Status, Health And Stupidity

U.S. residents are dumber than people living in every other industrialized nation.


  That conclusion doesn’t come from some left-wing Frenchman or Russian commie or pinko Canadian — it is the logical inference of a recent Forbes magazine article.  In “Why the Rich Live Longer” Dan Seligman provides “a stunning new explanation for upscale longevity;” wealthier people live longer because they have higher IQs — this according to research by a U.S. sociologist and British psychologist summarized by Seligman for Forbes’ (well-to-do) readers.


Of course Seligman doesn’t draw the conclusion himself, but since the life expectancy of the USA is right near the bottom of the list of industrialized countries that must mean American citizens have the lowest average IQ. The argument that the poor die younger because of their own failings is not new. Ideologues of wealth have been making similar arguments for hundreds if not thousands of years. Still, Seligman’s article is revealing for its thinking regarding the importance of curative medicine, personal health habits and maybe most significantly the stress of low status jobs, all of which is meant to divert attention from the health effects of inequality. Seligman begins with an important question. “Why is it that, all around the world, those with more income, education and high-status jobs score higher on various measures of health?” Or as the World Health Organization puts it: “People further down the social ladder usually run at least twice the risk of serious illness and premature death of those near the top.”


“The traditional answer”, according to Seligman, “has been that greater wealth and social status mean greater access to medical care.” Responding to his “traditional answer” Seligman notes; “If access was the key, then one would have expected the health gap between upper and lower classes to shrink or disappear with the advent of programs like Britain’s National Health Service and America’s Medicare and Medicaid, not to mention employer-sponsored health insurance.” Yet “the gap widened in both Britain and America as these programs took effect.”


What gives? Obviously not Seligman’s “traditional answer.” The notion that curative medicine (i.e. sick care) – what Medicaid and the NHS mostly provide – is the leading source of improved life expectancy doesn’t withstand scrutiny. While estimates on the issue vary, health ‘experts’ agree that the majority of life expectancy improvements over the past century are the result of public health promotion not curative medicine. At one end of the spectrum, Laurie Garrett in the Betrayal of Trust estimates that “86 per-cent of increased life expectancy was due to decreases in infectious diseases. The same can be said for the United States, where less than 4 percent of the total improvement in life expectancy since the 1700s can be credited to twentieth century advances in medical care.” Others disagree with her strong enthusiasm for public health promotion. Nevertheless, there is a general agreement that prevention is what works, even today with all our high technology medicine.


The idea that curative medicine has a great capacity to improve/maintain health is something propagated by the bio medical establishment – traditionally dominated by doctors though increasingly influenced by drug and medical apparatus companies – and supported by the broader capitalist class which prefers to focus on genetics, drugs, individual choice, doctor care etc… not on industrial pollutants, workplace health and safety, corporations pushing unhealthy products etc. Curative medicine can and often does save people’s lives. Still, curative medicine has not and likely won’t, in the near future at least, lead to significant health and longevity benefits amongst entire populations. This is the reason why the advent of Medicaid and the NHS has not affected the life expectancy gap between wealthier (higher status) and poorer (lower status) people.


This doesn’t matter to Seligman who is trapped within the curative medicine paradigm. He claims that an important reason for poorer people – those with a lower IQ, which according to Seligman “powerfully influences where people end up in life.”  – having a reduced life expectancy is their inability to take medicine properly. (Honestly, I’m not making this up.) Seligman proclaims: “One reason for the failure of broad-based access [NHS, Medicaid, etc…] to reduce the health gap is that low-IQ patients use their access inefficiently. He cites a slew of statistics showing the prevalence of health mistakes. “More than half of the 1.8 billion prescriptions issued annually in the U.S. are taken incorrectly… 10% of all hospitalizations resulted from patients’ inability to manage their drug therapy… almost 30% of patients were taking medications in ways that seriously threatened their health…” And those poorer (low IQ) people are committing these mistakes since research shows “noncompliance with doctors’ orders is demonstrably rampant in low-income clinics, reaching 60% in one cited study” and “in two urban hospitals, 42% did not understand the instructions for taking medicine on an empty stomach, and 26% did not understand when the next appointment was scheduled.”  Of course he doesn’t mention the mistake rate at wealthier people’s clinics. And, if it is lower, he ignores the possibility it could have something to do with the time doctors’ spend with rich patients or their attitude towards their patients of their own or higher class. Or how about factoring in language? Since recent immigrants tend to be poorer, perhaps not understanding English could have something to do with these sorts of errors? These questions aren’t of interest to Seligman. Instead we’re left with the poor people are stupid option.


