Nursing essay: Health inequality - the impact of income inequality on mental health outcomes
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Vak
Nursing
Instelling
University Of The Highlands And Islands (UHI)
Assignment type: Essay
Grade awarded: A
Level 7
Referencing style: Harvard
Number of pages: 7
The present essay provides an overview of health inequalities outlining their principle causes. Its primary focus is the impact of income inequality on mental health.
The impact of income inequality on mental health outcomes
Based on their comprehensive literature review and synthesis study, McCarthey et al.
(2019:28) argued that health inequalities would be best defined as unfair, systematic
differences in health outcomes detectable between populations and between social groups -
both categorical groups including race, sexual orientation, and ranked ones such as social
class, income bracket- within the same population. Although pathways posited as
contributing to physical and mental health inequalities are rather complex, their primary
causes are recognized as uneven distributions of power, income, and wealth across society
(Richardson et al. 2020: e150). Additionally, Hatzenbuehler, Phelan and Link (2013) proposed
that stigma should also be considered a principal cause. These fundamental factors then
influence wider environmental variables impacting on health including access to goods and
services such as diet, housing, leisure activities, healthcare services, educational
opportunities and employment prospects (Molony and Duncan 2016:258). These wider
environmental influences, in turn, shape people’s individual experiences including those of
poverty and discrimination as well as life-style choices and health behaviours; with all adding
up to produce an unfair distribution of physical and mental health. In the following section,
inequalities in mental health outcomes are explored in greater detail with a specific focus on
the impact of income.
The impact of income inequality on mental health outcomes
Psychiatric disorders represent about 7% of overall disease burden; with over a billion
people worldwide estimated to have at least one mental illness (Rehm and Shield 2019). In
Scotland, psychiatric and substance misuse disorders represent the third biggest cause of
disability (The Scottish Government 2018:24). However, psychiatric problems are not equally
distributed across populations; with socioeconomically disadvantaged individuals being at a
much greater risk (Allen et al. 2014). Millard and McCartney (2015) reported that in Scotland,
adults residing in the most deprived areas had twice the likelihood of experiencing poor
mental health relative to those living in affluent areas. Similarly, minors in the poorest
households in Britain were found to be approximately three times more likely to develop
mental health problems compared to their socioeconomically more privileged peers (Roberts,
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, Donkin and Marmot 2016). Furthermore, Iob, Steptoe and Fancourt (2020) documented that
in the UK, people experiencing socioeconomic adversities were among the groups most
disproportionately affected by the COVID-19 pandemic in terms of psychiatric health; with
significantly higher levels of reported self-harm and suicidal ideation. The inverse relationship
between SES and mental health outcomes is well-established; with higher SES having been
linked to lower risks of major depressive disorder (MDD), psychological distress and less
suicidal ideation (Assari 2020, Ribeiro et al. 2017). Moreover, numerous studies (Meltzer et
al. 2013, Richardson, Elliott and Roberts 2013) reported that individuals who had financial
debts were significantly more likely to have common psychiatric disorders including social
anxiety disorder, specific phobias, MDD, generalized anxiety disorder and substance
dependence than people with no debts. In addition to material deprivation, income inequality
negatively affects mental well-being via psychosocial mechanisms such as poverty-related
stigma, which has been linked to increased stress, feelings of shame and diminished self-
esteem (Inglis et al. 2019).
The relationship between income and mental health is a two-way one; as individuals with
lower incomes are more likely to develop mental disorders and people with psychiatric
conditions are more likely to be un- or underemployed and experience financial hardship
(Goldie, Dowds and O’Sullivan 2013:3). It remains a challenge for individuals with a history of
mental illness to gain employment in part due to the negative stigmas attached to these
conditions. Hipes et al. (2016) reported that a history of psychiatric illness resulted in
significant discrimination in the labour market. In their field experiment, the researchers sent
out fictitious applications for advertised jobs, with half of the applications indicating a history
of hospitalization due to a psychiatric disorder, and the other half a history of hospitalization
due to a serious physical injury. All applicants indicated in their cover letters that they had
successfully recovered from the disclosed condition. Yet, and in spite of identical credentials,
the employers were much more reluctant to call back applicants with a psychiatric history.
Although the researchers did not explicitly test for mechanisms that underlie this
discrimination, they argued that it had likely resulted from negative, harmful stereotypes
associated with mental illnesses such as diminished competence and dangerousness. A
mental disorder diagnoses have also been shown to promote underemployment. Wahl (1999)
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