The relationship between health care and health. "In developed countries, the marginal contribution of medical care to life expectancy is very small." (Fuchs1998) Many critical factors associated with poor health may be outside the health care system. Universally, the poor are sicker, and inequalities in health persist in industrialized countries with universal financing systems designed to provide equal access. Great Britain, Sweden, Finland, Holland, and the World Health Organization extensively documented large and often increasing gaps in health status and social and economic parity. There is growing recognition that these health disparities cannot be explained by differential access. Gunning-Schepers and Stronks (1999) note "differences in health between social groups, defined by class, educational level, income or professional status have been recorded in every country that has carried out research and have not visibly diminished despite social policies such as universal access to health care, greater access to educational opportunities, occupational health efforts, or reductions in income inequality." In the United States, differential access for the poor through Medicare, Medicaid, and private health insurance persists. Vladek reported government cost-containment policies have had a differentially greater impact on the poor. (1981) However, in a recent report, Ross and Mirowsky (2000) note the poor use more health services because they are sicker; their health status is independent of insurance coverage although poorest health is observed among Medicaid recipients. Health problems are correlated with other life stresses. Ross and Mirowsky noted that potentially reduced economic hardship from having health coverage might indirectly improve health status.
Along with the relationship between poverty and health, is the growing recognition that universal differences in mortality and morbidity are associated with education, literacy, and income.