Not only does this stupidity lead to more medication errors, but poorer people’s lower intelligence also results in worse personal health habits. According to an article Seligman cites, “for better or worse, people are substantially their own primary health care providers. … Today the major threats to health are chronic diseases–which, inescapably, require patients to participate in the treatment, which means in turn that they need to understand what’s going on.” That is in contrast to “the past [when] big gains in health and longevity were associated with improvements in public sanitation, immunization and other initiatives not requiring decisions by ordinary citizens.” (Ah, the good old days when the stupid commoners needn’t involve themselves in health matters.)


But is it true that today’s illnesses are mostly the byproduct of poor individual health choice? What about the environment?


There’s a slew of evidence linking chemical exposure to cancer. The Toronto Star reports “that five air pollutants contribute to about 1,700 premature deaths and 6,000 hospital admissions in the city every year.” (July 8th 2004) Asthma rates among children are often higher in poorer and minority communities due to increased traffic pollutants. The obesity epidemic, which is linked to many major modern illnesses, is largely social in character and strongly linked with being poor. Rapid increases in belt sizes over the past quarter century are best explained by looking at changes in urban planning, moves towards sedentary work and increases in junk food advertising and serving size. Poor people’s higher rates of obesity are best understood in the context of inequities in access to wholesome food stores, less money to spend on healthier foods, the use of TV as a babysitter and entertainment, and the craving for high fat food induced by stress. (To read more on obesity: http://zmagsite.zmag.org/Dec2003/engler1203.html)


The issue of stress and more specifically the stress of low status – largely derived from thankless work and low pay – is glossed over by Seligman. Even though it is, by his own admission, the “standard answer” given by “the WHO and other large health bureaucracies.” “The argument is that low status translates into insecurity, stress and anxiety, all of which increases susceptibility to disease.”


Seligman’s not convinced. He has two objections. First, “we lack serious comparative data on tension and anxiety levels in low- and high-status jobs. It is far from clear that barbers, elevator operators and lower-level civil servants suffer more tension than do surgeons, executive vice presidents and higher-level civil servants.” In fact, it is very clear from numerous studies which jobs produce the most stress. They are high demand, low control jobs which are predominantly at the middle and lower ends of the pay scale.


Seligman’s main problem isn’t the lack of data, but rather capitalist mythology supported by his bosses at Forbes. Unequal compensation is justified by claims that well paid jobs are more stressful than lower paid work. The CEO who pains over decisions that impact the entire company or doctors performing stressful operations are common images. Rarely does the stress of impolite customers or of a society that degrades your occupation garner attention. In short, the continuous stress of low status work is more hazardous than any tensions of higher status work.


Seligman’s second objection is “the notoriously high rate of smoking in the low-status population.” While smoking is a major health hazard – more severe than had been accepted as the U.S Surgeon General recently pointed out — it does not adequately explain the health gap between poorer and wealthier people. As Dr. Stephen Bezruchka from the University of Washington explains: “Japanese men smoke the most of all rich countries. Yet they are the healthiest population on the planet. It seems you can smoke in Japan and get away with it. It’s not that smoking is good for you, but that compared to other things, it isn’t that bad. Smoking is much worse for you in the U.S. than it is for the Japanese in Japan, where the gap between the rich and poor is much less… Similarly, it isn’t Japan’s health care system that is responsible for its remarkable health. Anyone who has looked at their system will tell you it isn’t much to write home about…Japan is a caring and sharing society that looks after everyone and that matters most for your health.”  (http://www.zmag.org/content/showarticle.cfm?SectionID=10&ItemID=4647)


In Inequalities Are Unhealthy Vicente Navarro, professor at the Johns Hopkins Bloomberg School of Public Health and editor-in-chief of the International Journal of Health Services explains the effects very well:  â€œInequality is in itself bad, i.e., the distance among social groups and individuals and the lack of social cohesion that this distance creates is bad for people’s health and quality of life.


