediates a portion of the relationship between neighborhood affluence and health. In contrast with Wilkinson's expectations, though consistently associated with better health and lower mortality, collective efficacy did not mediate the effects of inequality, suggesting that social resources are not the mechanism though which inequality operates. Results suggest the relative position hypothesis applies to self-rated health, supporting Wilkinson at the individual level. Further, as expected by theory, the relationship was mediated by individual sense of control; a proxy for stress. Results do not suggest collective efficacy mediates any portion of the relationship between relative position and morbidity, and effects of relative position did not vary across the level of inequality in the neighborhood.;I conclude that low relative position may be problematic for health, but neighborhood economic heterogeneity is not detrimental for individual health in local communities, and question the theoretical mechanism posited by Wilkinson. Instead, I suggest economically heterogeneous (or unequal) neighborhoods, perhaps especially in Los Angeles County, may contain characteristics that promote health. Implications for policy and future research are discussed. |
