>X-Authentication-Warning: clarknet.clark.net: Urachel set sender to >rachel!rachel.clark.net!peter using -f >>Received: by rachel.clark.net (UUPC/extended 1.12r); > Thu, 05 Feb 1998 11:42:19 -0500 >Date: Thu, 5 Feb 98 11:42:19 -0500 >From: Peter Montague <[EMAIL PROTECTED]> >Subject: Rachel #584: Major Causes of Ill health >To: [EMAIL PROTECTED] >Sender: [EMAIL PROTECTED] >Precedence: bulk >Reply-To: Peter Montague <[EMAIL PROTECTED]> > >=======================Electronic Edition======================== >. . >. RACHEL'S ENVIRONMENT & HEALTH WEEKLY #584 . >. ---February 5, 1998--- . >. HEADLINES: . >. MAJOR CAUSES OF ILL HEALTH . >. ========== . >. Environmental Research Foundation . >. P.O. Box 5036, Annapolis, MD 21403 . >. Fax (410) 263-8944; Internet: [EMAIL PROTECTED] . >. ========== . >. Back issues available by E-mail; to get instructions, send . >. E-mail to [EMAIL PROTECTED] with the single word HELP . >. in the message; back issues also available via ftp from . >. ftp.std.com/periodicals/rachel and from gopher.std.com . >. and from http://www.monitor.net/rachel/ . >. Subscribe: send E-mail to [EMAIL PROTECTED] . >. with the single word SUBSCRIBE in the message. It's free. . >================================================================= > >MAJOR CAUSES OF ILL HEALTH > >Numerous studies in England and the U.S. have shown consistently >that a person's place in the social order strongly affects health >and longevity.[1] It now seems well-established that poverty and >social rank are the most important factors determining health >--more important even than smoking.[2] > >This conclusion has been a long time in the making. A British >study in 1840 observed that "gentlemen" in London lived, on the >average, twice as long as "labourers." Starting in 1911, British >death certificates have been coded for social class based on >occupation. (In the U.S., death certificates are coded for race >or ethnicity without reference to class or occupation.) The >British database of deaths coded by class has allowed many >studies, which have shown consistently that lower social status >is associated with early death. > >For example, in 1980, Sir Douglas Black, who was then the >President of the Royal College of Surgeons, published a study >covering the period 1930-1970 in England. The so-called Black >Report concluded that "there are marked inequalities in health >between the social classes in Britain." Specifically, people in >unskilled occupations had a two-and-a-half times greater chance >of dying before retirement than professional people (lawyers and >doctors).[1] > >Furthermore, the Black Report showed that the gap in death rates >between rich and poor had widened between 1930 and 1970. In >1930, unskilled workers were 23% more likely to die prematurely >than professional people, whereas in 1970 they were 61% more >likely than professionals to die prematurely. > >Several subsequent studies confirmed the findings of the Black >Report and demonstrated that, even within privileged groups, >those with less status lived shorter lives. In other words, >social rank affects health even among those who are well off. >The so-called Whitehall studies in England examined the health of >10,000 British government employees (civil servants) over 2 >decades and found a 3-fold difference in death rates between the >highest and lowest employment grades. The Whitehall studies >showed (and later a U.S. study confirmed) that conventional risk >factors such as smoking, obesity, physical activity, blood >pressure and blood-levels of cholesterol could explain only 25% >to 35% of employment-grade differences in mortality.[2] In other >words, social rank was more important a determinant of health >than were all the conventional risk factors. In sum, being lower >in the pecking order makes you sick and shortens your life. > >Researchers have examined the opposite hypothesis, that perhaps >health status determines social class --that being sick makes you >poor, instead of the other way around. They have found that this >explains only about 10% of the health disparities between social >ranks.[1] > >In the U.S., a study in Chicago during 1928-1932 examined death >certificates in relation to place of residence at time of death. >Chicago was categorized into 5 socioeconomic levels based on >average monthly rental payments. The study showed a fairly >smooth curve: the higher the rent, the lower the death rate for >people of similar ages. > >This study was redone in 1973, looking at changes between 1930 >and 1960. There had been "no relative gain" in recent decades >for those paying the lowest rents. So even though the general >standard of living may rise, those lower on the income scale die >at younger ages. > >In 1986, researchers at the National Center for Health Statistics >showed that Americans with annual incomes of $9000 or less had a >death rate 3 to 7 times higher (depending on gender and race) >than people with annual incomes of $25,000 or more. Furthermore, >they showed that this situation had worsened between 1960 and >1986.