>
>Deadly Disparities
> Americans' Widening Gap in Incomes May Be Narrowing Our
> Lifespans
>
> By James Lardner
>
> Sunday, August 16, 1998; Page C01
>
> Americans are famous for not getting too excited about
differences in
> income or wealth, but we have outdone ourselves lately.
Since the 1970s,
> virtually all our income gains have gone to the
highest-earning 20 percent of
> our households, producing inequality greater than at any
time since the
> 1930s, and greater than in any of the world's other rich
nations (and many
> of its poor ones) today. Bill Gates alone is wealthier
than half the American
> people put together, and from the halls of the Federal
Reserve Board on
> down to your corner tavern, economic pundits treat the
issue as a
> regrettable footnote in the glowing story of
world-beating job creation,
> soaring corporate profits and all-but-invisible inflation.
>
> Now comes a new point to consider. Arriving at the
question from a
> variety of angles and disciplines, researchers in the
United States, Canada
> and Britain have found evidence that more unequal
societies are more
> unhealthy--not just in some highfalutin moral sense but
in the plain old
> medical sense, and not just for the poor (as anyone
would suspect) but for
> the bulk of the population. To put it more baldly, if
you live in a place
> where differences in income and wealth are unusually
large (the United
> States, for example), your chances of escaping chronic
illness and reaching
> a ripe old age are significantly worse than if you live
in a place where
> differences are not as large (Sweden, for example).
>
> In the scheme of risk factors, moreover, we are talking
about one as
> dangerous as cigarettes, fatty foods or any of the other
health habits that
> we periodically work ourselves into tizzies over.
>
> An inkling of this came, two decades ago, from a study
of 17,000 British
> civil servants. Surprisingly, the annual heart-attack
fatality rate among
> clerks and messengers was four times what it was among
administrators.
> (So much for the idea of executive stress as a big
contributor to heart
> disease.) Even at the bottom of the ladder, these were
office workers with
> the means to feed and house themselves decently and with
access to
> high-quality national health care. In any case,
differences in rank proved to
> be just as eerily accurate a guide to heart-attack rates
at the top of the
> ladder (a senior assistant statistician was twice as
vulnerable as a chief
> statistician), and a similar pattern held for cancer and
other diseases that
> might have been assumed to choose their victims more
randomly.
>
> After weeding out such obvious explanations as
class-related differences in
> smoking and diet, Michael Marmot, an epidemiologist at
the University of
> London, began to suspect that intangible issues such as
job control and
> sense of security--the sheer experience of rank, in
other words--might be
> involved. Looking down from a higher statistical
altitude, Richard
> Wilkinson, an economic historian at Sussex University,
had a similar
> insight. Wilkinson's focus was the health differences
among, rather than
> within, nations; here, standard of living--such a
sure-fire yardstick of
> individual health in the Whitehall study--became, oddly,
almost a
> nonfactor.
>
> As long as per-capita gross domestic product exceeded
about $5,000,
> Wilkinson found, Nation A (the United States, for
example) could have
> twice the per-capita income of Nation B (Greece, for
example) and still lag
> in life expectancy. By contrast, Wilkinson's data
suggested that equality of
> income was a very reliable predictor of health. This was
an idea that, like
> the key piece in a jigsaw puzzle, simply looked right
the instant it fell in
> place. In fact, it seemed to solve a number of puzzles
at once:
>
> * The greatest gains in British life expectancy (among
the civilian
> population, that is) came during the two world wars,
which were
> accompanied by a dramatic compression of incomes and a
powerful
> national reaction against class.
>
> * The Japanese, well-known for the relatively small gap
between the
> earnings of their top executives and ordinary workers,
are the world's
> longest-lived people. Japanese men, who are twice as
likely to smoke as
> American men, not only live longer but, remarkably, have
lower rates of
> lung cancer.
>
> * In Eastern Europe and the nations of the former Soviet
Union, where the
> last decade has brought spectacular economic gains to a
relative handful
> and a deterioration of living standards to many, average
life expectancy has
> actually been falling--a phenomenon almost without
precedent in the 20th
> century.
>
> * Of the developed nations, Britain and the United
States have, by most
> reckonings, the most inequality and the worst life
expectancy. The contrast
> with Japan is particularly striking because unlike, say,
Sweden, it has a low
> tax burden and a low rate of spending on health care.
Yet the 3.6-year gap
> in life expectancy between the United States and Japan
(76.2 and 79.8
> years, respectively) is equal to the gain we would
realize if heart attacks
> vanished as a cause of death.
>
> As interesting as these comparisons are, though, some of
the strongest
> evidence involves U.S. states, cities and counties,
which offer the
> advantages of comparable data and a largely shared
culture. In the July
> issue of the American Journal of Public Health, a team
of researchers led
> by John Lynch and George Kaplan of the University of
Michigan describe
> a study of 282 metropolitan areas, finding, as Wilkinson
did, that mortality
> rates are considerably more closely linked to relative
than to absolute
> income. What do Biloxi, Miss., Las Cruces, N.M., and
Steubenville, Ohio,
> have in common? High inequality, high mortality.
Allentown, Pa., Pittsfield,
> Mass., and Milwaukee, Wis.? Low inequality, low mortality.
