From: Kathryn Aegis (aegis@igc.apc.org)
Date: Mon Aug 17 1998 - 18:11:59 MDT
DEADLY DISPARITIES: AMERICANS' WIDENING GAP IN INCOMES MAY BE NARROWING OUR
LIFESPANS
By James Lardner
Washington Post
Sunday, August 16, 1998; Page C01 (Outlook Section)
Americans are famous for not getting too excited about differences in income
or wealth, but we have outdone ourselves lately. Since the 1970s, virtually
all our income gains have gone to the highest-earning 20 percent of our
households, producing inequality greater than at any time since the 1930s,
and greater than in any of the world's other rich nations (and many of its
poor ones) today. Bill Gates alone is wealthier than half the American
people put together, and from the halls of the Federal Reserve Board on down
to your corner tavern, economic pundits treat the issue as a regrettable
footnote in the glowing story of world-beating job creation, soaring
corporate profits and all-but-invisible inflation.
Now comes a new point to consider. Arriving at the question from a variety
of angles and disciplines, researchers in the United States, Canada and
Britain have found evidence that more unequal societies are more
unhealthy--not just in some highfalutin moral sense but in the plain old
medical sense, and not just for the poor (as anyone would suspect) but for
the bulk of the population. To put it more baldly, if you live in a place
where differences in income and wealth are unusually large (the United
States, for example), your chances of escaping chronic illness and reaching
a ripe old age are significantly worse than if you live in a place where
differences are
not as large (Sweden, for example).
In the scheme of risk factors, moreover, we are talking about one as
dangerous as cigarettes, fatty foods or any of the other health habits that
we periodically work ourselves into tizzies over.
An inkling of this came, two decades ago, from a study of 17,000 British
civil servants. Surprisingly, the annual heart-attack fatality rate among
clerks and messengers was four times what it was among administrators. (So
much for the idea of executive stress as a big contributor to heart
disease.) Even at the bottom of the ladder, these were office workers with
the means to feed and house themselves decently and with access to
high-quality national health care. In any case, differences in rank proved
to be just as eerily accurate a guide to heart-attack rates at the top of
the ladder (a senior assistant statistician was twice as vulnerable as a
chief statistician), and a similar pattern held for cancer and other
diseases that might have been assumed to choose their victims more randomly.
After weeding out such obvious explanations as class-related differences in
smoking and diet, Michael Marmot, an epidemiologist at the University of
London, began to suspect that intangible issues such as job control and
sense of security--the sheer experience of rank, in other words--might be
involved. Looking down from a higher statistical altitude, Richard
Wilkinson, an economic historian at Sussex University, had a similar
insight. Wilkinson's focus was the health differences among, rather than
within, nations; here, standard of living--such a sure-fire yardstick of
individual health in the Whitehall study--became, oddly, almost a nonfactor.
As long as per-capita gross domestic product exceeded about $5,000,
Wilkinson found, Nation A (the United States, for example) could have twice
the per-capita income of Nation B (Greece, for example) and still lag in
life expectancy. By contrast, Wilkinson's data suggested that equality of
income was a very reliable predictor of health. This was an idea that, like
the key piece in a jigsaw puzzle, simply looked right the instant it fell in
place. In fact, it seemed to solve a number of puzzles at once:
* The greatest gains in British life expectancy (among the civilian
population, that is) came during the two world wars, which were accompanied
by a dramatic compression of incomes and a powerful national reaction
against class.<p>
* The Japanese, well-known for the relatively small gap between the
earnings of their top executives and ordinary workers, are the world's
longest-lived people. Japanese men, who are twice as likely to smoke as
American men, not only live longer but, remarkably, have lower rates of lung
cancer.
* In Eastern Europe and the nations of the former Soviet Union, where the
last decade has brought spectacular economic gains to a relative handful and
a deterioration of living standards to many, average life expectancy has
actually been falling--a phenomenon almost without precedent in the 20th
century.
* Of the developed nations, Britain and the United States have, by most
reckonings, the most inequality and the worst life expectancy. The contrast
with Japan is particularly striking because unlike, say, Sweden, it has a
low tax burden and a low rate of spending on health care. Yet the 3.6-year
gap in life expectancy between the United States and Japan (76.2 and 79.8
years, respectively) is equal to the gain we would realize if heart attacks
vanished as a cause of death.
As interesting as these comparisons are, though, some of the strongest
evidence involves U.S. states, cities and counties, which offer the
advantages of comparable data and a largely shared culture. In the July
issue of the American Journal of Public Health, a team of researchers led by
John Lynch and George Kaplan of the University of Michigan describe a study
of 282 metropolitan areas, finding, as Wilkinson did, that mortality rates
are considerably more closely linked to relative than to absolute income.
