Is inequality making us sick?

Health care doesn't affect what makes us ill in the first place
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OPINION The rich get richer, the poor get poorer, and the middle class gets squeezed. It's gone on so long, we hardly get angry anymore. But we do get sick.

Several recent studies indicate that the life expectancy gap between the most and least deprived Americans has widened since the early 1980s, paralleling the growing economic inequality during the same period. And, if the past is an accurate gauge, today's economic crisis will only make things worse.

The wealth-health gradient is evident everywhere, even here in San Francisco. According to the SF Department of Public Health, rates for congestive heart failure are 42 percent higher in the Sunset than St. Francis Wood/West Portal; 131 percent higher in Mission/Bernal Heights, and 279 percent higher in Bayview/Hunters Point.

Contrary to myth, it's not the CEOs who are dropping dead from heart attacks; it's their subordinates. And it's not violence or drugs that are the biggest killers in poor neighborhoods but chronic diseases.

Some point the finger at our broken health insurance system. But studies suggest medical care accounts for only about 15 percent of our health gap. That's because health care repairs our bodies when they break down; it doesn't affect what makes us sick in the first place.

What about making healthy choices? Don't the poor smoke more and eat unhealthy foods? True — it's hard to eat well if you live in a food desert like the Bayview, where there are no supermarkets. But even after correcting for individual behaviors, health inequalities remain. Poor smokers are more likely to get sick than rich smokers.

Many factors affecting health have little to do with individual behaviors. They include exposure to lead and other toxics; the quality of schools; the outsourcing of jobs; proximity of parks; the wages and benefits companies pay; exposure to discrimination; secure, quality housing; affordable preschool ... When these conditions are distributed unequally, so is our health.

A century ago, U.S. life expectancy was about 48 years. Much of the 30-year increase since is due not to new drugs or medical technologies, but to improved living conditions. The abolition of child labor, the eight-hour workday, housing and sanitation codes, and other reforms won working Americans a bigger share of our growing prosperity.

By 1976, thanks to civil rights, Medicare, and other progressive policies, economic inequality had reached a 20th century low. The health gap between rich and poor, as well as that between whites and African Americans narrowed between 1966 and 1980.

Then we reversed course. While most European countries were providing paid parental leave, universal preschool, four or more weeks of paid vacations, and guaranteed health care, the United States, starting with the Reagan administration, cut taxes on the rich, slashed social programs, and deregulated business and banking. Economic inequality in the U.S. is now greater than it's been since the 1920s. The consequence? The health gap is growing again too.

The wide class and racial inequities in the U.S. and the health inequalities they drive are not natural. They are the products of social policies that we as a society have made — and can make differently. We once did. Solutions lie not with new drugs or technologies, but our political priorities.

Larry Adelman is executive producer of the documentary series Unnatural Causes: Is Inequality Making Us Sick? (www.unnaturalcauses.org ) Find out more about the health of San Francisco neighborhoods at www.thehdmt.org and www.healthmattersinsf.org.