Essay: In Sickness and in Wealth – Is Inequality Making us Sick?

In last week’s class, we watched “In Sickness and in Wealth,” an episode from the California Newsreel documentary series Unnatural Causes: Is Inequality Making us Sick?” While discussing children and poverty, Jack P. Shonkoff, a paediatrician at Harvard Centre on the Developing Child, explained the concept of “pile-up risk”, which is “the cumulative burden of having things that are increasing your chances of having problems, as opposed to the cumulative protection of having things in your life that increase the likelihood that you can have better outcomes.” In essence, the pile up of risk factors during crucial developing years can translate into a weaker foundation for a child, such as a brain that’s experienced disruption or a threatened immune system. In addition, I watched  two other episodes in the series, “Bad Sugar” and “Collateral Damage.” Together, these three aimed to explore the connection between social inequalities and health inequalities.
The first episode, “In Sickness and in Wealth,” focused on the stories of individuals living in different sections of Louisville, where there seems to be significant differences in health statistics. The first individual interviewed was Jim Taylor, a CEO who lived a good life. He was part of the 1%, and as such, could afford to live in an affluent community and was relatively healthy. Then, the focus shifted and the narrator went on to discuss the Whitehall Studies, which found that the lower the grade of employment, the higher the risk of heart disease. A similar trend was also observed for every other major cause of death. Curious, they introduced the next individual, Tondra Young. Tonda works as a lab supervisor and described herself as financially comfortable, part of the middle class. She had actually went back to college while working full-time. And according to recent statistics, college grads typically live 2.5 years longer, on average) than high school graduates. Moving on to a different section in Louisville, they interviewed a man named Corey Anderson, who works full-time, along with his mother. Together, their combined salaries place them at the national median income. Corey was diagnosed with hypertension at 37 years old, making him part of the 33% of his district’s population with the same medical condition. Lastly, we met Mary Turner. Unemployed and living with three children and a disabled husband, Mary has to budget monthly food expenses to $200. From my own experience, my roommate and I usually spend $100 on groceries each week. I imagine that a majority of the food Mary buys are processed and prepared meals, contributing to an unhealthy diet. An interesting reasoning for the health inequalities involved stress response. Basically, they rationalized that systems working overtime, which tends to happen in low-income families and jobs requiring manual labor, produce too much cortisol. This leads to impaired immune function, and ultimately, diabetes, heart disease, and accelerated aging.
The second episode, “Bad Sugar,” focused on two American Indian Tribes, the Tohono O’odham and Pima, both of which suffer the highest rates of Type II diabetes in the world. Basically, half of the adults in the tribe have it. Interestingly, this is not an isolated case: Pacific Islanders, African Americans, and Aboriginal peoples in Australia all suffer from Type II diabetes at rates two times that of the national averages. What they all have in common, is that they have been dispossessed of their land and of their history, without the chance to  re-create it. For example, the Pimas’ livelihood greatly depends on the water from the Gila River. However, in the 1890s, the water was diverted by dams and water projects and given to the settlers, farmers, and ranchers. Without the water needed to grow crops and provide for themselves, the Pima people suffered. No water meant no crops, no work, and led to an economic decline. In response, they depended on US military distribution of free commodity foods, which introduced new foods into their diets (such as cheese, white flour, refined sugar, lard, and canned foods). Besides living below the poverty line, this diet change increased the risk of diabetes, heavily impacting the individuals’ lives and their healthcare. The loss of river water access led living conditions below the poverty line, diet changes that increased the risk of diabetes, and loss of their identity, raising stress levels. As discussed before, high stress levels lead to overproduction of glucose that builds up in the bloodstream and can lead to diabetes.
The third episode, “Collateral Damage,” focused on the Marshallese people of Ebeye. In 1944, the U.S. gained control of the islands, which they held until the late-1970s. However, they retained control of Kwajalein, which is the location of the Ronald Reagan Ballistic Missile base. There were very obvious differences in the lifestyle and economic conditions between the two populations. More densely populated than Manhattan, the island of Ebeye was often subject to power outages and water shortages. Sometimes, there was not enough clean water for laundry and they had to ferry to the other island to wash their clothes. There were also no private restrooms, just public stalls assigned to families, where they had to go home to wash their hands. In addition, there was a high instance of tuberculosis among the people. This stems from the 67 nuclear devices that were detonated on and around the northernmost Marshall Islands between 1946 and 1958, which were still inhabitied by many people. As a result, many were resettled onto different islands for studying the effects of nuclear fallout on human beings, tearing apart the Marshallese culture. And even though there was a significant population of Marshallese people who immigrated to Springdale, Arkansas, where jobs are plentiful and cost of living is relatively low, tuberculosis rates were still high. This demonstrates how the effects of having lived in poverty, massive dislocation and cultural disruption can remain and transcend generations.
As Troutman poignantly stated: “The bigger issues are the social conditions that drive the ultimate health status of populations…Power is a public health issue.”