September 15, 2009

Inequality and health

Image courtesy of wikipedia.

Topics like economic inequality and health outcomes show up frequently in this blog, but lately I've been nudged into looking at the overlap between the two. In the public health field, a growing amount of attention has been paid to what is called the "social determinants of health," which kind of is what it sounds like.

A large body of scientific research has shown that how long we live and how well we are is influenced in no small degree by our social standing. It has long been known that life can be nasty brutish and short for the very poor, but the latest research shows that this applies all across the board.

This also means that negative health outcomes increase as inequality grows.

It's not all about money or education level, although they are a major part of it. As Michael Marmot put it in The Status Syndrome: How Social Standing Affects our Health and Longevity,

...for people above a certain threshold of material well-being, another kind of well-being is central. Autonomy--how much control you have over your life--and the opportunities you have for full social engagement and participation are crucial for health, well-being, and longevity. It is inequality in these that plays a big part in producing the social gradient and health. Degrees of control and participation underlie the status syndrome.

In our society, autonomy and participation are closely correlated with income and education. And, as I've written about many times before, one of the nastiest things about poverty is that it robs you of both. The interesting thing about the latest research is that it shows the effect of status on health at all levels of education and income. In other words, it's everybody's business.

More on this to come.

HOW DID I MISS THIS? Here's a major NY Times article about water quality that highlights mining's effect on health in West Virginia. And here's way more on the subject from Ken Ward's Coal Tattoo.

HEALTH CARE. One positive feature of proposed health care reform is an expansion of eligibility for Medicaid benefits, but the politics are complicated. And here is an op-ed by a friend about the public option.

UNEMPLOYMENT is up in El Cabrero's beloved state of West Virginia, but is still below the national average.

HEALTH ADVICE. Your mama got it right sometimes. Other times, not so much.


1 comment:

Rick said...

Thanks for posting this overview. While the social determinants of health may be intuitive to readers of this site, we need a broad, ongoing awareness campaign to challenge conventional wisdom that health = health care. Sites like are helping in this regard.

Our work in communities around the country also tells us that even when people initially grasp the idea of social determinants, it is much more difficult to sustain awareness in a way that leads to relevant action. There is progress, however, when communities come together to discover for themselves what really matters to health and what can be done together to improve it.

Rick Brush