Just the facts, Ma’amSince some of my readers want less drama and more facts, here are the facts. Class, open your books to chapter eight. Which book, you ask?
The Social Determinants of Health edited by Wilkinson and Marmot. If you didn’t bring your copy, you can share. Or open your laptops and go to Google eBooks. You can read most of the chapter online.
First, a point of clarification. While poverty is a disease that has many associated ills, today we are talking about something worse than poverty. The topic today is wealth disparity. What is worse for your health than being poor? Being poor in an affluent country.
Yes, yes, I know it sounds unlikely. What about trickle down economics? The poor folks in a rich nation will surely notice the good health of their more affluent neighbors and they will attempt to follow their model by joining a health club and eating lots of fresh fruits and vegetables. They will have fresh sea food at least three times a week and drink a glass of red wine with dinner. They will move away from polluted areas near petrochemical refineries and find themselves a nice little enclave far from the city, preferably gated, because then they won’t have to worry about crime. When they feel their stress level rising, they will see a therapist. Or maybe they will try yoga or biofeedback. A trip to a spa can do wonderful things for the blood pressure. The poor will see that the rich have abandoned tobacco products and they will follow suit, because they want to be rich and successful, too.
That’s the way it ought to be. But it ain’t.
Let’s consider one of the leading causes of death of young people, homicide. Turn to the graph on page 157. Notice how high homicide rates are in the states with the highest degree of wealth disparity and how low they are in places where money in distributed more equally. What’s that? You say these statistics indicate that the poor are killing the rich in order to get their money? Nice thought, but the evidence does not bear it out. Turn the page.
A boy brought up in Harlem has less chance of living to 65 years old than a boy in Bangledesh. For men and women under the age of 65, relative risks in Harlem compared to the rest of the United States were highest for drug deaths, homicide, alcohol deaths and chirrosis—in that order.
When there is a huge gap between the haves and the have-nots, it is the have-nots that die at an increased rate. And they die of medical problems that are directly related to the stress, depression and self loathing that comes from being poor in a land of plenty. When everyone in your country is hungry, you feel the hunger pangs, but you do not blame yourself for being hungry. You know that there is a larger problem, one that your society needs to address. If you and your kids go to bed hungry while the guy down the road throws uneaten steak to his dog, you feel like a failure. You know that the rich guy’s kids laugh at your kids for having torn up shoes. You know that in your town, you are called “Poor white trash” or “Welfare Queen” depending upon whether you are Black or white. When your kids ask for a computer so they can do their homework, your heart breaks a little inside even as you answer gruffly “We don’t need that kind of silliness.” And the children ---those kids that you love enough to throw yourself in the path of a moving car in order to save them----they look at you and think
Mom is mad at me But you aren’t angry at the children. You are angry at yourself. Because you haven’t done enough for them.
When folks internalize their anger, they start looking for ways to ease the pain. Alcohol helps---temporarily. The same goes for drugs. Cigarettes can be your best friend if you feel friendless. And so what if you are cutting short your life by smoking? You are worthless. Worse than worthless. You are a drag on society, a parasite, an ugly blight that no one wants to see. When the anger gets to be too much to bear, you lash out at anyone who gets near---including your spouse and your kids. Eventually, all that stress leads to depression. You are tired all the time. You find it hard to get motivated. Yes, you could go back to school, but with what money? Yes, there are government grants, but they would probably just laugh at you. Those of you who have never seen the world through the deep grey tinted lenses of major depression can not understand how debilitating the disease is and how difficult it can be to pull yourself up by your own bootstraps when you can not even see your own bootstraps through the fog---
Yes, I know. I am getting emotional. Let’s back away from our own country’s ills and study a land on the other side of the ocean, Great Britain. Everyone remembers Margaret Thatcher, right?
During the 1980s income differences widened more rapidly than they had ever been recorded to have done before, and more rapidly than they had in any other developed country---
That’s on page 158. On page 159:
The widening of income differences during the later 1980s was accompanied by a slowing down in the rate of improvement in national mortality rates among age groups below 45 years old and by the widening of differences in death rates between the richer and poorer areas of the country.
That’s just Great Britain’s crappy socialized medicine? Nice try. The same thing has happened in the United States, the land with the “best health care system on earth.” Take out the assigned article from the
New York TimesIn 1980-82, Dr. Singh said, people in the most affluent group could expect to live 2.8 years longer than people in the most deprived group (75.8 versus 73 years). By 1998-2000, the difference in life expectancy had increased to 4.5 years (79.2 versus 74.7 years), and it continues to grow, he said.