[1] > >In the U.S., within groups of people having similar incomes, >African-Americans have worse (and worsening) health status, >compared to whites, for many diseases including asthma, diabetes, >hypertension (high blood pressure), major infectious diseases, >and several cancers.[3] Among researchers who have studied these >problems, the basis of these health differences is thought to be >racism, not genetics.[1] > >As we have reported previously (REHW #497), several studies have >now revealed two important facts about the relationship of wealth >to health: > >1. Between countries, there is no relationship between gross >domestic product (GDP) --a conventional measure of wealth --and >health. In other words, comparing countries at similar levels of >industrialization, it is quite possible for people in poorer >countries to be healthier than people in richer countries. The >absolute level of income does not determine health or longevity. > >2. On the other hand, within individual countries there is a >consistent relationship between health and the size of the gap >separating rich from poor. Countries with the longest life >expectancy at birth are those with the smallest spread of incomes >and the smallest proportion of people living in relative poverty. >Such countries (for example, Sweden) generally have longer life >expectancy than countries that are richer but tolerate larger >inequalities, such as the U.S. > >Within the U.S., comparisons between states have come to similar >conclusions: it is not the average level of income in a state >that determines health status --it is the size of the gap between >rich and poor in a state that determines health. > >George Kaplan and his colleagues at the University of California >at Berkeley measured inequality in the 50 states as the >percentage of total household income received by the less well >off 50% of households.[4] It ranged from 17% in Louisiana and >Mississippi to 23% in Utah and New Hampshire. In other words, by >this measure, Utah and New Hampshire have the most EQUAL >distribution of income, while Louisiana and Mississippi have the >most UNEQUAL distribution of income. > >This measure of income inequality was then compared to the >age-adjusted death rate for all causes of death, and a pattern >emerged: the more unequal the distribution of income, the greater >the death rate. For example in Louisiana and Mississippi the >age-adjusted death rate is about 960 per 100,000 people, while in >New Hampshire it is about 780 per 100,000 and in Utah it is about >710 per 100,000 people. Adjusting these results for average >income in each state did not change the picture: in other words, >it is the gap between rich and poor within each state, and not >the average income of each state, that best predicts the death >rate. > >Inequality is growing throughout the world, both between >countries and within countries. As of 1996, 89 countries (out of >174) were worse off, economically, than they had been a decade >previously. In 70 developing countries, incomes are lower now >than they were in the 1960s and 1970s.[5] And the level of >inequality is already astonishing. For example, in 1996, 358 >billionaires controlled assets greater than the combined annual >incomes of countries representing 45 percent of the world's >population (2.5 billion people).[5] Between 1961 and 1991, the >ratio of the income of the richest 20% of the world's population >to the poorest 20% increased from 30-to-1 to 61-to-1.[2] > >Within the U.S., inequality is wider than it has been for 50 >years, and it is getting worse. The U.S. now finds itself among >a group of countries, including Brazil and Guatemala, in which >the national per capita income is at least four times as high as >the average income of the poorest 20 percent.[5] In the U.S. >between 1980 and 1990, inequality of income increased in all >states except Alaska.[1] Inequality in the distribution of income >and wealth[6] has been increasing in the U.S. for about 20 >years.[7,8,9,10] In 1977 the wealthiest 5% of Americans captured >16.8% of the nation's entire income; by 1989 that same 5% was >capturing 18.9%. During the 4-year Clinton presidency the >wealthiest 5% have increased their take of the total to over 21%, >"an unprecedented rate of increase," according to the British >ECONOMIST magazine.