Tuesday, May 30, 2006

Does capitalism kill?

A while back a series of studies reported that socio-economic status is related to health and mortality rates. The first of these actually came as a surprise to people--it concerned coronary heart disease, and until that time people thought heart attacks were an ailment of the workaholic corporate executive set. Nowadays, we take the connection between poverty and health for granted, though even so, the raw data is pretty sobering. Here's researcher Michael Marmot, in a JAMA article from this past March that I can't show you because of copyright laws, summarizing findings by these researchers:
[W]hen traveling along the distance of nearly 12 miles on the Washington, DC, Metro from downtown to Montgomery County, Maryland, life expectancy of the local population segment rises about a year and a half for each mile traveled. Poor black men at one end of the journey have a life expectancy of 57 years, and rich white men at the other end have a life expectancy of 76.7 years.
That's a shocking gap between the ends of the spectrum. The other notable thing, however, is the continuum he describes in-between. As the suburbs get more and more affluent, life expectancy goes up--there's a social gradient in health. So being able to afford healthcare certainly has something to do with it, but it's also a lot more complicated than that, because the uber-rich appear to be healthier than the just plain rich. The current prevailing explanation is that the psychological changes associated with these smaller steps up the status ladder--things like sense of autonomy and social influence--affect human biology. This interpretation seems to have been solidified by a recent study which indicated that subjective social status is actually a better predictor of health outcomes than is objective social status. Finally, quite logically, the researchers report that the steeper the income gradient within a country, the steeper the gradient in health outcomes. So, while the effect still exists as nations veer closer to welfare-state status, it's less marked. You can imagine where that leaves us in the United States. Get rich. Or die trying.


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