Poverty and racism are bad for your health

March 21, 2008

Helen Redmond looks at how inequality impacts our health.

UNNATURAL CAUSES...Is Inequality Making Us Sick? is a provocative and eye-opening new PBS documentary that provides irrefutable evidence that race and class impact health.

In a country that denies class exists and thinks racism is a thing of the past, Unnatural Causes is an important corrective. Even more controversial is the assertion that racism itself is the reason infant mortality rates among African Americans are twice as high as for white Americans.

The other central contention that anchors each of the four hour-long segments of this documentary is that a person's health cannot be separated from the environment they live in. A toxic mixture of poverty, pollution, poor education, substandard housing, lack of grocery stores, cheap fast food, violence and unemployment combine to make people sick.

This analysis is refreshing because it blames the economic system, capitalism, instead of individuals. The documentary provides a wealth of evidence that human health doesn't exist in a vacuum. Moreover, it confronts and demolishes the deeply ingrained, conservative notions of personal responsibility and bad choices.

The stories take the viewer from Louisville, Ky., to the Marshall Islands in the South Pacific, to Västervik, Sweden, and study how economic policy profoundly affects the health, hopes and lives of everyone. Sir Michael Marmot, who decades ago published the landmark Whitehall Studies showing that social class is the most important determinant of health, is interviewed throughout the documentary.

The first segment, "In Sickness and in Wealth," profiles three people who work at University Hospital in Louisville and backs up Marmot's findings. Jim Taylor, who is white and the CEO of the hospital, is in excellent health at age 60 and, like most CEOs, lives in luxury.

Tondra Young is Black and the supervisor of the blood lab. She considers herself middle class, owns a home and yet has accumulated massive educational debt. Tondra still worries about her future. Corey Anderson is a Black janitor, father of two children and has high blood pressure. He rents an apartment in a poor neighborhood where neighbors get strangled and shot to death.

Lastly, there is Mary Turner, a white 49-year-old woman who looks at least a decade older. She is an unemployed wife and mother of three teens, suffers from heart disease and arthritis. There is only $200 a month for food. She states, "You have to eat what fits your budget." At the end of the month, Mary cuts down to one meal a day so her children will have enough food.

In these interviews, we see how stress, control and hierarchy affect health. Marmot asserts that those in high-status jobs have less stress because they have more control at work and resources to manage stress. Less stress equals better health.

Most working-class people have more stress because they are deprived of a sense of control and autonomy in the workplace. And they don't have as many resources or time to reduce stress. When people are under stress the body releases a hormone called cortisol. Unremitting stress, which is a fact of daily life for the unemployed and the poor, leads to consistently high levels of cortisol and puts people at higher risk for diseases like diabetes, hypertension and heart disease.

THE SEGMENT "Not Just a Paycheck" dramatically illustrates the differences between two groups of workers--one in Greenville, Mich., the other in Västervik, Sweden, when Electrolux plants close down. Sandy Beck worked at the plant for 31 years and made $21 an hour with union benefits. Now she works at a fast-food restaurant and makes $7 an hour with no benefits. Her unemployment and severance pay are gone and she worries about paying the bills and losing her home.

At the Greenville hospital, there is a heartbreaking scene with laid-off worker Richard Ort, who worked for Electrolux for 38 years. The hospital social worker points out, "We are seeing a lot more walk-ins to the ER. People are just coming in and don't know how to cope with everything that is happening. They worry constantly about losing their house, health coverage, paying for medication, and having their things repossessed."

After the plant closed, hospital visits tripled as a result of an increase in domestic violence, alcohol abuse and depression.

In Sweden, laid-off Electrolux worker Peter Sternberg isn't worried at all. He's been studying philosophy and computers. He receives 80 percent of his salary as long as he studies or looks for work. His medical care is covered by the national health care system and he goes to college for free. Eighty percent of workers in Sweden are unionized.

The government and the metalworkers union that he is a member of negotiated a $3 million payment to the community from Electrolux for closing the plant. UAW Local 137 in Greenville got nothing when the company relocated to Juarez, Mexico, where Electrolux workers earn only $1.57 an hour.

Two other segments deal with environmental racism against indigenous peoples and the impact on their health. "Collateral Damage" examines the lives of Marshall Islanders in the South Pacific, whose health was damaged after the U.S. military exploded over 67 nuclear devices, raining down radioactive fallout on the islands.

Then, the military destroyed their culture by forcing the Marshallese to relocate to the island of Ebeye, where astronomically high rates of tuberculosis are fueled by poverty and squalid living conditions. There are regular power outages and no indoor plumbing in many homes.

"Bad Sugar" is about the Pima and Tohono O'odham Indians in Southern Arizona. These tribes have the highest rates of Type 2 diabetes in the world--half of all adults are diabetic. Terrol Dew Johnson, a Tohono Native American declares, "It's part of growing up."

But a century ago, the disease was unheard of. What happened? Powerful businesses and successive governments built dams diverting the Gila River to build cities like Phoenix and Scottsdale. The two tribes, who depended on water for farming, were sunk into poverty and despair--two of the most accurate predicators of disease.

Unnatural Causes is a timely, informative and passionately made documentary. It convincingly connects all the dots between health, race, class, economics and social policy and comes to the conclusion that capitalism is making us sick.

It's a documentary that will provoke anger, discussion, and debate. That's a good thing, because there are over 47 million uninsured in America and the crisis in health care is at the top of the domestic agenda.

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