What makes a population healthy? The economic structure of a nation may be the most important determinant of the health of its citizens. People living in countries or regions where the economic gap between the rich and poor is small are healthier than those living in countries or regions where the gap is larger.
Dr. Stephen Bezruchka, an Emergency Room physician and senior lecturer at the University of Washington, has extensively researched population health and social hierarchy.
“We need to think of health as the expression of our life’s experiences. We all know the physical effect that stress has on our minds and bodies, our immune system and our ability to fight disease. The reason poorer people have poorer health has something to do with the basic nature of living in poverty,” Bezruchka comments.
The effects of class and social ranking affect your parent’s physiology and thus your biology at a very early age. Studies suggest that the critical time for health is from conception to age 2.
Having low income in a high income society means that you don’t do as well in school, you are more likely to be raised in a home where your single parent has to work at several jobs to make ends meet, and healthcare becomes unaffordable and inaccessible. You will not feel as secure walking down the street.
Women tend to be healthier and to live longer than men. Studies show that when women play a bigger role in the political life of communities, they are even healthier. What is even more astounding is how men’s health improves in that situation even more than the gain for women. In other words, we all do better where women do better. Unfortunately, their role is minimized and subordinated in regions where relative income is so disparate.
The role of psychosocial variables such as relative deprivation, educational disadvantage, racism, gender discrimination, social and family disruption, (loss of positive early childhood development) and fear of crime are profound in the effect on one’s health. Hypertension, high cholesterol, insulin resistance (diabetes) are much higher in these populations and may help explain this ‘health gradient.’
In the last 60 years our corporate tax bill has dropped from 40 percent to its current level of 7 percent with an ever-increasing burden going to the middle class further widening the economic gap. This is in direct contradistinction 50 years ago in this country when the tax structure and burden differed markedly and we were one of the healthiest countries in the world. From 1983 to 1995, the bottom 40 percent of families in America actually lost assets, which was simultaneously coupled with federal and state cuts in funding for low cost housing, public schools, basic research and development.
This further helped to decimate the family at a time when family values were being extolled. The United States has the highest percentage of single-person households among all rich countries with the greatest number of children being raised in “single-parent families”. Studies in Sweden have shown that children of single-parent families become sicker, spend more days in hospitals, have more behavior problems, and higher mortality; this in a country with social supports unimagined in the United States.
With 45 million Americans now without health insurance, we are basically rationing our healthcare dollar. Burgeoning technology and our consumer mentality has produced a “cascade effect” that leads to dependency, overuse and waste in our country’s healthcare delivery. Despite Japan’s equal technological capabilities, their utilization of healthcare services is far below the United States. The example of Japan’s post World War II remarkable transformation must not be lost on us. We must work towards improving the understanding of these issues between our politicians, health policy makers, physicians and our corporate base.
As Thomas Pynchon wrote in “Gravity’s Rainbow,” “If you can get them asking the wrong questions, the answers don’t matter.” It is time that we in healthcare start asking the right questions.
Jeffrey A. Ratner, MD, specializes in Pulmonary and Internal Medicine and is in private practice in State College. He is currently Chief of Staff at Mount Nittany Medical Center.