This was last months column from The Free Lance-Star.
At the risk of being a bit esoteric, for a variety of reasons I am focused on health and social inequities in the US.
I’m talking about what the American Public Health Association defines as “a particular type of health difference that is closely linked with social, economic, and environmental disadvantage.”
One in three deaths in the United States is attributed to high levels of inequality. And there are reports of what are called “death of despair” from suicide, drug overdose and alcoholic liver disease in places of greatest inequality like Appalachia.
It’s of particular interest now because the COVID-19 pandemic and Black Lives Matter movement have highlighted these disparities. I am also focused on this because there’s an election coming up and an opportunity to elect leaders who are more concerned about these inequities. And I have to give a talk on the subject to the Unitarian Universalist Fellowship of Fredericksburg.
Inequity, with it’s connotation of unfairness, is the kind of thing Unitarians thrive on – but maybe I am being a bit hypocritical making fun here, as I am one of those “bleeding hearts” and find I am attracted to the liberal, philanthropic philosophies and politics of my fellow congregants there.
Social Determinants causing Inequality
The mechanism of these disparities is through what social workers call Social Determinants of Health, or “SDOH” is the spiffy abbreviation. A hot topic these days.
I have previously told the story of some SDOH victims. Less fortunate folks I have encountered – mostly through working at the Moss Free Clinic.
The guy who couldn’t get his cataracts fixed because he lived in a tent. The diabetic woman who couldn’t afford the food she needed as her food stamp delivery through the mail was held up - and she didn’t have transport to get to the post office. The self-employed carpenter with no insurance who finished up with a bill of half a million dollars after having a heart attack.
More specifically SDOH’s are due to education – or lack of it – which has a lot to do with what kind of living and working conditions you end up in.
Housing/environment – that determines exposure to illnesses, pollutants, stress levels, and access to healthcare, food and recreation.
Ethnicity - which may make you subject to prejudice that can have distinct adverse effect.
Even personal choice of things like diet, smoking, drinking, drug use and other behaviors that affect your health, tend to be tied to your socioeconomic status.
Money Tops Them All
The most significant social determinant however is money.
If you have enough, you can pay for good education, housing, food, recreation and of course health insurance and healthcare.
A report in the Lancet notes “economic inequality in the USA has been accompanied by increasing disparities in health outcomes.” It’s reached the point where “the life expectancy of the wealthiest Americans now exceeds that of the poorest by 10–15 years.”
Americans are usually happy to be the biggest and the best. But maybe not so for what a 2018 United Nations report noted. The US “has the highest level of income inequality in the Western world.”
We recently watched Inequality For All on Netflix, featuring previous Secretary of Labor Robert Reich.
Though made in 2013 it is still relevant for pointing out the causes of wealth inequity in the US. How the middle class was doing OK until about the 1990’s, then the comparative wealth of middle class started falling off – and with it it’s purchasing power with an adverse effect on the economy (after tax income of the bottom fifth rose 18 percent between 1979 and 2007 while the wealthiest 1per-cent increased 275 per cent).
Reich criticizes things like the 2017 Tax Cuts and Jobs Act that reduced the amount of corporate taxes paid (by 40 percent according to the Tax Policy Center).
It’s a Social Issue
I am straying a little out of my field of expertise commenting on economics – and probably am raising the blood pressure of people who see the whole issue differently.
The bottom line is that your socio-economic status – which in turn is dependent on your wealth, or lack of – has a lot to do with your health. And the way to change this is not just improving the healthcare system, although it badly needs it.
A study in the New England Journal of Medicine, on SDOH, noted that “states that allocate more resources to social services than to medical expenditure have substantially improved health outcomes.”
Poor health is a social issue. We need to pay attention, and allocate resources – which means money of course – to housing, education, food, environment, transport. And/or distribute wealth in a more equitable way so people can afford this for themselves.