What do Biloxi, Miss., Las Cruces, N.M., and Steubenville, Ohio, have in
common? High inequality, high mortality. Allentown, Pa., Pittsfield, Mass.,
and Milwaukee, Wis.? Low inequality, low mortality.
Ichiro Kawachi and Bruce Kennedy of the Harvard School of Public Health have
used domestic data to explore the thesis that much of inequality's influence
on health may be due to an erosion of trust or, to use a term coined by the
sociologist James Coleman, "social capital." Kawachi and Kennedy have come
up with ways of measuring these variables, which turn out to be closely
related to inequality and, at the same time, to a city's or state's death
rate from a wide range of causes.
They also point to the Brigadoon-like story of Roseto, Pa., an Italian
American town whose inhabitants smoked heavily and cooked with lard but
nonetheless had an unusually low incidence of heart attack. Alighting on
Roseto in the 1950s, the physician-sociologist team of Stewart Wolf and J.G.
Bruhn traced its good health to a conspicuously old-fashioned immigrant
culture and closeness. By the '60s, however, they began to see younger
Rosetans adopting the more individualistic ways of the wider world--for
example, building terraces in back of their houses rather than porches in
front. Within another decade, Roseto's heart-attack fatality rate was as high
as that of neighboring towns.
As bizarre as some of these ideas may sound in the context of modern
medicine, they sit well with an array of recent discoveries about how
psychosocial forces affect physical health.
Social isolation or lack of friends, for example, accounted in one study of
a group of coronary patients for a threefold difference in survival rate
after three years; in another study, for a fourfold difference in the rate
at which otherwise healthy research subjects got sick after being exposed to
cold viruses.
Nor are the biological pathways that could explain such things beyond
comprehension. Working with wild baboons in the Serengeti, Robert M.
Sapolsky, a Stanford University neurobiologist, has found that animals lower
down in the tribal hierarchy tend to resort habitually to the kind of
hormonal mobilization that, in higher-status animals, is reserved for
emergencies. Over time, escalated levels of cortisol and other
stress-related hormones become the norm; the hippocampus gland (important to
learning and memory) shrinks, and disproportionately many animals succumb to
cancer, brain damage or stroke.
In a laboratory setting, Carol Shively, a psychologist at Wake Forest
University, has taken Sapolsky's work a scary step farther, manipulating the
status of macaques by bumping them from one social group to another. The
results, for monkeys who go from dominant to subordinate, include an
accelerated pulse and the buildup of fat in the arteries.
For all the questions that remain to be sorted out (assuming they ever are),
it is hard not to see in this body of research a cellular-level glimpse of
truths that have lain in the realm of intuition and parable: the idea, for
example, that when a society creates steep discrepancies in income and
wealth, it excites a preoccupation with material pleasures, money and
status, and aggravates feelings of anxiety and inferiority that (it is all
too accurate to say) eat away at people. These feelings "are so
fundamental," Wilkinson observes, that "it is reasonable to wonder whether
the effects on the quality of life are not more important than the effects
on the length of life."
Wilkinson's emphasis on the psychosocial dimension of inequality has been a
point of disagreement between him and others in the field who argue that
material considerations and access to social services may, in fact, play a
large role, especially when, as Clyde Hertzman of the Canadian Institute for
Advanced Research observes, one includes the latent effects of
income-related differences in prenatal care and parenting.
Whatever the balance of factors, however, it ought to be clear that these
problems won't be solved with a little 1960s-style income redistribution.
They involve the ways in which we distribute money (and power and status) in
the first place, and, that being so, call for a basic change of thinking on
the part of society, corporate chieftains included. And trailing just a
millisecond behind that thought is this one: sure, in a million years.
But consider, for a moment, the slender basis for much of what we currently
accept as economic gospel. Communism collapses, and the most timid forms of
social planning are seen as a first step down the road to the gulag. Western
Europe falters, and we are ready to throw a century's worth of social
welfare measures in the trash. The American economy goes into high gear for
a few years, and the idea of corporate executives who earn hundreds of times
as much as their
employees becomes a law of nature. Indeed, the confidence with which eternal
verities are thrown around by experts, and accepted by masses of people, in
the capital- and market-driven part of the world these days recalls nothing
so much as the Soviet Union a generation or two ago. This dogma too shall
pass, and we will all be better off.
James Lardner writes about business and technology for U.S. News and World
Report.
Copyright 1998 The Washington Post Company
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