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MY VIEW: Inequality affects US public health

Published: Sunday, July 24, 2011

By Special to The Birmingham News

Kay H. Smith, Chair

Health Care Task Force

evidence that one's health may be better determined by one's ZIP code than by any other factors.

One way to conceptualize the impact of these social determinants of health is in understanding the evidence that one's health may be better determined by one's ZIP code than by any other factors. From this perspective, it is easy to see the markedly poorer health of people in lower-socioeconomic levels as actually symptoms of the larger social issues of poverty and hopelessness.

As a new (if significantly older than most) student of public health, I came in convinced that many, if not most, of our contemporary health issues -- from diabetes to lung cancer -- were in large part self-inflicted. Although I would not say I blamed the victim, I did consider the poor diet, sedentary habits and other behavioral aspects of American life and culture a significant contributor to the chronic disease "epidemics" of the 21st century.

I entered a master's degree program at the University of Alabama at Birmingham School of Public Health in part, at least, to find out why the health behavior-altering initiatives of the past several years have had such limited success. I soon found out, but the answer was not what I had expected.

A significant concept that public health students learn about, as I did, besides health behavioral theories, is that of the "social determinants of health." These include such social issues as poverty, poor education and limited job opportunities. One way to conceptualize the impact of these social determinants of health is in understanding the

However, there is yet another important factor to consider -- that of income inequality and its effect on the health of Americans. What does income inequality -- or the fact that 25 percent of income in this country goes to the top 1 percent of earners -- have to do with health?

It is undoubtedly a complex process, and there are, of course, those features of our health care system, including its substantial proportion of uninsured and underinsured residents, that play into this process. However, medical researchers have shown a link between chronic stress -- such as the stress inherent in struggling to feed, clothe, house and educate a family on a too-limited income, or that of suppressed anger due to experience with racism -- and the production of cortisol in the body, which leads to such common U.S. health risks as heart disease and diabetes.

As the middle class gradually loses its hold on the American Dream as this recession drags on, and the poor find their lives even less secure, one has to consider there's a lot of cortisol being produced in 21st-century America. Even if one discounts the evidence demonstrating that income inequality actually causes poor health, it has been proved in a number of studies that as the United States has become less of an equitable society over the past 20 or 30 years, it has also become less healthy.

Meanwhile, other countries, such as Japan and Denmark, with much more equitable societies are healthier than ours in many respects. For example, while life expectancy at birth has gone up over the past few decades in this country, it has not gone up as much as most other advanced countries and, in fact, stopped its upward trajectory for American women between 2000 and 2006.

To cite another well-known and sad indicator of health in the U.S., the infant mortality rate here is consistently higher than the wealthy European countries. (Lest my sources should be suspected as biased, I refer the reader to the "CIA World Factbook" for the global comparative rates of inequality, the U.S. Centers for Disease Control and Prevention, and the World Health Organization for health indicators, and the Institute of Medicine as well as numerous medical and public health journal articles for the effect of inequality on health.)

So, I came to revise my initial assessment of the reasons for poor health in the United States. To be sure, individual "lifestyle choices" do play a role, as do such factors as ready access to quality health care. However, I have come to the conclusion it will require greater diligence as a citizen in demanding social policies that significantly address income inequality more than greater diligence in exercise and nutrition that will determine our health and that of our children and grandchildren in years to come.

Kay H. Smith lives in Hoover. Email: khsmith1264@gmail.com.

Addressing Tough Questions of Religion and Culture

An Interfaith Conversation

Sunday, September 11, 2011

Shades Valley YMCA

3551 Independence Drive, Homewood AL 35209

3-5 pm

Join us for an opportunity to further interfaith understanding and discuss challenging questions where religious faith and culture meet.

For more information, contact: Rev. Helene Loper, Interfaith Dialogue Chairperson, revhhl@gmail.com

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MY VIEW: Inequality affects US public health

Published: Sunday, July 24, 2011