Objective–To examine the relation between health outcomes and the equality with which income is distributed in the United States. Design–The degree of income inequality, defined as the percentage of total household income received by the less well off 5001. of households, and changes in income inequality were calculated for the 50 states in 1980 and 1990. These measures were then examined in relation to all cause mortality adjusted for age for each state, age specific deaths, changes in mortalities, and other health outcomes and potential pathways for 1980, 1990, and 1989-91. Main outcome measure–Age adjusted mortality from in causes. Results–There was a significant correlation (r=0.62, P<0.001) between the percentage of total household income received by the less well off 50% in each state and all cause mortality, unaffected by adjustment for state median incomes. Income inequality was also significantly associated with age specific mortalities and rates of low birth weight, homicide, violent crime, work disability, expenditures on medical care and police protection, smoking, and sedentary activity. Rates of unemployment, imprisonment, recipients of income assistance and food stamps, lack of medical insurance, and educational outcomes were also worse as income inequality increased. Income inequality was also associated with mortality trends, and there was a suggestion of an impact of inequality trends on mortality trends. Conclusions–Variations between states in the inequality of the distribution of income are significantly associated with variations between states in a large number of health outcomes and social indicators and with mortality trends. These differences parallel relative investments in human and social capital. Economic policies that influence income and wealth inequality may have an important impact on the health of countries.; Greater inequality between incomes in the United States appears to be associated with higher mortality. Researchers compared income distribution in 1980 and 1990 to mortality and to other health and social indicators such as birthweight and level of education. The less of total household income that the poorer half of each state had, the greater the mortality in that state. This association was seen after adjustment for age and for average income. This association was also considerably stronger than the association between average income and mortality. Homicide was strongly associated with income inequality. Violent crime, medical care expenditures, low birthweight, smoking, sedentary activity, disability, and police protection expenditures were also associated with income inequality. Other social indicators, such as the percentage of the population in prison or receiving food stamps, were associated with income inequality. States with greater income inequality spent less on education. States with greater income inequality in 1980 experienced a smaller decline in mortality in the subsequent decade.