Poverty and (ill)Health

PBS recently aired a documentary by Larry Adelman, Unnatural Causes: Is Inequality Making Us Sick:

What connections exist between healthy bodies, healthy bank accounts, and skin color? Four individuals from different walks of life demonstrate how one’s position in society - shaped by social policies and public priorities - affects health. 

“In Sickness and In Wealth” travels to Louisville, Kentucky, not to examine health care but to discover what makes us sick in the first place. The lives of a CEO, lab supervisor, janitor and unemployed mother illustrate how social class shapes access to power, resources and opportunity, resulting in a health-wealth gradient. On average, people at the top live longer, healthier lives. Those at the bottom are more disempowered, get sicker more often and die sooner. Most of us fall somewhere in between. 

Louisville Metro maps reveal 5- and 10-year gaps in life expectancy between the city’s rich, middle- and working-class neighborhoods. Experiments with monkeys and humans shed light on chronic stress as one culprit. 

We also see how racial inequality imposes an additional risk burden on people of color. Solutions being pursued in Louisville and elsewhere focus not on more pills but on more equitable social policies.

unnatural causes.org sells the DVD as well as running a series of events in the US and offering companion tools to the series/DVD

Gary Bloch, a Canadian physician:

It is time to open a new front in the war on poverty.

The Canadian health-care system has devoted sizable energy and resources to reducing risks to our health over the past couple of decades. This effort has included large campaigns targeted at smoking, obesity and exercise.

Amazingly, we have largely ignored the one risk that surpasses all of these in its potential to cause ill health and its cost to our health system - poverty.

As a family physician, I see the health effects of poverty on a daily basis. One of my patients, “Sally,” is a 37-year-old single woman working at a full-time minimum wage job in Toronto that provides her with $1,280 a month (and no benefits), $450 below the Statistics Canada poverty line.

She is currently healthy, but studies have shown that her poverty places her at a 300 per cent higher risk of developing diabetes and a 200 per cent higher risk of having a major episode of depression. Her risk of developing heart disease is about the same as if she had high blood pressure or was a smoker (both conditions into which we have pumped millions of health-care dollars for prevention). Her life expectancy is 1  1/2 years shorter, and her risk of dying from a chronic disease is 16 per cent higher per year than the average Canadian.

These are the kinds of numbers that usually make doctors, nurses, public health planners and health ministers jump into action. But we typically see poverty as a moral and political issue, not as a health risk.

While moral and political issues are easily dismissed as partisan and only of benefit to “special interest groups,” health is seen as a universal right and a fundamental social responsibility, worthy of significant social expenditure. The shift from a moral to a health perspective has taken place with smoking and is in the process with obesity. The next great preventive health frontier needs to be poverty.  TheStar.com

See also CIHR:

Life expectancy and the burden of disease for Aboriginal Canadians differs from other Canadians. From the data that are available we know the following:

• In 2000, First Nations males had a life expectancy of 68.9 years compared to 76.6 years for females. In comparison, non-Aboriginal Canadians’ life expectancies in 2001 were longer by 8.1 years for males and 5.5 years for females.^*
• The infant mortality rate among First Nations in 2000 was 6.4 deaths per 1,000 live births, compared to the Canadian infant mortality rate of 5.5.^*
• The tuberculosis rate among First Nations people is 6.2 times higher than in the general population. ^*
• Diabetes is 2.7 times more prevalent among First Nations than in the general population.^*
• First Nations peoples on reserves have reported rates of heart diseases 16% higher than the general population.