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The Health of Nations: Inequality, Stress and Dissatisfaction

Stephen Bezruchka wrote an article in Sunday's Seattle Post-Intelligencer noting the higher average health found in nations with more egalitarian distributions of wealth.  The article, "Economic equality is best medicine" bore the subtitle "Health of societies mostly relies on political and economic policies, not the individual treatment of disease."  Bezruchka notes that Japan has the highest rate of male smokers of any wealthy country, and yet also has the highest average health, based on statistics collected in the Human Development Report from the United Nations Development Programme.  The United States, despite being the world's wealthiest country, is not even close to being the world's healthiest country, on any of the metrics in the report (e.g., it ranks 29th in life expectancy, just ahead of Cuba). 

The distribution of wealth in a country is a challenging thing to measure.  A recent Guardian article, Wake Up: The American Dream is Over (found via Bridging the Income Gap), reports that the richest quintile (top fifth) of Americans have incomes 9.3 times higher than the poorest quintile, up from a multiple of 6.8 25 years ago, and that a higher proportion of Americans (12.7%, or 37 million) are living in poverty than the citizens of any other developed country.  A Wikipedia entry with a List of Countries by Income Equality shows that Japan ranks second in income equality (after Denmark), with a richest to poorest quintile multiple of only 3.4, whereas the United States ranks 92nd (out of 122).

Of course, a correlation between two factors does not necessarily entail a causal connection.  Bezurchka speculates on how and why large disparities in income may diminish the average health of a population:

Intuitively, we can see that not everyone shares the same stress in a bigger-gap society and those lower down suffer more of the slings and arrows of misfortune rained down from above. There is less caring and sharing in society when the gap is in our face.

Another study, "Economic inequality, working-class power, social capital, and cause-specific mortality in wealthy countries" corroborates this correlation ... and much to my surprise, finds a weaker correlation between another difficult to measure concept, social capital, and population health.

Bezruchka suggests that in our quest for better health in this country, we have been asking the wrong people the wrong question.  Invoking the wisdom of Mark Twain -- "It is very difficult to get people to understand something when their salary depends on their not understanding it" (an observation also made by Al Gore in An Inconvenient Truth, in analyzing why we're not making [more] progress on recognizing and reversing global warming trends) -- he recommends that if we want to address the question of "What makes a healthy society?", we focus our attention on politics and economics: "Economic justice is the medicine we need".  Of course, in a country where recent polls show that 68% of the people support a repeal of the estate tax, which only affects the wealthiest 2% of Americans, this may be very tough medicine to swallow.

I find this poll result counterintuitive -- why would so many people be against a policy that would benefit them?  I wonder if many people (66%) are consciously or unconsciously thinking that someday they may be in the wealthiest top 2%, and thus wouldn't want their future estates to be subject to additional taxes.  This reminds me of some of the observations made by Daniel Gilbert in Stumbling on Happiness, regarding our generally poor ability to project into the future.  It may also illuminate one of the sources of stress that Bezruchka intuits: dissatisfaction, i.e., many of us are stressed out because where we are (financially) so far short of where we want to be.  This, in turn, reminds me of one of the questions raised by Oriah Mountain Dreamer in the prelude to her book, The Dance:

What if the question is not why am I so infrequently the person I really want to be, but why do I so infrequently want to be the person I really am?

Interestingly, although much of the analysis and recommendations for addressing income inequality may seem rather socialistic, Chapter 4 of the UN report is about "International Trade: Unlocking the Potential for Human Development", which brings to [my] mind Adam Smith's Wealth of Nations:

Adam Smith railed against [the] restrictive, regulated, 'mercantilist' system, and showed convincingly how the principles of free trade, competition, and choice would spur economic development, reduce poverty, and precipitate the social and moral improvement of humankind. To illustrate his concepts, he scoured the world for examples that remain just as vivid today: from the diamond mines of Golconda to the price of Chinese silver in Peru; from the fisheries of Holland to the plight of Irish prostitutes in London. And so persuasive were his arguments that they not only provided the world with a new understanding of the wealth-creating process; they laid the intellectual foundation for the great era of free trade and economic expansion that dominated the Nineteenth Century.

So perhaps what we need is an intellectual foundation, perhaps a manifesto, that would promote free trade, competition, and choice for both the creation and distribution of wealth, one that would take into account the modern, technologically-enhanced means of production and [thus] focus more on networks than hierarchies.

Speaking of which, I just picked up The Wealth of Networks: How Social Production Transforms Markets and Freedom, by Yochai Benkler ... which I believe may represent just such a manifesto, laying down a new intellectual foundation for a new era of free trade among small parts loosely joined.  I haven't read the book yet, but was inspired and intrigued by an earlier, shorter, paper on the topic, Coase's Penguin, or Linux and the Nature of the Firm, which lays out a framework for "commons-based peer-production".  I'm sure I'll have more to say about this in the future.

Circling back to the topic that got me started, the health of nations: on Dr. Bezruchka's Population Health Forum page, he lists six actions people can take to support better health through better political and economic equality:

  1. Fight for JUSTICE to reduce the gap between rich and poor. Being active as a public citizen is good for your health.
  2. Advocate for CHILD-SUPPORTIVE ENVIRONMENTS where children get love, care, and opportunities to develop. Ways of becoming involved center around acting to promote true family values.
  3. Promote SPIRITUAL AND SOCIAL CONNECTIONS in your community. Know and share with your neighbors. Communities where people trust and help one another are healthier than places with less cooperation.
  4. Work to increase WOMEN’S STATUS AND OPPORTUNITIES in society. Where women’s status is higher, everyone’s health is better. When women have a larger role in society, it’s good for all of us.
  5. Strive to end stressful, low-paid WORK. A sense of control and a decent workplace go along with the right to have a union and a commitment to end discrimination at work. We must improve working conditions for everyone.
  6. JOIN the POPULATION HEALTH FORUM. Subscribe to our listserv, join us at our meetings, and consider organizing chapters in your communities. We want to hear your ideas for making the world a healthier place!

Sounds like a good prescription to me!

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