By Drexler, Madeline
Nieman Reports , Vol. 63, No. 1
Fruits and vegetables, daily exercise, and high-tech medical care won't necessarily keep you healthy. What will, more likely, is a decent income, a good education, strong community ties, feeling safe from bias and crime, being able to control your day and your destiny, and other so-called "social determinants of health." Put simply, health and disease are stamped not by lifestyle, but by life. The epidemiological evidence, building over decades, is clear.
"Unnatural Causes: Is Inequality Making Us Sick?"--a winner of the 2009 Alfred I. duPont-Columbia University Awards for broadcast journalism-digs deep into medical and public health research to portray both the layered complexity of the social determinants of people's well-being and the personal tragedies that follow when policymakers all too often fail to factor in such critical information.
Yet the four-hour, seven-part series, broadcast by PBS in the spring of 2008, goes further. It was conceived not merely as a primetime educational feature but as a spark plug for social change. Its long afterlife as a tool for health activists--with more than 12,0OO screenings since its original airdate and a growing list of citizen and government initiatives inspired by the film--has made it a touchstone in the unfolding debates about how to improve America's deep health inequities.
Consider some facts:
* African-American women with a college degree have higher rates of delivering low birth weight infants and infants who die at birth than do white women who are high school dropouts.
* The longer your parents owned a home when you were growing up, the less likely you are to catch colds as an adult.
* The higher your income, the less your body releases the potentially damaging stress hormone cortisol.
Biology, in other words, is socially patterned. Though America's hyper-individualistic culture insists that we are each solely responsible for our well-being, research shows that individual behaviors--such as exercise, cigarette smoking, alcohol abuse, eating habits--exert a comparatively small effect on health status, despite what we might believe from the daily doses of health reporting that we receive. The strongest predictor of health is class position, whether measured by income, schooling or occupation. The behavioral choices we make reflect the choices we have--and those choices, in turn, hang on larger social, po1itical and economic structures.
"Unnatural Causes" documents this challenging idea through story after story depicting the bodily toll of racism, poverty, joblessness, crime, job stress, cultural dislocation, and other societal ills. It brings stacks of scientific data to life--deftly cutting between bar charts, functional medical imagery, atmospheric street shots, and intimate family scenes.
One of the more gripping segments, titled "Bad Sugar," describes the stunning prevalence of diabetes in the Tohono O'odham and Pima Indian tribes of southern Arizona. For the past 40 years, the Tohono O'odham people have suffered the highest rates of Type II diabetes in the world; 50 percent of adults are diagnosed with the disease. Yet for centuries, diabetes was unheard of in the tribes, which thrived self-sufficiently on tepary beans, cholla buds, local game, and crops irrigated by rain and ground water.
What changed? Everything. Beginning in the late 19th century, the U.S. government dammed the Gila River to divert its life-giving water to white farmers, ranchers and miners, and later to Sunbelt swimming pools, golf courses, and artificial lakes. As a
result, the Native Americans, unable to grow food or develop economically, starved. To make amends, the U.S. military showered the tribes with free commodity surplus items: white flour, cheese, refined sugar, lard, canned goods. Decades of federal cynicism served up a diabetic's nightmare.
So much for the primacy of personal choice. …