Fall 2006

Better Health Through Fairer Wealth

by Brydie Ragan

Research now tells us that lower socio-economic status may be more 
harmful to health than risky personal habits...

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 

"<>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 equality.

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.