That conclusion doesnâ€™t come from some left-wing Frenchman or Russian commie or pinko Canadian â€” it is the logical inference of a recent Forbes magazine article. In â€œWhy the Rich Live Longerâ€ Dan Seligman provides â€œa stunning new explanation for upscale longevity;â€ wealthier people live longer because they have higher IQs â€” this according to research by a
Of course Seligman doesnâ€™t draw the conclusion himself, but since the life expectancy of the
â€œThe traditional answerâ€, according to Seligman, â€œhas been that greater wealth and social status mean greater access to medical care.â€ Responding to his â€œtraditional answerâ€ Seligman notes; â€œIf 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 Britainâ€™s National Health Service and Americaâ€™s Medicare and Medicaid, not to mention employer-sponsored health insurance.â€ Yet â€œthe gap widened in both
What gives? Obviously not Seligmanâ€™s â€œtraditional answer.â€ The notion that curative medicine (i.e. sick care) â€“ what Medicaid and the NHS mostly provide â€“ is the leading source of improved life expectancy doesnâ€™t withstand scrutiny. While estimates on the issue vary, health â€˜expertsâ€™ 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 â€œ86 per-cent of increased life expectancy was due to decreases in infectious diseases. The same can be said for the
The idea that curative medicine has a great capacity to improve/maintain health is something propagated by the bio medical establishment â€“ traditionally dominated by doctors though increasingly influenced by drug and medical apparatus companies â€“ and supported by the broader capitalist class which prefers to focus on genetics, drugs, individual choice, doctor care etcâ€¦ not on industrial pollutants, workplace health and safety, corporations pushing unhealthy products etc. Curative medicine can and often does save peopleâ€™s lives. Still, curative medicine has not and likely wonâ€™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 doesnâ€™t matter to Seligman who is trapped within the curative medicine paradigm. He claims that an important reason for poorer people â€“ those with a lower IQ, which according to Seligman â€œpowerfully influences where people end up in life.â€ â€“ having a reduced life expectancy is their inability to take medicine properly. (Honestly, Iâ€™m not making this up.) Seligman proclaims: â€œOne reason for the failure of broad-based access [NHS, Medicaid, etcâ€¦] 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. â€œMore than half of the 1.8 billion prescriptions issued annually in the U.S. are taken incorrectlyâ€¦ 10% of all hospitalizations resulted from patientsâ€™ inability to manage their drug therapyâ€¦ almost 30% of patients were taking medications in ways that seriously threatened their healthâ€¦â€ And those poorer (low IQ) people are committing these mistakes since research shows â€œnoncompliance with doctorsâ€™ orders is demonstrably rampant in low-income clinics, reaching 60% in one cited studyâ€ and â€œin 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.â€ Of course he doesnâ€™t mention the mistake rate at wealthier peopleâ€™s clinics. And, if it is lower, he ignores the possibility it could have something to do with the time doctorsâ€™ 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 arenâ€™t of interest to Seligman. Instead weâ€™re left with the poor people are stupid option.
Not only does this stupidity lead to more medication errors, but poorer peopleâ€™s lower intelligence also results in worse personal health habits. According to an article Seligman cites, â€œfor better or worse, people are substantially their own primary health care providers. â€¦ 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 whatâ€™s going on.â€ That is in contrast to â€œthe 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.â€ (Ah, the good old days when the stupid commoners neednâ€™t involve themselves in health matters.)
But is it true that todayâ€™s illnesses are mostly the byproduct of poor individual health choice? What about the environment?
Thereâ€™s a slew of evidence linking chemical exposure to cancer. The Toronto Star reports â€œthat five air pollutants contribute to about 1,700 premature deaths and 6,000 hospital admissions in the city every year.â€ (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 peopleâ€™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 â€“ largely derived from thankless work and low pay â€“ is glossed over by Seligman. Even though it is, by his own admission, the â€œstandard answerâ€ given by â€œthe WHO and other large health bureaucracies.â€ â€œThe argument is that low status translates into insecurity, stress and anxiety, all of which increases susceptibility to disease.â€
Seligmanâ€™s not convinced. He has two objections. First, â€œwe 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.â€ 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.
Seligmanâ€™s main problem isnâ€™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.
Seligmanâ€™s second objection is â€œthe notoriously high rate of smoking in the low-status population.â€ While smoking is a major health hazard â€“ more severe than had been accepted as the U.S Surgeon General recently pointed out â€” it does not adequately explain the health gap between poorer and wealthier people. As Dr. Stephen Bezruchka from the
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 peopleâ€™s health and quality of life.
â€œStudies 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 polesâ€”the corporate class and the chronically unemployedâ€”is ten years. This average distance in the European Union is seven years. In the
â€œSocial 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
â€œWhy? The answer is simple. It is more difficult to be a poor person in the
â€œIn 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
So, there you have it, two possible explanations for the relatively low life expectancy of
â€œWhy the Rich Live Longerâ€ can be read at: http://www.forbes.com/forbes/2004/0607/113_print.html [email protected]