The Health of Nations:Why Inequality Is Harmful to Your Health
The Health of Nations:Why Inequality Is Harmful to Your Health
Ichiro Kawachi and Bruce P.Kennedy
The New Press, New York.
Hardcover $25
95 I-56584-582
Inequality does far more harm than society is willing to acknowledge. This is the concept underlying a challenging book. Years of data accumulated and analyzed by two public health researchers from Harvard refute the conservatives' trickle-down theory of economic development, popularized in the phrase promoted by Reagan, "A rising tide raises all boats. " Many boats are sinking, as these two highly qualified professors point out.
Kawachi is Associate Professor of the Harvard School of Public Health, and Director of the Harvard Center for Society and Health; Kennedy is Assistant Professor at the Harvard School of Public Health. Kennedy and Karachi are recipients of the Robert Wood Johnson Investigation Awards in Health Policy Research.
These researchers maintain that the growing inequalities in the United States threaten what the benefits of economic development were supposed to produce---freedom from ill health, freedom from want, freedom for choice in life, and freedom to pursue leisure and happiness through personal and social relationships. In this wide-ranging book, health is viewed not only in terms of medical categories, but in terms of wellbeing and quality of life. All judgements are arrived at by fine-tuned statistical tools, used in the service of a larger context of values.
One rather startling illustration of the role played by inequality emerged in a study initiated by the Thatcher regime in the United Kingdom, intended to demonstrate that the National Health Service had diminished the gap in health between upper and lower incomes. In the Whitehall study of civil service ranking, a group where differences in culture are comparatively small, the results varied according to job classification. Everyone's health improved, but the higher job classifications improved more, and the gap actually widened.
Another equally surprising result of a statistical study in the United States was that very high salaries for individual American baseball players intended to motivate improved performance did not succeed. Actually it had the opposite effect, diminishing team morale, and ultimately audience support by the fans. Competition in this instance between team members, hindered rather than helped achievement of the original goal. Inequality did not improve the mental health of the team.
Finding statistical support for general principles in a field as diverse as public health is usually a very dificult task. This alone makes their results all the more impressive. A study of variations in premature death rates in relation to income inequality across the fifty US states shows that the lower the total income in the bottom half of the population is, in relation to the upper half, the worse the rates for overall mortality, and premature death from heart attack, cancer, murder and infant mortality. Comparing metropolitan areas all over the country, areas with high income inequality and low per capita income, with the opposite, low inequality and high per capita income, results in startling numbers-- a drop in mortality comparable in size to eliminating all deaths from lung cancer, diabetes, motor vehicle crashes, suicide, and homicide in this country. Reasoning from this, even a modest reduction in inequality could have an important effect on public health.
Social justice may be an arguable concept, but the numbers show that it matters!
Looked at intuitively by those who are statistical innocents, these results are confirmed by observation, and don’t seem after all to be so surprising. If you are an Asian-American woman living in Westchester, you can expect to live to 90.3. If you are an African-American male in the District of Columbia, your life expectancy is 57.9, lower than a male citizen of Ghana, Bangladesh, and Bolivia. It is less the fact of the difference than the degree that is so shocking, because it implies the severity of the problem.
Why is this happening? Karachi and Kennedy have many ideas of what constitutes the good life to be enjoyed as many as possible, and many observations of the disadvantages of an economy geared to competition and consumption--"keeping up with the Dow-Joneses" Their case is supported by many thinkers, the most famous being the Nobel Prize winning economist, Amartya Sen. This is a book which ties its facts together into a moral point of view. Conservatives will hate it, but it should be read by all who care about these issues, because they are affecting all of us.
Phyllis Ehrenfeld has received the Arnold Gingrich Award in prose for the most highly evaluated fellowship from the New Jersey State Council for the Arts. She has been Editor of the American Anorexia Bulima Associaton for many years. Several of her plays have been presented as staged readings in the Bergen County area. She is presently representative to the united Nations for the National Service Conference of the American Ethical Union.
The Health of Nations:Why Inequality Is Harmful to Your Health
Ichiro Kawachi and Bruce P.Kennedy
The New Press, New York.
Hardcover $25
95 I-56584-582
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