Is Inequality Making Us Sick?

This is a followup to my post - Life Expectancy Inequality Growing - and the PBS show I mentioned: Unnatural Causes: Is Inequality Making Us Sick? The short answer is yes. I watched the show last night and found it interesting and surprising. It discussed how class, race, genes, housing and other factors affect our health, but I found the segment discussing the biology of stress and our ability to control our own destiny the most interesting.

Here's an excerpt from the show's transcript:

S. LEONARD SYME (Epidemiologist, UC Berkeley): We know that social class is the most important determinant of health above any other risk factor. But what does social class mean? Is it housing, or medical care? Education?

NARRATOR: Or is it power? Confidence? A sense of security?

SYME: Which one of those is most important? Hopeless, they’re all inextricably intertwined, can’t take them apart. So it’s really a challenge.

NARRATOR: But how do we carry social class in our bodies? How does it get under our skin?

SYME: As you go through the alternative explanations, the one that seemed most impressive to me was this idea of control of destiny. I don’t like that word. What I mean by it is the ability to influence the events that impinge on your life, even if it means not doing anything, but one way or the other, managing those pressures.

MICHAEL MARMOT: There’re all sorts of ways we’ve devised for depriving people of a sense of control over their lives. Living in a community where it’s not safe to go out.

ITON: Middle class families having to work two jobs. Middle class families not being able to spend time with their kids.

MARMOT: Being relatively poor, having job insecurity. All of those things will decrease control over people’s lives, and all of those things are likely to increase risk of illness. And there are good biological reasons why that might be the case.

NARRATOR: When we feel threatened or don’t have control in our lives, one critical biological reaction kicks in: the stress response. When the brain perceives and threat, it signals the adrenal glands to release potent stress hormones. Among them, cortisol. They flood your bloodstream with glucose, increase your heart rate, raise blood pressure… They put your body on alert.

Researchers studied the cortisol levels of blue collar workers all the way up to CEOs and discovered the CEOs had virtually no cortisol in their bloodstreams compared to lower income workers. The study showed "the more education you have, the less cortisol you release during the day. The more income you have, the less cortisol you release during the day."

Bottom line: Higher status, less stress. Less stress, better immune function. That translates into better health and a longer life. In fact, one startling fact they mentioned concerned cigarette smokers: High income, professional workers that smoke have less likelihood of dying from cancer than low income, blue collar workers that smoke.

The show discussed much more than I've mentioned here so read the transcript or watch the show online. (This is segment one of four.) What they concluded we need to do to improve the health inequalities in our country may surprise you because they're non-medical things like a more equal distribution of wealth in our society, better education for people, and better housing - areas where other industrialized nations are head and shoulders above us.

Those countries have found ways to break the tight linkage between income and wealth and health. And they invest in better education systems, housing support, childcare, access to recreation. They subsidize through tax policy, mechanisms that break that strong relationship. Those countries where wealth is more equitably distributed are healthier.

There's no good reason we can't be that kind of country. We just need to find the will.

(Also posted at Blogging for Michigan.)