Wealth vs. Health

Knox County Health Department public information series asks: Are the wealthier healthier?

Although the United States has the second highest Gross Domestic Product per capita in the world and its citizens spend more on health expenditures than residents of any other country, 28 other nations have higher life expectancy rates at birth. According to the U.S. Census Bureau, 47 million Americans were uninsured in 2006. The highest uninsured rates were among blacks and Hispanics, with 20 percent of African Americans and 34 percent of Hispanics lacking health insurance.

About 30 health care professionals and interested citizens gathered on a recent Wednesday at the Knox County Health Department to learn these and other facts about American health care in an ongoing documentary and discussion series “Unnatural Causes …  Is inequality making us sick?”

The series began June 25 and is presented every Wednesday from noon to 1 p.m. through August 13 at the health department. Public health educator Carlos Yunsan says the community is invited to participate to learn more about disparities in health care coverage among members of various incomes and backgrounds and the services provided locally to combat them.

“We would like to raise awareness that even the neighborhood we live in can affect our health as mush as smoking, poor diet, not exercising or the latest virus we hear about,” Yunsan says.

The health department series examines the various degrees of life expectancy based on the location in which a person lives, how social circumstances of employment and residency affect biology and how health care coverage in the United States compares to other countries around the world.

When told that Japan has both higher smoking rates and a higher life expectancy than the United States, one participant said focus on the individual can detract from the wellness of larger society.

“Certain members of my family have the idea of individual and competition,” she says. “In Japan, things are done as a group. There is a great deal of judgment and shame if you demand for yourself and are taking away from the group. People who think in this model know that you can actually multiply on our resources by contributing … [This] might be what Japanese culture has over us.”

The first film and discussion meeting June 25 followed four individuals in Louisville, Ky., to highlight the affect of their various communities on their daily health.

The availability of food choices, exercise options and public safety revealed that wealthier residents had easier access to fresh fruits and nutritious vegetables and meats and had lower stress levels because they owned vehicles to travel to work and recreation.

Members of the middle class were shown to possess some of these resources, but still exhibited higher stress due to increased debt-to-income ratios related to higher education expenses and work demands, leading to a lower life expectancy for members of this income bracket.

“Twenty-five years ago American life expectancy was much higher than it is today,” says Yunsan. “I don’t know why that is. Policies or the absence of them, what role do they play?”

The film shows the working poor typically live paycheck to paycheck. Many may not own a vehicle and dependence on public transportation increases the commute to and from work, limiting time available for recreational opportunities.

A tight budget can lead to nutrition problems related to diet limitations and a lack of access to healthier options. Many in this income bracket earn just enough to meet basic needs like rent and electricity, but remain ineligible for public assistance. Economic constraints raise stress levels higher than members of the upper and middle class, lowering life expectancy even further. The situation can become even more dire for people who are elderly, disabled or unemployed, with higher stress levels due to lack of income, transportation issues and public safety concerns.     

Those gathered to learn about the socioeconomic effect on our health expressed surprise at information on varying life expectancies, smoking rates and health coverage around the world.