Health Inequality

Over the past few years, renewed concern for health inequalities and the health of the poor has begun to produce important feelings and research. None more important than those raised by Dr. Adewale Troutman of Louisville, KY and his research conducted in the various community areas of his city. Dr. Troutman is the Director of Public Health and Wellness in Louisville. In this paper we will review some of the basic thought provoking ideas presented in Dr. Troutman’s research (Troutman, 2008) and the concepts of Unnatural Causes: Is Inequality Making us Sick? (California Newsreel, 2008)

There are three ideas to discuss. Health Inequalities or disparities which are empirically evident differences that exist across different social groups in a society. Among all inequalities there exist subsets of disparities that are avoidable and therefore unfair or inequitable. Health inequities are a subset of health inequalities or disparities involving circumstances that may be controlled by a policy, system, or institution so that the disparity is avoidable. These kinds of health disparities may include health and healthcare disparities. A society must use moral and ethical judgment to determine which inequalities are inequitable. And finally, Social Justice which is the fair distribution of society’s benefits, responsibilities and their consequences. It focuses on the relative position of one social group in relationship to others in society as well as on the root causes of disparities and what can be done to eliminate them.

Let’s consider some facts about health and societal environments and the United States as noted in Dr. Troutman’s findings.

According to Troutman (2008), “U.S. businesses lose more than $1 trillion dollars a year in productivity due to chronic illness. Per person, the United States spends more than twice the average of other industrialized countries on health care – 16% of our Gross Domestic Product (GDP) in 2006, yet we have the worst health outcomes; worse than 28 other countries in life expectancy (including Jordan) and 29 other countries in infant mortality (including Slovenia). The United States child poverty rate (21.9%) is five times that of Sweden (4.2%). It’s not surprising that, when it comes to social spending, the figures are reversed: Sweden allocates 18% of its GDP to social spending while the United States allocates only 4%.

Interestingly, it has been established that people in the highest income group are expected to live, on average, at least six and a half year longer than those in the lowest paying income groups. In fact, low income adults are 50% more likely to suffer heart disease than top earners. Those second from the top are almost 20% more likely to suffer than those at the top. (California Newsreel, 2008)

Children are also affected by these inequities in health care. Children living in poverty are about “seven times more likely to be in poor or fair health than children living in high income households. Middle class children are twice as likely to be in poor or fair health as those in the highest levels of income.” (California Newsreel, 2008)

Research also indicated that the “rates of illnesses for adults in the United States in their thirties and forties with low income and lower education were comparable to those of affluent adults in their sixties and seventies.” (California Newsreel, 2008)

Education can also be viewed as a contributor to health inequalities. There are those who have suggested that “college graduates can expect to live at least five years longer than those who have not finished high school and almost two years longer than those who didn’t finish college.” (California Newsreel, 2008) So the message through social circles is to stay in school and increase your health.

Incredibly, “low income smokers are more likely to become ill and die sooner from tobacco related diseases than smokers who are wealthy.”(California Newsreel, 2008) Does this mean the tar and nicotine recognize a smoker’s social status when it is inhaled and affects them in different ways? Where is the social justice in that? In fact when we look to figures from around the world, “Japanese smoke twice as much as Americans but still live four years longer, on average, than Americans do.”(California Newsreel, 2008) Again, is that social justice?

The United States has in comparison to all the rich countries of the world for which there is data:

the highest infant mortality rate; the highest homicide rate; the highest teenage birth rate; the highest incarceration rate (we house one fourth of the world’s prisoners); the highest child poverty rate; the highest child injury death rate; the greatest gap between high and low mortality