"outcomes are significantly worse in more unequal rich countries." Causation is not correlation. People who are not healthy, may not be able to be as motivate

"outcomes are significantly worse in more unequal rich countries." Causation is not correlation. People who are not healthy, may not be able to be as motivated and productive, and are 'pushed out of the economic system'. America is a highly competitive place, in comparison to most other countries and I think that all of these factors have feedback cycles. Also - America does not have socialized medicine or 'full coverage' and I think that really skews the numbers. Some countries with high inequality also have totally different cultures / groups living side by side, and that also changes the numbers.