Nation's Health Depends on Equality, Not Wealth
by Crawford Kilian
First published in the Georgia Straight (Vancouver, BC), June 8, 2000

Measured by life expectancy, good health in the advanced industrial
countries doesn't depend on national wealth, good medical care, or even
good genes. Instead, you will live a healthier, longer life if you are a
part of a tightly cohesive, egalitarian society in which the incomes of
the poorest and the richest are not that far apart. Among public-health
experts, this basic point is settled, but it still hasn't sunk in with
politicians and the public. Canada is such a country, but it may not
remain so for long.

A remarkable book has gained almost canonical status in this field.
Unhealthy Societies: The Afflictions of Inequality, by Richard G.
Wilkinson (Routledge, 1996), summarizes decades of research in Europe,
North America, and Japan. Wilkinson, a professorial research fellow at the
University of Sussex, England, shows that a country's overall wealth
doesn't buy longterm health. After per-capita income hits about $10,000,
further increases in personal wealth bring relatively poor improvements in
life expectancy. What matters is the income gap between a country's
richest and poorest citizens.

Wilkinson mentions the "Whitehall survey" --headed by Michael Marmot, an
epidemiologist with University College London--which has studied 17,000
British civil servants since the 1960s. All of them were well educated and
have good access to health care. Yet the clerks at the bottom of the
income scale have had three times the mortality rate of the senior
administrators at the top, and four times the rate of death from coronary
heart disease. An American study, the Multiple Risk Factor Intervention
Trial, first published in the Journal of the American Medical Association
in 1982, has surveyed 300,000 men since the early 1980s and found that
every income class is healthier than the one below it, and sicker than the
one above it.

But health isn't just a function of personal income. In 1965 Japan had a
slightly lower life expectancy than Britain. By 1986, however, Japan had
the highest life expectancy in the world, and the narrowest range between
its rich and poor. During this period, Japanese society was also tightly
cohesive, providing a place, and respect, for everyone.

In effect, disease and death rates are grounded in "psychosocial" factors
according to Wilkinson. When people experience economic insecurity, when
they lack control over their lives and jobs, chronic stress and anxiety
weaken their immune systems. Stress and insecurity early in life can stunt
both children's growth and their chances for success as adults.

Wilkinson and other researchers contend that stress also encourages
hostility, mistrust, depression, rage, and destructive behaviour such as
drug use, alcoholism, violence, homicide, and spousal and child abuse --
all of them with deadly impact on life expectancy, and all of them much
worse in societies with wide gaps between rich and poor.

Research in North America has largely confirmed Wilkinson's findings. In
the US the key factor seems to be the percentage of state or metropolitan
income on which the bottom half of the population must live. The poorer
half of Louisiana, for example, was living on just 17% of the state's
income in 1990. (In effect, out of every $100, one person received $83
while another received only $17.) According to the US Census and the
National Center for Health Statistics, Louisiana had the highest mortality
rates (and homicide rates) in the US that year.

According to a study published this past April in the British Medical
Journal, Canada has maintained a narrower income range than the Americans.
The widest income gap in Canada is in Saskatchewan, with the poorer half
living on 22% of provincial income. The narrowest gap, at 24%, is in
Prince Edward Island. The chief virtue of our health-care system, despite
its funding problems, is that it effectively narrows the income gap still
more, saving relatively poor Canadians from anxiety about falling ill. And
the less anxiety people feel, the healthier they are.

James Dunn, an assistant professor of geography at UBC, is one of the
authors of the BMJ study. He says he and his colleagues were surprised by
their own findings.

"We knew from hundreds of studies in developed countries over a century
that for individuals, wealthier is consistently healthier," he said in an
interview. "There's a persistent relationship between social status and
health status. We expected to see the same consistency for the
relationship between income inequality and population health in Canadian
provinces and cities, but we didn't. It seems Canada has transcended the
relationship altogether. Our social safety net has helped us produce high
standards of health across all provinces and cities."

Income inequality in wages, Dunn said, has grown since the mid-1980s. "But
the tax redistribution system is ameliorating the effect." Redistribution
means employment insurance, social assistance, and better access to
education as well as health care, he said, and that gives less-wealthy
Canadians a strong sense of stability, predictability and control.

One critical factor, Dunn suggested, is that most social services are
funded by provincial or federal governments. No matter where you live in
Canada, health, education and other social services will be pretty good.
In the US, by contrast, local municipalities fund those services to the
extent that their taxpayers are willing and able to do so. This, Dunn
said, leads to excellent social services at low tax rates in rich
communities with few needs, and less adequate services at high cost in
communities with greater need. Anyone who can afford to escape such poor
communities will do so, aggravating the problem for those left behind.

Current trends -- toward two-tiered health care, toward privatized
education-- carry the seeds of more psychosocial stress, more hostility
and mistrust, and greater relative inequalities. Those in turn mean more
disease, more destructive behaviour, and earlier deaths. Poor and
middle-income Canadians should therefore defend their social programs as
if their lives depended on them.

-30-

Crawford Kilian's latest book is Writing for the Web (Self-Counsel Press,
1999).




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