Inequality Is Literally Killing Us: The Most Unequal Societies Suffer Most In Public Health Metrics

Oleh Admin 28 Nov, 2022 Posting Komentar

In 1992, the British Medical Journal published a post by Richard Wilkinson showing simple graphs of life expectancy in nine rich countries in 1981 and the percentage of income received by the poorest 70% of households in each country. It shows how much inequality within a country is related to lower life expectancy, with a weak correlation between national income and mortality. Rich countries are not healthier than rich countries, at least among developed countries. Increases in income inequality over time are associated with higher death rates. But are the results valid?

This is a shaky way of making claims based on a study as conclusive evidence. Knowledge is driven by conjecture, critical comment, debate, and general acceptance or rejection. However, five previous studies beginning in 1979 showed similar results. In 1996, two studies from the University of California and Harvard reported similar results in the United States: states with greater inequality had higher death rates. A subsequent study found similar results in major US cities.

Even small increases in inequality lead to significant increases in deaths from COVID-19.

That same year, Wilkinson's seminal book Unhealthy Societies: The Problem of Inequality was published, outlining these ideas. My highly commented copy reflects the importance of this book as an important step in recognizing the impact of the social environment on health, recently highlighting the important role social policy plays in human survival during COVID-19. Similar studies have linked US state and county death rates from COVID-19 to income inequality. The first paper found that more unequal states had higher COVID-19 death rates. In June 2021, a study found that income inequality was highest in US states with the highest rates of covid-19 cases and deaths.

While the British media detailed the study with an article in The Economist in July 2021 , most of the US media remained silent. A subsequent study in 84 countries found that more deaths from COVID-19 were associated with growing economic inequality. Even small increases in inequality lead to significant increases in deaths from COVID-19.

Income inequality has widened, providing more damning evidence that the epidemic is killing. However, correlation does not imply causation. How do we know that something caused something else?

The 1964 US Surgeon General's report, Smoking and Health , set out the criteria for concluding that something, in this case smoking, causes something, in this case a decline in health. The criteria are correct. First, there must be multiple studies by different researchers showing relationships with different populations at different time periods. So you have to deal with the chicken and egg problem: do people start smoking and then their health deteriorates, or is it the other way around: their health deteriorates and they start smoking? Third, is there a good explanation for the association? Finally, is there a biological possibility, namely the mechanism by which smoking worsens health?

In 1964 we had conclusive evidence that all these conditions were met because tobacco is harmful to health. Today, with the same criteria, we can say that demographic inequality leads to poor health.

Evidence for a link between higher economic inequality and poorer health depends on several factors. Income inequality requires a threshold: it must be greater than a certain order of magnitude before the association is recognized. For relatively equal countries, the health implications are less clear. There may be a gap between rising income inequality and related health outcomes. For small geographic groups, such as small neighborhoods, people tend to live within their own species, so inequality and health tend not to be related there. However, science shows that the difference is detrimental to health.

Richard Wilkinson brought the field of health disparities to academic prominence after his work in 1992. Working with Kate Pickett, they wrote The Spirit Level: Why Greater Equality Makes Societies Stronger in 2009, a popular book linking many social and health issues. health with income inequality in 23 rich countries. Kill the difference. They find that the United States has the highest income inequality and the worst score on the index. This important book has been translated into many languages and has sold over a million copies.

We are moving towards increasingly centralized political power as we all face an epidemic of powerlessness.

In their book Social Inequality, Harvard University professors Ichiro Kawachi and SV Subramanian address the health of income inequality by presenting three main arguments. First, there are "lower pensions" for health care as income increases. The second effect of inequality is its psychosocial impact, suggesting that inequality leads to stress and depression, which in turn leads to poorer health. Third, discrimination has a context effect. The rich increasingly control the political process and enjoy favorable policies at the expense of others. We're going to try it.

low returns

Rich people have better health than poor people, as measured by mortality. However, the income of, say, the very rich does little or nothing to improve health, while adding this amount to the income of the poor has important health benefits. This relationship is seen in almost all societies.

psychosocial consequences

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Its second link is the psychosocial stress due to the difference. People may have enough resources to meet their basic needs, including food, water, shelter, and general security, but may not have enough resources to maintain the more prosperous lifestyles they see enjoyed by others. Due to the huge income and wealth gap, they realize what they don't have and compete for higher levels. Such an unbalanced society generates stress and depression. We recognize the need to be "nice" to our managers if we want to keep our jobs or look good in society.

Status anxiety, an inevitable consequence of income inequality, is found at all income levels. Very rich people often don't want to talk about their wealth. In her book Uneasy Street: The Anxieties of Affluence, Rachel Sherman points out that many wealthy people don't realize that they are more than the middle class, trapped by multiple homes and wealth. Although they are objectively very rich, they think that those who have more than they are "rich".

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Where income disparities are low, the situation is less worrisome. In one survey, respondents were asked to agree or disagree with the statement, "Some people look down on me because of my employment status or income." Those in more unequal societies, at any income level, fear the state more than those in less equal societies.

The difference also applies to self-medication with drugs. Three quarters of global opioid use occurs in the United States, where we have the highest rates of use. Opioid overdose deaths have risen faster here since 1994 than in other wealthy countries. Could the high use of opioids here reflect growing inequality and fear of the state? Research shows that frequent drug use, including opioids, cocaine, amphetamines, marijuana, and ecstasy, is higher in the most diverse countries, and that more drug-related deaths occur in the most diverse states of the world. USA.

The effects of contextual differences: the politics of wealth control

Large income gaps separate beneficiaries from the rest of society. This is called the alienation of the rich. Consider the lifestyles of those at the top of the unequal distribution of wealth, called the one percent. It's really 0.1% or 0.01%. They live in gated communities, send their children to private schools, and work as domestics cleaning, gardening, and preparing food. They enjoy personal security services and medical attention from doctors and other service personnel at their disposal. Because they pay for these services with a higher income, they see much less need to help others. They often say, "We work hard to pay for this benefit ourselves, so why should we help others who don't?" Basically, they are cut off from the rest of society.

Most rich people like less government intervention, less regulation, lower taxes, and letting the so-called free market dictate what society is like. While some of us work for wages or salary, the rich get most of their income from what economists call rent or unearned income, like investing in real estate or stocks so they don't have to show up for work.

We are moving towards increasingly centralized political power as we all face an epidemic of powerlessness. Government funding for education is being cut, public school standards are falling, and students are borrowing heavily to earn their bachelor's degrees. Public transport and other social services have been weakened. The decline of roads, bridges, and transportation systems, especially compared to other rich countries, shows the decline of infrastructure here. Stories of American bridges and houses collapsing due to delayed maintenance, or reports of sloppy or delayed structural engineering are other examples of the contextual effects of inequality. Access to health services is considered a privilege, not a human right as in many other countries. As the poor are powerless and the rich gain power, social relations in general become healthier.

Providing healthcare for all is necessary, but it is only the first step. We can achieve truly healthy societies with little redistribution from rich to poor. In times of great inequality, we can easily afford it.

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