“Studies performed among civil servants in Great Britain have shown, for example, that life expectancy (the years that people can expect to live) among the top civil servants, grade 32, is longer than the life expectancy of civil servants of grade 31, who have longer life expectancy than civil servants of grade 30, and so on, reaching the lowest life expectancy at grade 1. There is no poverty among British civil servants, but there are significant differences in their life expectancies. The same finding has been replicated in other countries. In Spain, for example, we performed a similar study, looking at life expectancy by social class, and we found that the members of the bourgeoisie (the European term to define the corporate class) live an average of two years longer than the petit bourgeoisie (the term to define the upper middle class), who live two years longer than the middle class, who live two years longer than the skilled working class, who live two years longer than the members of the unskilled working class, who live two years longer than the unskilled working class that has been chronically unemployed. The difference between the two poles—the corporate class and the chronically unemployed—is ten years. This average distance in the European Union is seven years. In the United States, it is 14 years. …


“Social distance and how that distance is perceived by people, in addition to the lack of social cohesion that it produces, is at the root of the problem. This situation appears clearly when we compare the life expectancy of a poor person in the United States (who makes $12,000 a year) with the life expectancy of a middle-class person in Ghana. The poor person in the United States is likely to have more material resources than the middle-class person of Ghana (who makes the equivalent of $9,000). The U.S. resident may have a car, a TV set, a larger apartment and other amenities that the middle-class person in Ghana does not. As a matter of fact, if the world were considered a single society, then the poor in the United States would be a member of the worldwide middle class and the middle-class person of Ghana would be part of the worldwide poor—certainly poorer than the poor in the United States. And yet, I repeat, the poor citizen of the United States (although of the worldwide middle class) has a shorter life expectancy than the middle-class person (although of the worldwide poor) in Ghana (two years less, to be precise).


“Why? The answer is simple. It is more difficult to be a poor person in the United States than a middle-class person in Ghana. For the poor person in the United States, the worst component of his or her existence is not primarily the absence of material resources, but rather his or her social distance from the rest of society. He or she feels frustrated, a failure, unable to fulfill the expectation of becoming a successful member of the ‘mainstream’ and attaining its standard of living, which incidentally, for those depicted in the media as mainstream (and very much in particular in the broadcast industry), is higher than the national average… Moreover, the massive poverty that exists in terms of political and collective resources available to defend the interests of the majority of working people in the United States explains their enormous feeling of powerlessness and lack of social cohesion, both of which give rise to disease.


“In fact, we have found that countries with strong labor movements, with social democratic and socialist parties that have governed for long periods of time, and with strong unions (Sweden, for example), have developed stronger redistribution policies and inequality-reducing measures of a universalistic type (meaning that they affect all people) rather than antipoverty, means-tested, assistance types of programs. These worker-friendly countries consequently have better health indicators than those countries where labor movements are very weak, as is the case in the United States, a corporate-class-friendly country. The reason for this difference is that the sense of social cohesion is larger in the worker-friendly countries, the sense of power and participation is higher, and the feeling of social distance is smaller than in the corporate-class-friendly countries. The evidence for this conclusion is plainly overwhelming.” (http://www.monthlyreview.org/0604navarro.htm)


So, there you have it, two possible explanations for the relatively low life expectancy of U.S. citizens: The left wing says it mostly because of inequality; Forbes magazine says it’s because Americans are stupid.  You decide which is true.


“Why the Rich Live Longer” can be read at: http://www.forbes.com/forbes/2004/0607/113_print.html [email protected]



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