Yes! Magazine  [Printer-friendly version]
October 15, 2006


[Rachel's introduction: Research now tells us that lower socio-
economic status may be more harmful to health than risky personal

By Brydie Ragan

[DHN editors' introduction: We have added some links within this story
to make it more informative for our readers.]

I recently saw a billboard for an employment service that said, "If
you think cigarette smoking is bad for your health, try a dead-end
job." This warning may not just be an advertising quip: public health
research now tells us that lower socio-economic status may be more
harmful to health than risky personal habits, such as smoking or
eating junk food.

In 1967, British epidemiologist Michael Marmot began to study the
relationship between poverty and health. He showed that each step up
or down the socio-economic ladder correlates with increasing or
decreasing health.

Over time, research linking health and wealth became more nuanced. It
turns out that "what matters in determining mortality and health in a
society is less the overall wealth of that society and more how evenly
wealth is distributed. The more equally wealth is distributed, the
better the health of that society," according to the editors of the
April 20, 1996 issue of the British Medical Journal. In that issue,
American epidemiologist George Kaplan and his colleagues showed that
the disparity of income in each of the individual U.S. states, rather
than the average income per state, predicted the death rate.

"The People's Epidemiologists," an article in the March/April 2006
issue of Harvard Magazine, takes the analysis a step further.
Fundamental social forces such as "poverty, discrimination, stressful
jobs, marketing-driven global food companies, substandard housing,
dangerous neighborhoods and so on" actually cause individuals to
become ill, according to the studies cited in the article. Nancy
Krieger, the epidemiologist featured in the article, has shown that
poverty and other social determinants are as formidable as hostile
microbes or personal habits when it comes to making us sick. This may
seem obvious, but it is a revolutionary idea: the public generally
believes that poor lifestyle choices, faulty genes, infectious agents,
and poisons are the major factors that give rise to illness.

Krieger is one of many prominent researchers making connections
between health and inequality. Michael Marmot recently explained in
his book, The Status Syndrome, that the experience of inequality
impacts health, making the perception of our place in the social
hierarchy an important factor. According to Harvard's Ichiro Kawachi,
the distribution of wealth in the United States has become an
"important public health problem." The claims of Kawachi and his
colleagues move public health firmly into the political arena, where
some people don't think it belongs. But the links between socio-
economic status and health are so compelling that public health
researchers are beginning to suggest economic and political remedies.

Richard Wilkinson, an epidemiologist at the University of Nottingham,
points out that we are not fated to live in stressful dominance
hierarchies that make us sick -- we can choose to create more
egalitarian societies. In his book, The Impact of Inequality,
Wilkinson suggests that employee ownership may provide a path toward
greater equality and consequently better health. The University of
Washington's Stephen Bezruchka, another leading researcher on status
and health, also reminds us that we can choose. He encourages us to
participate in our democracy to effect change. In a 2003 lecture he
said that "working together and organizing is our hope."

It is always true that we have choices, but some conditions embolden
us to create the future while others invite powerlessness. When it
comes to health care these days, Americans are reluctant to act
because we are full of fear. We are afraid: afraid because we have no
health care insurance, afraid of losing our health care insurance if
we have it, or afraid that the insurance we have will not cover our
health care expenses. But in the shadow of those fears is an even
greater fear -- the fear of poverty -- which can either cause or be
caused by illness.

In the United States we have all the resources we need to create a new
picture: an abundance of talent, ideas, intelligence, and material
wealth. We can decide to create a society that not only includes
guaranteed health care but also replaces our crushing climate of fear
with a creative culture of care. As Wilkinson and Bezruchka suggest,
we can choose to work for better health by working for greater


Brydie Ragan is an indefatigable advocate for guaranteed health care.
She travels nationwide to present "Share the Health," a program that
inspires Americans to envision health care for everyone.