Only the Poor Die Young? Long-Term Solutions for a Sick Country
“Do we not always find the diseases of the populace traceable to defects in society?”, asked Rudolf Virchow, the 19th century physician and polymath who is widely credited with being one of the earliest medical scholars to acknowledge the link between socioeconomic marginalization and disease. In different societiesthroughout history, such societal “defects,” including poverty, have long contributedto disease and shorter life spans.
More disturbing is that our own society is no exception.
In a recent studywe published in the American Journal of Public Health, we set out to tally the number of deaths in a single yearfrom the combined effects of social problems like low high school graduation rates, racial segregation, individual and neighborhood poverty, weak socialsupport, and income inequality.
The results werealarming. For example, we found that dropping out of high school wasresponsible for 245,000 deaths in the year 2000more than the number of deathsby heart attack. We also found that weak social support took as many lives aslung cancer and that racial segregation killed the same number of people asstroke.
The relationshipis clear: poverty and socioeconomic exclusion really can kill you.
What۪s themechanism behind this relationship? Lack of access to information and resources.The poor, uneducated, and marginalized are often unable to access knowledgeabout protecting themselves from disease. Even when they do have the rightinformation, they may not have the resources to put it to use.
The epidemic of typeII diabetes in the South Bronx, where nearly one in five has the disease, is anillustrative example. Type II diabetes is particularly common among low-incomeAfrican American women who have not completed high school. Surveys suggest thatwomen in this demographic are largely unaware of how proper nutrition can lowertheir risk of diabetes. Unfortunately, even with appropriate education, theSouth Bronx is a “food desert”, meaning it has few outlets that sell highquality, nutritious foods.
These and other examples suggest that, sadly, it is not surprising that the poor die young. Infact, it is all too common.
What is surprising is the lack of a meaningful response, and that the sheer scale of the problemhas gone largely unrecognized. We hope our findings can help turn the tide, butit۪s important to recognize that awareness won۪t be enough. Deeper impediments toinvesting in social welfare remain.
First, our national health paradigm is dominated by the “biomedical” model of disease.What this means is that we tend to invest in the biology of a problem, focusingon characterizing genetic determinants and biochemical pathways to developdrugs to treat disorders.
Instead, we need to invest more in prevention, by addressing such disease-contributing factorsas dirty water, overcrowding, poor food quality, or disproportionate exposureto stress-inducing circumstances.
Second, our bureaucraticinstitutions – like departments of health or social welfare – are builtnarrowly around particular policy concerns. This poses a challenge because itlimits their ability to address root causes. Many of society۪s mostmarginalized face challenges that cross silos (for example, they are poor andthey require health services).
Despite theintersections that color the lives of the people these institutions serve,human services departments often face disincentives to collaborate. In manyplaces, health and welfare agencies directly compete for funds, and may feel theyhave little incentive to acknowledge the substantial overlap in theirresponsibilities for fear of jeopardizing access to short-term funding.
These short-termfunding cycles create their own set of challenges. Addressing the socialdeterminants of poor health is not a short term-commitment. Data suggest thatimproving the health of an impoverished neighborhood through investments insocial welfare can take generations.