May 24th Asynchronous Session

 Unnatural Causes: In Sickness and in Wealth (2008) 

California Newsreel

    In Sickness and in Wealth, a documentary from filmmaker Larry Anderson, asserts the undeniable fact that wealth and social class have serious consequences on a persons life expectance and overall health. 

    Dr. Tony Iton, Director of the Alameda County Public Health Department in California states this problem best: " We can predict on aggregate based on where somebody lives, high school graduation rates, and income how long they'll live, and when they will die... We should not be able to do that. Your life expectancy... should not be dependent on the resources open to you." There are many factors that cause this discrepancy between the life expectancy of the rich and the poor, but first we must understand the facts. 

    In a country that spends over $2 trillion, over half of the total amount spent on health in the world,  we see the one of the highest infant mortality rates among developed countries (5.22 deaths per 1,000 live births) , lower life expectancy (80.43 years, 46th highest)  and on average lead 'sicker' lives. Within  our boarders, the life expectancy of the poor can differ by almost 10 years from that of the rich. 

Figure 1: This graph shows the life expectancy, average income and high school graduation rates for 3 congressional districts in Louisville, KY. District 5 has the lowest average income, and District 16 has the highest. 

    Anderson's film shows, in grave detail, the  ways in which income insecurity manifest as poor health. Nancy Krieger, a social epidemiologist with the Harvard School of Public Health, described a study in which "identical twins who lived together until age 18.. if they diverge[d] and one became professional and the other was working class they [would] end up with different health statuses as adults." The risks of developing diabetes or heart disease sore  as you move across income brackets. 

Figure 2: Rates of disease by income bracket. 

    The Whitehall studies, lead by Sir Michael Marmot in the 1970s, were among the first series of papers to describe this inequity among the British working class. Sri Marmot states that "what we found in Whitehall was the lower the grade of employment the higher the risk of heart disease, but not just heart disease... every major cause of death." However these papers did not discern the cause of this inequality. 

    Previously, it was though that those at the top of the social hierarchy would be more likely to die from heart disease as they tended to work demanding, high level jobs. The though behind this, more stress = lower health, rings true it does not take into account that those at the top have access to the resources needed to manage their stressors.  Another powerful factor is the amount of control one can exercise in their own life. A study done on primates found that the more dominant members had significantly less plaque build up in their arteries than subordinate primates of the same age (Figure 3). 

Figure 3: Cross section of primate artery. Dominate primate shown on left and subordinate primate shown on right. 

    Lower levels of control activate a stress response in the human body that leads to higher levels of  cortisol. Over time, extended periods of stress can lead to impaired immune function, and lower  memory function. Feelings of loss of control can stem from more than just the working environment. 

    Within poverty stricken communities, access to fresh produce, health care, and public transportation is often limited. This lack of resources turns around and manifests as more stress. 

  It is also of great importance to note that within income brackets, race plays a factor in life expectancy as well. Black Americans face systemic racial injustices that in turn cause extended periods of stress that lower overall health and life expectancies. 

    Dr. Ana Diez-Rout points out that "of course these differences are not a natural thing... it's not the design of nature that these environments are different. They arise as a result of policies or a lack of policies that create these enormous inequities in resources." 

    So then it comes to the question : "But how do we fix it?" The answer is not in medical research but instead in the form of massive social and legislative reform. The health gap narrows with access to education, public health care, cleaner environments, and fair working conditions. 

    These social changes can begin with the empowerment of the community. In the Bronx, New York the Black Joy Farm fights to bring fresh produce to the community and host educational events. Tanya Fields and her team are at the forefront of radical community empowerment, but the burden should not fall on communities alone. 

    As a country it is time to re-examine the harmful and deadly affects of systemic racism and the gutting of social programs. These legislative decisions are major road blocks to health equity here in America.