Document Type

Research Report

Publication Date



The Stanford Center on Poverty and Inequality


Inequalities in access to health and health care are especially important forms of inequality because they speak to who lives long and who lives well.

It is well known that, even though the United States spends more on health care per capita than any other country, it has some of the worst access and outcome results among wealthy nations.1 While important, such cross-country comparisons hide substantial health inequality within the United States. Even a cursory inspection of the data suggests that some states are indeed better performers on key health measures. For example, only one in ten adults in Utah smoke, whereas more than one in four do so in West Virginia. The purpose of this brief is to examine whether state differences of this magnitude are commonly found across various other health measures.

We focus not just on average levels of health access, behaviors, and outcomes, but also on how unequally they are distributed. Although everyone would presumably prefer a state with high average health scores, it also matters whether the health disparities between the poor and relatively well-off are very large. If a state has a high mean level of health but also subjects its poor residents to a large “health penalty,” then anyone who is at risk of being poor would presumably want to avoid that state (at least insofar as the penalty is large enough to render them worse off than their counterparts in other states).

Therefore, we examine two important features of a state’s health profile: the average level of health, behavioral, or access problems in the state; and the variation in the distribution of these outcomes by income.


Reprinted with permission.



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