The Health of Nations: Why Inequality Is Harmful to Your Health

By Ichiro Kawachi and Bruce P. Kennedy. 232 pp. New York, The New Press,
2002. $25.95. ISBN 1-56584-582-X.

The Health of Nations presents evidence from many disciplines that
political policies that widen inequalities in income may harm a nation's
health. Kawachi, an internist turned social epidemiologist, and Kennedy,
an educational psychologist, examine a number of indicators of health,
such as mortality rates (with respect to which the United States performs
miserably in comparison with all the other rich countries), and present
arguments to show that one's relative position in society is more
important than absolute wealth or income, not only when it comes to
general well-being, but in terms of mortality as well.

The authors contend that our "consumption cancer" has left us with huge
consumer debt, limited savings, and an inequality that is posited to be
the root cause of our poor health. We work longer and harder, and we have
less time for our families. These factors lead our country, they argue, to
higher rates of violent crime and incarceration, to the establishment of
gated communities with security guards, and to the outsourcing of the care
of children. With the weakening of social bonds comes a dramatic increase
in the incidence of depression. Paradoxically, they suggest, if the
government were to launch an effort to redistribute the wealth from the
rich to the poor, the poor might not even support it: although the
likelihood of upward economic mobility by the poor in the United States is
lower than that in other rich countries, poorer people in this country
continue to dream of being among the lucky few who win the big one.

Goods that were once considered luxuries in the United States, such as
automobiles, telephones, television sets, and videocassette recorders, are
now near-necessities, and most people have them. Kawachi and Kennedy point
out that despite rising living standards, we have not become "deliriously
happy," as economists had predicted. There is little correlation between
increasing income and the level of happiness in industrialized countries.
We end up not "getting what we want" but "wanting what they get."
According to the authors, "A notable trend during the past two decades has
been the contrasting difference between massive intensification of
consumption wants for material goods, but the stagnation (or even decline)
of expressed needs for spiritual goods, such as a fulfilling job or happy
marriage."

The authors also address common misperceptions of the purported benefit of
inequality: that it produces increased economic growth and productivity is
unquestioningly accepted as good. In a counterexample drawn from
major-league baseball, the authors show that teams are more successful
when players' salaries are more equitably distributed. We work harder and
longer just to keep up with our 1973 standard of living. This additional
work translates into 5 to 10 more weeks of work each year for members of
the American labor force than for their European counterparts. Politicians
preach about "family values," but how can families prosper without time
for maintenance? As a result of the orientation toward individual rather
than family needs, some people see children as obstacles to individual
growth. The authors point out that higher rates of crime occur when the
high cultural value placed on competitive achievement clashes with
widespread disparities in actual living standards within a society.
Inequality is harmful, and we pay the ultimate price for it with premature
deaths.

Why should this book be important for clinicians and biomedical
researchers? To improve health in the United States or elsewhere in the
world, we must address factors that affect the health of populations but
have only indirect relevance for patient care. The chapter "Politics and
Health" points out that, in contrast to people from healthier European
countries or Japan, Americans are less inclined to expect their government
to work for the common good, as indicated by the fact that the largest
"political party" in this country consists of the nonvoters. The erosion
of social capital -- resulting in distrust in neighbors and unwillingness
to help others -- is more prevalent where income gaps are greater. In
parts of the United States where there is a greater divide, voter turnout
is significantly lower. Not surprisingly, mortality rates are higher in
such places as well. Clearly, the political arena is the place where
doctors concerned with the health of the population must work.


Stephen Bezruchka, M.D., M.P.H.
University of Washington School of Public Health and Community Medicine
Seattle, WA 98195-3576 [log in to unmask]
New England Jr. of Medicine, Jan 2, 2003, Vol 348, pg 90-91



We welcome posting on social justice & public health that provide:

a) information (e.g. about conferences or job announcements or publications
relevant to and making explicit links between social justice & public health),
and

b) substantive queries or comments directly addressing issues relevant to and
making explicit links between social justice and public health.

If your posting is only about social justice/political issues, or only about
public health issues, and does not explicitly connect issues of social justice
& public health, please do not post it on this listserve.

Please do NOT post petitions containing text suggesting (or requesting) that
signatures should be sent to the Spirit of 1848 bullein board, as the
signatures & replies clog up the works. Instead, if you have a petition you
want to circulate, please post a notice about the petition (which can include
its text) and provide YOUR email address so people can email you with their
signature and/or get a copy of the petition that is to be signed (or else
provide the email address and/or website where people should send their
signature and/or get a copy of the peition). Also, to limit e-mail volume,
please do not send posts directed toward a single individual to the list at
large. Instead of hitting 'reply', cut and paste the person's address into the
'to' field, and send your message directly to the her/him.

Community email addresses:
  Post message: [log in to unmask]
  Subscribe:    [log in to unmask]
  Unsubscribe:  [log in to unmask]
  List owner:   [log in to unmask]
  Web page:     www.progressivehn.org

To subscribe or un-subscribe send an e-mail to the address
specified above with the word "subscribe" or "unsubscribe"
in the subject line.

Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/

Send one line: unsubscribe click4hp to: [log in to unmask] to unsubscribe
See: http://listserv.yorku.ca/archives/click4hp.html to alter your subscription