Magazine article The American Prospect

Health and Wealth: Our Appalling Health Inequality Reflects and Reinforces Society's Other Gaps

Magazine article The American Prospect

Health and Wealth: Our Appalling Health Inequality Reflects and Reinforces Society's Other Gaps

Article excerpt

A LOOK AT AMERICANS' HEALTH REVEALS THE astonishing inequalities in our society. American girls are born with a life expectancy that ranks 19th in the world (in another survey they fall to 28th). Male babies rank 31st--in a dead tie with Brunei. Among the 13 wealthiest countries, the United States ranks last or nearly so in almost every way we measure health: infant mortality, low birth weight, life expectancy at birth, life expectancy for infants. The average American boy lives three and a half fewer years than the average Japanese baby, despite higher rates of cigarette smoking in Japan. The American adolescent death rate is twice as high as, say, England's.

These dismal American averages mask vast differences across our population. A male born in some sections of Washington, D.C., for example, has a life expectancy 40 years lower than a woman born in many wealthy neighborhoods. In short, great differences in wealth match up to--indeed, they create--terrible differences in health.

Why do Americans come out so badly in the cross national health statistics? Why are our infants more likely to die than those in, say, Croatia? Our health troubles have three interrelated causes: inequality, poverty, and the way we organize our health-care system.

Let's start with inequality. A famous study of the British civil service found that with each rung up the ladder of success, people suffered fewer fatal heart attacks--the clerks and messengers at the bottom were four times more likely to die than the executives at the top. Researchers following up this study reached a surprising conclusion that seems to hold up in one nation after another: The wider the inequality, the worse the nation's overall health.

Why should this be so? For one thing, falling behind in the race to make ends meet generates stress and physiological harm--the results are depression, hypertension, other illnesses, and high mortality rates. In addition, the middle-class scramble to get ahead erodes neighborly feelings, frays our communities, and lowers trust in institutions like churches and governments. All of these are factors in other countries. But most industrial nations buffer their citizens against economic uncertainty and lost jobs. In the United States, only the market winners get security.

Of course, American health problems go beyond inequality and are closely correlated with the poverty in which more than one in 10 Americans now live. Of our 34.6 million "poor" citizens, according to the U.S. Census Bureau, more than 14 million are "severely poor," meaning they don't even make it halfway to the federal poverty line. The numbers are worse for minorities, with nearly a quarter of blacks and more than a fifth of Hispanics living in poverty.

And poverty brings troubles like hunger (33 million Americans live with "food insecurity," as defined by the Department of Agriculture) and homelessness (perhaps as many as 3.5 million a year), which disproportionately fall on kids. Poor neighborhoods face high crime, inferior schools, few good jobs, and inadequate health care facilities. Instead, poverty attracts danger--too much alcohol and tobacco, illegal drugs, and fast foods. One observer after another has gone off to study poor communities and come back with the same report: The lives of the poor are full of stress and the struggle to get by.

People die younger in Harlem than in Bangladesh. Why? It is not what most people think--homicide, drug abuse, and AIDS are far down the list. Rather, as The New England Journal of Medicine reports, the leading causes of death in poor black neighborhoods are "unrelenting stress," "cardiovascular disease," "cancer," and "untreated medical conditions."

Finally, beyond the fundamentals--inequality and poverty--there is that stubborn American policy dilemma: No other industrial nation tolerates such yawning gaps in health insurance. According to the Congressional Budget Office, 43. …

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