After 20 years, the lowest socioeconomic group lagged further behind the most affluent, Dr. Singh said, noting that “life expectancy was higher for the most affluent in 1980 than for the most deprived group in 2000.”
http://www.nytimes.com/2008/03/23/us/23health.htmlThe second article is even scarier. From 2008
For the first time since the Spanish influenza of 1918, life expectancy is falling for a significant number of American women….The downward trend is evident in places in the Deep South, Appalachia, the lower Midwest and in one county in Maine. It is not limited to one race or ethnicity but it is more common in rural and low-income areas. The most dramatic change occurred in two areas in southwestern Virginia (Radford City and Pulaski County), where women's life expectancy has decreased by more than five years since 1983.
http://www.washingtonpost.com/wp-dyn/content/article/2008/04/21/AR2008042102406.htmlPoor women in poor counties are actually living shorter lives than they did 20 years ago. The article blames smoking and obesity. Those who believe in Welfare Queens will tell you that these women have been eating too much steak and sitting in their Easy Boy recliners, watching too much cable television while squandering their SSI on cigarettes and booze and crack cocaine or meth. However, sloth and gluttony are not necessarily to blame. The poor tend to live in heavily polluted areas where it is impossible to go outdoors to exercise. They can not do what their more affluent neighbors do, i.e. join a health club. The poor have to make a limited food budget stretch, and the cheapest, most filling foods are high in fat. Women have an especially hard time quitting smoking, because of the stigma that is attached to being overweight. If they put on ten pounds when they try to quit, they feel worse about themselves, rather than better. And, of course, they lack health insurance, so there is no supportive health care practitioner---a nurse practitioner or a family physician---to coax them into making healthy lifestyle choices. Yes, they know what they are supposed to eat. But there is a big difference between knowing and doing when it comes to healthy living. Factors that encourage healthy lifestyles include a sense of self determination---“I y’am what I y’am”---a sense of being part of a community effort and the conviction that the lifestyle change will do some good. If your days are filled with regret and self loathing and despair, it is hard to imagine that anything you do can make a difference.
I can see from your frowns that you still do not understand. It is mighty hard to put yourself in the shoes of someone who has no shoes if you have never been forced to go barefoot yourself. So, I’m going to switch gears for a moment. Let’s put aside the textbooks and the scientific studies and read some fiction that was not entirely fiction.
There was a brief time in America’s history when the poor were not reviled. Their plight could not be ignored, because everyone was either poor or knew someone who was poor or both. And there was a government in Washington that did not try to dress up the numbers to make it appear that they were bringing prosperity. The federal government went out of its way to give the voiceless a voice. It hired photographers to record the faces of people who would never have been able to afford a family portrait. It showed that poverty and suffering have a human face---a face just like yours and mine, except etched with worry.
During that national disaster, that epidemic of poverty, John Steinbeck did more than quote statistics. He made it impossible for Americans to look away from the pain of being poor in a land of plenty. He did this by getting inside their heads, letting us live their hopes and their despairs. From the
Grapes of Wrath----Yes, I know it’s not on your syllabus. So I’ll read a passage to you aloud.
“People gonna have a look in their eye. They gonna look at you an’ their face says ‘I don’t like you, you son of a bitch.’ Gonna be deputy sheriffs, an’ they’ll push you aroun’. You camp on the roadside an’ they’ll move you on. You gonna see in people’s face how they hate you. An’---I’ll tell you somepin. They hate you ‘cause they’re scairt. They know a hungry fellow gonna get food even if he got to take it. They know that fallow lan’s a sin an’ somebody’ gonna take it. What the hell! You never been called ‘Okie” yet.”
Tom said “Okie? What’s that?”
“Well. Okie use ta’ mean you was from Oklahoma. Now it means you’re a dirty son-of-a-bitch. Okie means you’e scum. But I can’t tell you nothin’. You got to go there.”
You got to go there. You have to see it for yourself. Sadly, the press today is more interested in the sex lives of wealthy debutantes than in the day to day suffering of our country’s poor. That’s why I encourage nonprofessional writers (like me) to tell these stories. Because the first step to treating the disease is to acknowledge that it is real.
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