Unnatural Causes: In Sickness and in Wealth

5/22/2018

Unnatural Causes:  In Sickness and in Wealth

Directed by: Larry Adelman

I never realized how much social status really did affect your health. I knew that those with a lower income had less access to health care which could in some way or another affect a person's health. However, it had not occurred to me that the stress associated with certain income levels alone would negatively impact a person's immune system. This film titled “In Sickness and in Wealth” from the documentary series Unnatural Causes: Is inequality making us sick? argues there are key health disparities that affect communities in the United States and the roles that social determinants of health play in these disparities.  The video followed four people of different socioeconomic statuses. As we see throughout the video, the family with the highest socioeconomic status is also able to maintain the highest level of health; they have time to exercise, take vacations, and are able to eat well. They also have the highest life expectancy. As the video starts to show families with lower and lower socioeconomic status, we see life expectancy decrease. These families tend to not have the time or resources to make choices to eat well or exercise frequently. Additionally, the video describes a study about chronic stress and corresponding high cortisol levels, which could contribute to poorer health and lower life expectancy. The CEO, lab supervisor, and janitorial worker were all linked later in the video because they all worked in the same hospital.  It was interesting how the video linked the people of different socioeconomic statuses to the same place of work. Although you don’t normally think about it every day, most places of work are divided into a hierarchy according to your socioeconomic status. This means that people are always under the stress of their socioeconomic status, at home and at work.

Health care can deal with the diseases and illnesses. But a lack of healthcare is not the cause of illness and disease. It is like saying that since aspirin cures a fever that the lack of aspirin must be the cause of the fever.  -Ichiro Kawachi (Epidemiologist, Harvard School of Public Health)

This quote from the film really struck me. I think most people automatically blame the lack of health care for people being sick or having a younger life expectancy but when you actually sit and think about all the determinants of health I think you will begin to see there are so many areas that contribute to the inequalities among individuals of different socioeconomic status. The video looks at a very clear social gradient in which the health along the gradient can be predicted to decrease as socioeconomic status decreases.  I believe in order to shrink the disparities in health along socioeconomic lines, you need to ensure that everyone is allowed access to the same opportunities even if they do not have the economic resources. This would involve providing resources such as quality education, decent housing, access to affordable health care, and access to healthy food and safe places to exercise to everyone despite gaps in affluence. Having access to such resources would simulate the control felt by the affluent when they come to make such choices regarding health.

Research over the past few decades has demonstrated that other factors have a greater effect on health than medical care. These underlying determinants of health, from food security to adequate housing to early childhood education, are inequitably distributed across communities. 

We all don’t begin life at the same starting line or have the same circumstances moving forward, and that makes all the difference in our relative health and well-being. This is why, despite advances in medical technology, the gap in life expectancy between the rich and the poor continues to widen.-Robert Hughes

Socioeconomic status plays a large role, if not the largest role, in determining a person’s overall chronic stress level. It’s important to realize that wealthy individuals have better access to resources that can improve their health conditions, as opposed to lower income people who are not able to afford it. Constantly worrying about not only housing, food, and money but also where they’re going to receive their medical care and how they are going to pay for it adds additional stress to their lives. The healthcare that they receive is often worse than that of the higher class; this is ironic since they should be receiving better care because they are more at risk for developing a variety of diseases and illnesses. People of higher socioeconomic statuses, simply have better financial means to deal with the stressor they are exposed to. However, this does not mean that they are exposed to less, they are just more equipped to deal with them.  The United States spends more than twice the average of other industrialized countries yet has the highest:

• Infant mortality rate
• Homicide Rate
• Child Poverty Rate
• Gap between high and low mortality rates in the country
• Gap between the wealthy and the rest of the population.

If the United States is the country with the highest gross national product, spending nearly half of the world’s medical dollars, why is the U.S. the sickest out of the industrialized nations?  Much of the money is being used to treat chronic and infectious diseases, and far less money is being spent on preventative measures or social policies to target the key problems regarding chronic and infectious diseases.  Other industrialized nations are spending more money working to improve general health as a form of prevention as opposed to using the majority of the money to treat after a disease is contacted.

Access to resources is greatly hindered if you do not have the money to access them, or are constantly having to worry about not being able to access them.   Not everyone can afford higher education, meaning that it is that much harder to afford a ticket out of poverty. College graduates live on average two years longer than high school graduates.  Life expectancy should not have to depend on the resources you have access to.

Test your knowledge of health equity! How does the U.S. stack up against other countries on key indicators? How do groups in the U.S. compare to one another? Are the conditions that shape our health as simple as what we eat, what’s in our genes, and whether or not we have good medical care?   Healthy Equity Quiz

I definitely would not be putting my results for this quiz up on my refrigerator….I only got a few answers correct but it was very eye-opening.

From the film:

• Americans spend $2 trillion annually on medical care, nearly half of all health dollars spent in the world.
• Among industrialized nations, the U.S. ranks 29th in life expectancy.
• 47 million Americans have no health insurance.
• In the U.S., the wealth of the top 1% is greater than the combined wealth of the bottom 90%.
• The majority of poor people in the U.S. are white.
• A 2005 study revealed that each year, more than 83,000 preventable African American deaths are attributable to the Black-white mortality gap.
• People who grew up in a house owned by their parents are less likely to get sick as adults when exposed to a cold virus.

Additional Resources:

Social Determinants of Health: Claire Pomeroy at TEDxUCDavis

Disparity in Life Spans of the Rich and the Poor Is Growing