摘要：

1998). However, providing a fully convincing theory characterizing the actual direct (or indirect) pathways by which inequality affects health remains a contentious issue. Subramanian and Kawachi (2004) identified three potential pathways by which greater income inequality may translate into poorer health. First, according to a structural pathways argument, increased inequality leads to spatial concentrations (poverty, race, and ethnic enclaves) and residential segregation is potentially detrimental to individual health (Wen et al., 2003). Second, building on the argument that individual health is influenced by social relations, the social cohesion and collective social pathway suggests that inequality affects health by weakening social cohesion and holding back the formation of social capital beneficial to health (Kawachi and Kennedy, 1997). Third, policy pathways hypothesis posits that income inequality could affect health via influence on the implementation of particular social and health related policies (Neckerman and Torche, 2007; Schwabish et al., 2006).Furthermore, studies have cast doubt on the robustness to model specification of the empirical association found in macro level analyses and have questioned the comparability of data sources both across countries (Gravelle et al., 2002; Judge et al., 1998) and across U.S. states (Mellor and Milyo, 2001, 2002). Rodgers (1979), Gravelle (1998) and Gravelle et al. (2002) cautioned that this apparent causal relationship may just be a statistical artefact if individual health is a nonlinear function of income. In order to identify the effect of income inequality on health, one needs to turn to individual level data and to control for relevant confounders, particularly individual income. Recent studies have taken this approach, and the new evidence about an association between health and income inequality is mixed at best.Few comparable micro level studies have examined the robustness of this association outside the United States. Results from these studies generally corroborate U.S. findings. For instance, Shibuya et al. (2002) found no significant evidence that income inequality measured at the prefecture level has a detrimental effect on self rated health status in Japan. Likewise, Gerdtham and Johannesson (2004) found no significant effect of community level income inequality on mortality in Sweden. Weich et al. (2001, 2002) found a significant association between the Gini coefficient in Britain‟s regions and mental disorders and self reported health status, but the results were highly sensitive to the choice of inequality measure. Lorgelly and Lindley (2008) confirmed the absence of a clear association within Britain. Distinguishing the effect by gender has been largely overlooked so far (Macintyre and Hunt, 1997). This is surprising given the often cited gender paradox in health; that is, women experience higher rates of various measures of morbidity despite living longer than men (Rieker and Bird, 2005).

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