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Income and Wealth Gaps, Inequitable Public Policies, and the Tentacles of Racism.

Toxicity, inequity, and inequality are powerful words in the public health lexicon and are increasingly dominating the public discourse as explanatory factors for health outcomes and their relationship to public resources, neighborhood contexts, and place-based quality of care in the United States. The central premise of Shapiro’s book is that inequality is driven not by differing attitudes, values, and characteristics that promote or hinder achievement among rich, middle-income, and poor populations, but rather by income and wealth gaps (Figure 1) and inequitable public policies (structural racism) that were designed to advantage one group over another. For his book, Shapiro conducted interviews of 187 Black and White families, three fourths of whom identified as middle class and more than 50% of whom were college educated, over a 12-year interval.