I am frustated by the fact America talks about health care but doesn't have a dialogue about the things that make nation healthy. Maybe it's because things like health equity and social justice are anti-American values and communist? Nothing could further from the truth. I don’t know if Congress has been paying attention but in April of 2010 many retired military commanders referred to our epidemic of childhood obesity as a national security threat. Nothing has changed in our health or food policies. Movies like Food Inc. and King Corn have raised social awareness of what's going on in food supply but nothing has changed much. Michelle Obama says things must happen from the grassroots up. Does the information get to the grassroots to create the fertile ground needed for change? Not at present.
Look at the CDC maps on obesity. It would hard for Republicans to say they care about the health of Americans with such statistics glaring at them. But when you break it down into counties as the USDA Food Environment Atlas has something more important emerges. Poverty, stress and inequities emerge as factors in the obesity epidemic. Look at the county/town (featured on Jamie Oliver's television show "Food Revolution") Huntington, West Virginia. The White House's "Let's Move" campaign asked people: in the Federal Register: "What makes towns Huntington, West Virginia stand out? Poverty? Yes. Stress? Watch the movie "We are Marshall" and ask yourself about the question of stress. If you answered yes what do you think Sept. 11th 2001 would will do? It is hard to tell.
The Califoria Newsreel documentary Unnatural causes in it's discussion guide bring up these ten things about health not often discussed:
- Health is more than health care. Doctors treat us when we are ill but what makes us healthy or sick in the first place? Research shows that social conditions- the jobs we do the money we’re paid, the schools we attend, the neighborhood we live in are as important to our health as our genes, our behavior and medical care.
- Health is tied to distribution of resources. The single strongest predictor of our health is our position on the class pyramid. Whether measured by income schooling or occupation, those at top have the most power and resources and on average live longer and healthier lives. Those at the bottom are most disempowered and get sicker and die younger. On average people in the middle are twice as likely to die early death compared than those at the top those on bottom four as likely. Even among people who smoke poor smokers have a greater risk of premature death than rich ones.
- Racism imposes an added health burden. Past and present discrimination in housing, jobs and education means that today people of color are more likely to be lower on the class ladder. But even at the same level, African Americans typically have worse health and die sooner than their white counterparts. In many cases, so do other populations of color. Segregation, social exclusion, encounters with prejudice, people’s degree of hope optimism access and treatment by the health care system – all of these can impact health.
- The choices we make are shaped by the choices we have. Individual behaviors- smoking, diet, drinking and exercise- do matter for health. But making good choices isn’t about self discipline. Some neighborhoods have easy access to fresh affordable produce others have only fast food, liquor joints and convenience stores. Some have nice homes clean parks, safe places to exercise and play and well financed schools offering gym, art, music and after school programs; others don’t. What government and corporate practices can better ensure healthy spaces and places for everyone?
- High demand + low control = chronic stress. It’s not CEO dying of heart attacks, it’s subordinates. People at the top certainly face pressure but they are more likely to have the power and resources to manage those pressures. The lower in the pecking order we are the greater our exposure to forces that can upset our lives – e.g. insecure and low paying jobs, uncontrolled debt, capricious supervisors, unreliable transportation, poor child care, lack of health insurance, noisy and violent living conditions – and less we have access to money, power, knowledge and social connections that help us cope and gain control over those forces
- Chronic stress can deadly. Exposure to fear and uncertainty trigger a stress response. Our bodies go on the alert: the heart beats faster blood pressure rises, glucose floods the bloodstream – all so we can hit harder or run faster until the threat passes. But when threats are constant and unrelenting our physiological systems don’t return to normal. Like gunning the engine of a car, this constant of arousal even at low level, wears down our bodies over time increasing our risk for disease.
- Inequality – economic and political -is bad for our health. The United States has far the most inequality in the industrialized world – and the worst health. The top 1% now owns more wealth than the bottom 90% combined. Tax breaks for the rich, cuts in social programs destabilize communities and channel, wealth, power and health to the few at the expense of the many. Economic inequality in the U.S. is now greater than at any time since the 1920s.
- Social policy is health policy. Average U.S. life expectancy increased 30 years during the 20th century. Researchers attribute much of that increase not to drugs or medical technologies but to social reforms; fro example improved wages and work standards, sanitation, universal schooling and civil rights laws. Social measures like living wage jobs, paid sick and family leave, guarantee vacations, universal preschool and access to college and guaranteed health care can further extend our lives by improving them. These are as much health issues as diet, smoking and exercise.
- Health inequities are neither natural nor inevitable. Inequities in health – arising form racial and class based inequities – are the result of decision that we as a society have made. Thus we can make them differently. Other industrialized nations already have, in two important ways; they make sure there’s less inequality (e.g. in Sweden the relative child poverty rate is 4%, compared to 21% in the U.S.) and they enact policies that protect from health threats regardless of personal resources (e.g., good schools and health care are available to everyone, not just the affluent). As a result, on average citizens of those countries live healthier longer lives than we do.
- We all pay the price for poor health. It’s not only the poor but also the middle classes whose health is suffering. We already spend $2 trillion a year to patch up our bodies, more than twice per person than the average rich country spends, and our health care system is strained to the breaking point. Yet our life expectancy is 29th in the world, infant mortality 30th, and lost productivity due to illness costs businesses more than $1 trillion a year. As a society, we face a choice: invest in the conditions that can improve health today, or pay to repair the bodies tomorrow.
Sir Richard Wilkinson and Kate Pickett authors of Spirit Level explain why inequality harms human health and offer some explanations (one being the epigenes). For more on epigenes watch BBC Horizon's Ghost In Your Genes.
All diseases are genetic/environmental intreactions. As a former boss of mine once put it: All diseases are sexually transmitted. I thought about it and she was right.
Obesity is going a very difficult fight. Much harder than Michelle Obama's "Let's Move" campaign sugggests because of what the National Academy of Science calls America 's weight loss stuggle:
"a continuous lifelong struggle with no expectation that the struggle required will diminish with time."
The science of epigenetics and effect of the health inequities and stress on our epigenome will change our society like the 1854 London cholera epidemic changed modern society. I don't know if it will be for better or worse. I hope for better but I emotionally prepare for the worst.
People have to have a dialogue and subsequent debate about health and health care. The national debate about health is not over. In fact it has not even begun. It is an important issue because it is a fight for our future and the kind world we want our children to go up in.