>
> Ichiro Kawachi and Bruce Kennedy of the Harvard School
of Public
> Health have used domestic data to explore the thesis
that much of
> inequality's influence on health may be due to an
erosion of trust or, to use
> a term coined by the sociologist James Coleman, "social
capital." Kawachi
> and Kennedy have come up with ways of measuring these
variables, which
> turn out to be closely related to inequality and, at the
same time, to a city's
> or state's death rate from a wide range of causes.
>
> They also point to the Brigadoon-like story of Roseto,
Pa., an Italian
> American town whose inhabitants smoked heavily and
cooked with lard
> but nonetheless had an unusually low incidence of heart
attack. Alighting on
> Roseto in the 1950s, the physician-sociologist team of
Stewart Wolf and
> J.G. Bruhn traced its good health to a conspicuously
old-fashioned
> immigrant culture and closeness. By the '60s, however,
they began to see
> younger Rosetans adopting the more individualistic ways
of the wider
> world--for example, building terraces in back of their
houses rather than
> porches in front. Within another decade, Roseto's
heart-attack fatality rate
> was as high as that of neighboring towns.
>
> As bizarre as some of these ideas may sound in the
context of modern
> medicine, they sit well with an array of recent
discoveries about how
> psychosocial forces affect physical health.
>
> Social isolation or lack of friends, for example,
accounted in one study of a
> group of coronary patients for a threefold difference in
survival rate after
> three years; in another study, for a fourfold difference
in the rate at which
> otherwise healthy research subjects got sick after being
exposed to cold
> viruses.
>
> Nor are the biological pathways that could explain such
things beyond
> comprehension. Working with wild baboons in the
Serengeti, Robert M.
> Sapolsky, a Stanford University neurobiologist, has
found that animals
> lower down in the tribal hierarchy tend to resort
habitually to the kind of
> hormonal mobilization that, in higher-status animals, is
reserved for
> emergencies. Over time, escalated levels of cortisol and
other
> stress-related hormones become the norm; the hippocampus
gland
> (important to learning and memory) shrinks, and
disproportionately many
> animals succumb to cancer, brain damage or stroke.
>
> In a laboratory setting, Carol Shively, a psychologist
at Wake Forest
> University, has taken Sapolsky's work a scary step
farther, manipulating
> the status of macaques by bumping them from one social
group to another.
> The results, for monkeys who go from dominant to
subordinate, include an
> accelerated pulse and the buildup of fat in the arteries.
>
> For all the questions that remain to be sorted out
(assuming they ever are),
> it is hard not to see in this body of research a
cellular-level glimpse of truths
> that have lain in the realm of intuition and parable:
the idea, for example,
> that when a society creates steep discrepancies in
income and wealth, it
> excites a preoccupation with material pleasures, money
and status, and
> aggravates feelings of anxiety and inferiority that (it
is all too accurate to
> say) eat away at people. These feelings "are so
fundamental," Wilkinson
> observes, that "it is reasonable to wonder whether the
effects on the quality
> of life are not more important than the effects on the
length of life."
>
> Wilkinson's emphasis on the psychosocial dimension of
inequality has been
> a point of disagreement between him and others in the
field who argue that
> material considerations and access to social services
may, in fact, play a
> large role, especially when, as Clyde Hertzman of the
Canadian Institute
> for Advanced Research observes, one includes the latent
effects of
> income-related differences in prenatal care and parenting.
>
> Whatever the balance of factors, however, it ought to be
clear that these
> problems won't be solved with a little 1960s-style
income redistribution.
> They involve the ways in which we distribute money (and
power and
> status) in the first place, and, that being so, call for
a basic change of
> thinking on the part of society, corporate chieftains
included. And trailing
> just a millisecond behind that thought is this one:
sure, in a million years.
>
> But consider, for a moment, the slender basis for much
of what we
> currently accept as economic gospel. Communism
collapses, and the most
> timid forms of social planning are seen as a first step
down the road to the
> gulag. Western Europe falters, and we are ready to throw
a century's
> worth of social welfare measures in the trash. The
American economy goes
> into high gear for a few years, and the idea of
corporate executives who
> earn hundreds of times as much as their employees
becomes a law of
> nature. Indeed, the confidence with which eternal
verities are thrown
> around by experts, and accepted by masses of people, in
the capital- and
> market-driven part of the world these days recalls
nothing so much as the
> Soviet Union a generation or two ago. This dogma too
shall pass, and we
> will all be better off.
>
> James Lardner writes about business and technology for
U.S. News and
> World Report.
>
>
> © Copyright 1998 The Washington Post Company
>
>
>
>
>
>
>
>
>
>
Visit our Web Site!
http://www.utoronto.ca/qol
****************************************************
Canalising a river
Grafting a fruit tree
Educating a person
Transforming a state
These are instances of fruitful criticism
And at the same time instances of art.
-Bertolt Brecht
****************************************************
Dennis Raphael, Ph.D.
Associate Professor and Associate Director,
Masters of Health Science Program in Health Promotion
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
McMurrich Building, Room 101
Toronto, Ontario, CANADA M5S 1A8
voice: (416) 978-7567
fax: (416) 978-2087
e-mail: [log in to unmask]
|
