Income provides economic resources that shape the choices individuals and families have in housing, education, childcare, food, medical care, and much more. Wealth is the accumulation of savings and assets that can be used as cushion and protection during times of economic distress. Income and wealth are strongly associated with morbidity and mortality. Poor health can also contribute to reduced income, creating a feedback loop sometimes referred to as the health-poverty trap [1]. As income and wealth increases or decreases, so do opportunities for health [2].

In 2017, the District had the highest median household income in the country, $83,382, compared to the national average of $61,372 [3]. However, in the same year, while 14.6% of the US population lived in poverty, 17.4% of District residents did so. [4]. 

Despite the median US income hitting a new record high in 2018, the gap between the richest and the poorest households in the US is now the largest it's been in the past 50 years. The Census Bureau found that in 2018, the District had the highest level of income inequality in the entire country [5].

The DC Healthy People 2020 goal related to this topic is:

 1. Achieve health equity by addressing social determinants of health and structural/system-level inequities.

Income and Health

The relationship between income and health is observed throughout all income brackets. Adults in the highest income brackets are healthier than those in the middle earning brackets, and on average live six years longer than those with the lowest incomes [1]. Likewise, the pattern is seen in preventative care utilization, with high-income earners participating in regular doctors visits and blood pressure and cholesterol checks at higher rates than middle- and, progressively, low-income earners [6]. Compared to higher-income Americans, low-income Americans face greater barriers to accessing medical care and are less likely to have health insurance [1]. In the 2019 DC Community Health Needs Assessment survey, 52% of respondents said they have trouble saving money and 26% have trouble paying credit card bills [10].

Income inequality in the US has increased dramatically in recent decades, and during this same time life expectancy differences by income-level have also grown [1]. In the District, the households earning the top 20% income earn 29 times more annually than the bottom earning 20% of households [7].  The evidence-base that examines the connection between income and health suggests that policies promoting economic equity may have broad positive population health effects [1]. 

In the US, race strongly influences socioeconomic factors including income. Black residents continue to have both lower median incomes and shorter life expectancy compared to white residents. The evidence suggests that chronic financial hardship caused by centuries of exploitation and segregation, and the direct toxic effects of discrimination on mental and physical health, have attributed to these persistent racial health disparities [1]. In fact, both poverty and income inequality in the District differ greatly along racial and ethnic lines [8]. In 2017, while the poverty rate for white District residents was 7.1%, it was nearly four times as high (26.4%) for Black residents and nearly twice as high (13.9%) for the Latinx community [4].

Structural Barriers to Income and Wealth Equality

An in-depth and widely publicized study of wealth inequality in the District, using survey data from 2013–2014, looked at assets, debts, and net worth of different racial and ethnic groups. It showed that the average net worth of a typical White household was $284,000, 81 times that of Black American households, which averaged $3,500 [6]. The $250,000 average home value for Black families was two-thirds of that of White and Latino families. Wealth inequities, referred to as ‘blocked wealth,’ are linked to two centuries of structural racism and barriers to wealth building, including some of the highest barriers embedded in law [6].

The study concluded that [9]:

More distressing, homeownership disparities are not a function of education. Higher education is closely tied to higher incomes, which should make homeownership more attainable. But in DC, 80% of Whites with a high school diploma or less are homeowners, while fewer than 45% of all Blacks in the District are homeowners. Fifty-eight percent of Black households do not own homes. 

Though gender pay gaps have narrowed somewhat since 1980, inequitable outcomes tied to career breaks, gender discrimination, and other factors persist. A Pew Research Center study indicates that in 2018, American women working full- or part- time earned 85% of what men earned, and would need to work 39 extra days to earn what a man did. This inequity does not go unnoticed—in a 2014 survey, 77% of women and 63% of men said that this country needs to continue making changes to give men and women equality in the workplace [11].

Promising Practices & Policies:

Child care subsidies

Child development accounts

Earned Income Tax Credit

• District’s Living Wage Act increased the minimum wage to $12.50 per hour in January 2018 and will increase it to $14.50 per hour in 2019 and to $15 per hour by 2020.

• Opened the DC Infrastructure Academy in Ward 8 to create a pipeline to in-demand jobs within rapidly-growing sectors, with an average hourly wage of $48.75.

Citations & Additional Data Resources

1.  Robert Wood Johnson Foundation. Health, Income, and Poverty Brief. 2018.

2.  County Health Ranking. Income. 2019

3. U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplements. 2017. Table H-8. Median Household Income by State 

4. U.S. Census Bureau, 2013-2017 American Community Survey 5-Year Estimates. Tables S1701 and B17001I

5. U.S. Census Bureau. U.S. Median Household Income Up in 2018 From 2017. 2019

6. DC Health Equity Report 2018

7. DC Policy Center. Income inequality and economic mobility in D.C. 2017. 

8. DC Fiscal Policy Institute. Income Inequality in DC Highest in the Country. 2017. 

9. Kijakazi, K. et al. The color of wealth in the nation’s capital.2016

10. DC Health. Center for Policy, Planning and Evaluation. DC Community Health Needs Assessment Survey. 2019.

11. Graf, N., Brown, A., and Patten, E. The narrowing, but persistent, gender gap in pay. Pew Research Center 2019

Photo Credits: 

Photo by Katie Harp - Pinterest Manager on Unsplash