Health and Wealth in the city

Health and Wealth in the city

Last updated on October 5th, 2023 at 02:47 pm

Health and Wealth in the city: The impoverished are less healthy compared to the wealthy


Urbanization is often related to increased wealth in some population groups while the opposite is true for others. In cities like Calgary and Lethbridge, for instance, there are populations that experience poor water and sanitation systems, and housing, as well as low income and lack of employment among other issues. While urban areas like Calgary and Lethbridge have health services being generally available, the acceptability, quality and cost barriers lead to inverse care, and the impoverished populations rarely use the services. Calgary has a higher low-income rate compared to Lethbridge (Hanel & Balerud, 2011). This annotated bibliography aims to explore studies showing how income relates to the wellbeing of populations, and thus show how the two cities compare in terms of health.

Annotated bibliography

Agarwal, S. (2011). The state of urban health in India; comparing the poorest quartile to the rest of the urban population in selected states and cities. Environment and Urbanization23(1), 13-28. doi: 10.1177/0956247811398589

The article highlights the differences that exist within the urban populations in Indian cities as related to health indicators, such as housing conditions, maternal and child wellbeing, and healthcare provision. Agarwal found that the impoverished populations in urban centres, not only in India but also in other populous countries, had low performance in a number of health-related indicators like low rates of child immunization and poor access to water. The author succeeded in showing highlight the disparities in access to sanitation, water, housing and healthcare services among the poor in urban areas, hence proving that the poor urban dwellers are faced with the most difficult situations regarding the aforementioned indicators. The author, Siddharth Agarwal, is an expert in the various fields related to medicine and urban health and, therefore, is a credible author.

Anderson, L. (2015). Worried sick: The high price of poverty. Retrieved from

Anderson highlighted several studies that found that that poverty (referring to families of four earning $2000 or lower monthly) negatively influences both the emotional and physical wellbeing of people. The author notes that people that earn $75000 or higher have good mental and health wellbeing. The article was published on the Deseret News website. In as much as the publisher may be inclined towards religion, it highlights the findings of important scientific studies. For instance, one study found that poor people are likely to report depression more than three times compared to people earning high incomes. Also, another study found that depression, sadness, mental distress and chronic pain are more likely to affect the poor compared to the rich, and that job loss can significantly increase the risk of illness. Anderson’s article underscores the argument that income and health are intrinsically related.

Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N., . . . Cutler, D. (2016). The association between income and life expectancy in the United States, 2001-2014. Jama315(16), 1750-1766. doi:10.1001/jama.2016.4226

The article aimed at investigating the degree, geographical variability and time trends between life expectancy and income on a sample of 1408287218 person-year observations for people aged 40-76 years between 2001 and 2014 in the United States. Chetty et al. found that increased income levels were linked with more longevity, and life expectancy the disparities in income groups rose with time. The authors also determined that the relationship between income and life expectancy depended on the locality, in that longevity disparities increased in some areas while it decreased in others across the various income groups. The author, Raj Chetty, is a professor affiliated with Stanford University’s Department of Economics. The article proved that the gap in life expectancy among the poor and the affluent is partly attributable to income disparities.

Deaton, A. (2016). On death and money: History, facts, and explanations. Jama315(16), 1703-1705. doi:10.1001/jama.2016.4072

The article presents a study that assists in informing and expanding on the evidence base linking longevity, health and the sociodemographic status of individuals. Although the study included data from the entire state of Missouri, interesting findings were noted on the metros, especially two communities in St. Louis. Separated by a mere ten miles, the two communities have contrasting socioeconomic statuses, and with an expected longevity disparity of 18 years. The low-income community have limited choices in terms of health care due to various access barriers, thus relying on safety-net hospitals across the care continuum. Authored by Angus Deaton (affiliated to Princeton University), the article contributes to the evidence linking a community’s socioeconomic status to the health outcomes, further reinforcing the notion that people’s locality predicts their health more than their genetic makeup.

Fessler, P. (2014). The Changing Picture Of Poverty: Hard Work Is ‘Just Not Enough’. Retrieved from

In her article in the series war on poverty, 50 years later, the author uses the example of impoverished families in New York to show how the middle-class employment opportunities are reducing (hence the income) thus making the victims feel overwhelmed and isolated.  out of control. The resultant situation is harmful to the welfare of children. Fessler reports that poverty encompasses the lack of not only material goods but also interpersonal or emotional stability and connection. Anderson successfully presents two important points. First, the worst affected parties by poverty are often the children. Secondly, overcoming poverty is not as simple particularly where absence of support, addiction and isolation are rife. This article affirms the relationship between wealth and wealth further, in that the poor continuously struggle with anxiety, instability and lack of opportunities and jobs to empower them.

Kahneman, D., & Deaton, A. (2010). High income improves evaluation of life but not emotional well-being. Proceedings of the national academy of sciences107(38), 16489-16493. doi: 10.1073/pnas.1011492107

The article reports that the majority of Americans have experiences not only related to happiness such as laughter but also high-stress levels that counterbalances their emotional health. The authors found that emotional health gradually improves with income made up to $75000 whereas low incomes (monthly household income equivalent to, or below, $3000) are linked with low emotional health. The authors are both distinguished researchers in their fields and make immense contributions to the conception of how the psychological wellbeing of people is impacted by income by highlighting situational differences, exceptions and nuances. While the article may be somehow old, Kahneman and Deaton reveal how opportunities depend on the economic status, and the rich have significant access and thus can better themselves and their children.

Smith, M. V., Kruse, A., Weir, A., & Goldblum, J. (2013). Diaper need and its impact on child health. Pediatrics132(2), 253-259. doi: 10.1542/peds.2013-0597

The article presents quantitative research investigating how access to diapers relates to the health of children and the mental health of parents. The researchers found that about a third of studied lacked full weekly diaper supply, and reported anxiety, depression and stress. For the children, lack of adequate supply of diapers made them susceptible to health issues such as urinary tract infection and dermatitis. In their view, the authors argued that sufficient diaper supply decreases parenting stress thus enhancing the quality of parenting and the overall outcomes of children. Also, parents with adequate diaper supply are better positioned to further improve their situations. The article highlights the broad range of problems facing low-income household beside shelter and food, hence showing how such a blend of issues serve to aggravate social immobility, anxiety and poverty.

Woolf, S. H. (2015). How are income and wealth linked to health and longevity? Retrieved from

According to Woolf, the higher the income, the lower the possibility of illness and death. The author notes that people at all levels of income are generally less healthy compared to their counterparts with higher incomes. Woolf argues that wealth is not only linked with improved health but also income influences health as well. People from low-income households are at least three times more likely to be limited in terms of normal routine activities such as dressing, grooming and feeding due to disease as compared to the rich people. Similarly, young people that live in poverty are increasingly exposed to risk factors like high blood pressure and obesity that are detrimental to their health in future. The author, Steven H. Woolf, is an accomplished scholar and a director of the Center on Society and Health at Virginia Commonwealth University.


This annotated bibliography has shown that income level is associated with the wellbeing of populations. Urban areas such as Calgary and Lethbridge have varying populations in terms of income. Most of the studies found that low income negatively influences health, thus making it possible to compare the two cities of Calgary and Lethbridge in terms of health. Since Calgary has a higher low-income rate compared to Lethbridge, there are more people in Calgary that experience poor water and sanitation systems, and housing, as well as low income and lack of employment among others. In as much as health services are available in Calgary, barriers like costs often result in inverse care among the low-income people in the city, thus making them to rarely use the services.



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