by Susan Rosenthal
The latest report by the Commonwealth Fund confirms what we already know; Americans pay more for health care and have poorer health compared with people living in nations that spend less on health care yet enjoy better health.
It is generally assumed that lack of access to medical care is to blame for America’s abysmal health statistics and that improved access will remedy the situation. This is mistaken. Lack of access is just one indicator of the social inequality that is driving America’s health crisis.
The myth that good health is a product of the health-care system was fueled by the expansion of the welfare state after World War II. The establishment of the British National Health Service (NHS) in 1948 was accompanied by better health and a reduction in the difference in death rates between the social classes.
Politicians claimed that the NHS had produced these benefits, but later studies revealed that population health improves with a rise in the general standard of living and a reduction in class inequality, as occurred in Britain after the war.
To investigate the link between health and inequality, researchers examined workers in the highly stratified British civil service. Despite all the subjects enjoying decent pay and equal access to medical care, the risk of illness and premature death increased as one moved down the social hierarchy. These health differences were significant and could not be accounted for by differences in smoking, diet or exercise.
Inequality is not only an independent factor in determining health, it is the most important factor. As inequality increases, health deteriorates. This holds true for everyone living in an unequal society, not just those on the short end of the stick.
A study published in 1998 compared income inequality with death rates in 282 American cities. Greater inequality was associated with higher death rates at all income levels. Areas with the greatest inequality suffered 140 additional deaths for every 100,000 people per year compared to areas with the lowest inequality. The difference in death rates was comparable to the loss of life from lung cancer, diabetes, motor vehicle crashes, HIV infection, suicide and homicide combined.
Inequality in the U.S. has grown steadily since the 1970s, when Corporate America pushed to raise productivity by driving down workers’ living standards. As corporate profits increased, health deteriorated, and poverty epidemics like HIV/AIDS and tuberculosis emerged in the world’s richest nation.
The U.S. has the worst health statistics in the industrialized world because it is the most unequal society in the industrialized world.
The accumulation of profit at the top of society creates an accumulation of sickness at the bottom. No form of health-care system can reverse the health-damaging effects of class inequality.
Next week, I will explain how the fight for equal rights is the key to winning better health and a universal health-care system.
For more on this subject, read POWER and Powerlessness. Available at www.powerandpowerlessness.com