[11] > >Inequality in the distribution of wealth in the U.S. is even >greater than the inequality in income. In 1983, the wealthiest >5% of Americans owned 56% of all the wealth in the U.S.; by 1989, >the same 5% had increased their share of the pie to 62%.[10,pg.29] > >These tremendous inequalities translate directly into sickness >and death for those holding the short end of the stick. > >As Dr. Donald M. Berwick, a Boston pediatrician, said recently, >"Tell me someone's race. Tell me their income. And tell me >whether they smoke. The answers to those three questions will >tell me more about their longevity and health status than any >other questions I could possibly ask."[3] > >Isn't it time that the public health community --physicians, >public health specialists, and environmentalists --recognized >that poverty, inequality and racism cause sickness and death? >Given what science now tells us, medical policy --including >medical training --should aim to combat and eliminate poverty, >inequality, and racism just as it now aims to combat and >eliminate infectious diseases and cancer.[2] With U.S. health >care costs now exceeding $1 trillion each year, anti-poverty and >anti-racism initiatives would be economically efficient as well >as humane. > --Peter Montague > (National Writers Union, UAW Local 1981/AFL-CIO) > >=============== >[1] Oliver Fein, "The Influence of Social Class on Health Status: >American and British Research on Health Inequalities," JOURNAL OF >GENERAL INTERNAL MEDICINE Vol. 10 (October, 1995), pgs. 577-586. > >[2] Andrew Haines, Michael McCally, Whitney Addington, Robert S. >Lawrence, Christine Cassel, and Oliver Fein, "Poverty and Health: >The Role of Physicians," ANNALS OF INTERNAL MEDICINE (in press). > >[3] Peter T. Kilborn, "Black Americans Trailing Whites in Health, >Studies Say," NEW YORK TIMES January 26, 1998, pg. A16. > >[4] George A. Kaplan and others, "Inequality in income and >mortality in the United States: analysis of mortality and >potential pathways," BRITISH MEDICAL JOURNAL Vol. 312 (April 20, >1996), pgs. 999-1003. > >[5] Barbara Crossette, "U.N. Survey Finds World Rich-Poor Gap >Widening," NEW YORK TIMES July 15, 1996, pg. A3. > >[6] Wealth is the net worth of a household, calculated by adding >up the current value of all assets a household owns (bank >accounts, stocks, bonds, life insurance savings, mutual fund >shares, houses, unincorporated businesses, consumer durables such >as cars and major appliances, and the value of pension rights), >then subtracting the value of all liabilities (consumer debt, >mortgage balances, and other outstanding debt). > >[7] Sheldon Danziger and others, "How the Rich Have Fared, >1973-1987," AMERICAN ECONOMIC REVIEW Vol. 79 (May, 1989), pgs. >310-314. > >[8] McKinley L. Blackburn and David E. Bloom, "Earnings and >Income Inequality in the United States," POPULATION AND >DEVELOPMENT REVIEW Vol. 13, No. 4 (December, 1987), pgs. 575-609. > >[9] Johan Fritzell, "Income Inequality Trends in the 1980s: A >Five-Country Comparison," ACTA SOCIOLOGICA Vol. 36 (1993), pgs. >47-62. > >[10] Edward N. Wolff, TOP HEAVY; A STUDY OF THE INCREASING >INEQUALITY OF WEALTH IN AMERICA (New York: Twentieth Century >Fund, 1995). Although this is a study of wealth inequality, >chapter 6 deals with income inequality. > >[11] "Up, down and standing still," THE ECONOMIST February 24, >1996, pgs. 30, 33. > >Descriptor terms: u.s.; uk; poverty and health; income and >health; wealth and health; inequality; longevity; morbidity >statistics; race and health; african americans; la; nh; ut; ms; >chicago; medical policy; equity; environmental justice; black >report; whitehall studies; brazil; guatemala; > >################################################################ > NOTICE >Environmental Research Foundation provides this electronic >version of RACHEL'S ENVIRONMENT & HEALTH WEEKLY free of charge >even though it costs our organization considerable time and money >to produce it. We would like to continue to provide this service >free. You could help by making a tax-deductible contribution >(anything you can afford, whether $5.00 or $500.00). Please send >your tax-deductible contribution to: Environmental Research >Foundation, P.O. Box 5036, Annapolis, MD 21403-7036. Please do >not send credit card information via E-mail. For further >information about making tax-deductible contributions to E.R.F. >by credit card please phone us toll free at 1-888-2RACHEL. > --Peter Montague, Editor >################################################################ >
