Document Type

Research Report

Publication Date



Stanford Center on Poverty & Inequality


There are many reasons why poverty matters, but it is especially troubling that it affects such fundamental outcomes as health and access to health care. If poverty did not bring about all manner of health risks, we would likely be somewhat less troubled by it. But of course poverty and other forms of social and economic disadvantage do often translate into deficits in health and health care. The purpose of this brief is to examine long-term trends in American health and to lay out the current state of evidence on the extent to which health and health care are unequally distributed. We also note how the recent economic downturn affected these trends and disparities.

The key backdrop to this assessment is the tripling of U.S. health expenditures since the 1960s. In 2012, per capita expenditures on health were $8,915, more than double those from 1995, though growth has slowed in the past 4 years.1 Some of this rise is attributable to population aging. Costs associated with Medicare, a program established in 1965 to subsidize health care for those aged 65 and older, have grown as the elderly population constitutes an ever-larger portion of the U.S. population. Still, overall U.S. health expenditures have increased faster than the growth of the elderly population and faster than health expenditures in other OECD countries.2

It is possible that such rising costs have led to a more unequal distribution of health and health care. At the same time, health inequalities may also be affected by the economy (e.g., recessions), changes in how insurance is provided, and any number of other factors. In this brief, our objective is not to attempt to tease out the causes of any possible changes in health inequalities, but rather to provide a descriptive summary of the current evidence on trends in (a) health, (b) foregone health care and insurance coverage, and (c) health risk factors.

To preview our results, we find first that some health indicators, such as life expectancy, show an overall improvement. But not all indicators are improving. For example, an increasing number of Americans report delaying or foregoing health care, particularly during the recent economic recession. Second, economic and racial disparities in health indicators are often substantial, and when changes in these disparities are observed, they usually take the form of an increase in absolute size. Third, a large proportion of Americans still remain uninsured in 2012 (i.e., 15 percent), although the proportion of children who are uninsured declined by nearly 2 percentage points between the late 1990s and 2012.


Reprinted with permission.



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