The Democrats have gone AWOL on the biggest health issue of our time. Thirty years of scientific research have shown that the most powerful predictor of human disease is economic inequality. But the Democrats have been mysteriously silent on this issue.
Reducing inequality is not about class warfare -- it is about keeping people alive and healthy, including middle-income people and the working poor. At a time when the U.S. is spending 16% of gross domestic product (GDP) on health care -- nearly $2 trillion per year -- you'd think the Democrats would be looking for ways to improve health, reduce medical costs, and appeal to voters at the same time. Reducing inequality could do all three.
This is not a new story. The New York Times reported June 1, 1999, "Scientists have known for decades that poverty translates into higher rates of illness and mortality. But an explosion of research is demonstrating that social class -- as measured not just by income but also by education and other markers of relative status -- is one of the most powerful predictors of health, more powerful than genetics, exposure to carcinogens, even smoking.
Did you get that? Back in 1999, an "explosion of research" was showing that, where your health is concerned, inequality is more important that smoking. Many studies since 1999 have confirmed and reconfirmed this finding.
Back in 1996, when the prestigious British Medical Journal (BMJ) began reporting the pernicious effects of inequality on health, they called it "The Big Idea." The BMJ editors wrote,
"Big ideas are exciting. Politicians are constantly searching for them and usually failing to find any. Every scientist would like to discover one, and scientific journals love them as well. Big ideas don't often arise, but the BMJ has been associated with several -- and one of them is explored further this week.... The big idea is that what matters in determining mortality and health in a society is less the overall wealth of that society and more how evenly wealth is distributed. The more equally wealth is distributed the better the health of that society. One political implication, appealing to those on the left, is that the best way to improve health in a society might be to take measures to distribute wealth as equally as possible. Such measures would be more likely to be effective than measures that increased overall wealth but also increased inequalities -- exactly the measures advocated over the past 10-20 years in Britain, the United States, and many other countries."
The New York Times summarized it this way: "What matters is not simply whether a person is rich or poor, college educated or not. Rather, risk for a wide variety of illnesses, including cardiovascular disease, diabetes, arthritis, infant mortality, many infectious diseases and some types of cancer, varies with relative wealth or poverty: the higher the rung on the socioeconomic ladder, the lower the risk."
It isn't the absolute level of well-being that matters so much as the relative level. Even among the well-to-do, those higher on the social scale are healthier. As the Times put it, current research is showing that a mid-level executive in a three-bedroom home in Scarsdale, N.Y. is more vulnerable to illness than his boss who lives in a 5-bedroom home a few blocks away.
No one is yet sure how all the parts of this idea fit together. A sense of control of one's life is a key part of it. Stress is another. Social exclusion and residential segregation -- especially by race but also by class -- both have important negative impacts. A sense of opportunity, dignity, self-esteem, the respect of others -- all these are important for health. Social cohesion -- a sense of neighborliness -- also plays a role: people live longer in places where they believe they can trust their neighbors.
As Harvard economist Juliet Schor has said, "The reasons may not turn out to be so very complicated. Humans are social. We judge our own situations very much in comparison to others around us. It is not surprising that people experience less stress, more peace of mind, and feel happier in an environment with more social cohesion and more equality."
If relative standing in the community is what matters most in protecting public health, then the U.S. has been headed in the wrong direction for 20 years. Inequality has been increasing for 20 years, and not by accident. Public policies have created a conveyor belt moving money from the pockets of the middle-class and the working poor into the wallets of the super-rich. Of course under the current administration the growth of inequality has accelerated.
What we have here is a powerful bridging idea that connects our health with the fundamental American values of fairness, compassion, community and responsibility. Economic inequality is as bad for our health as it is for our democracy. You don't have to be a brain surgeon to see that we now have irrefutable arguments, grounded in science, for taxing the super-rich, preserving the middle class, abolishing poverty and protecting local economies from the "gales of creative destruction" brought on by globalization. Reducing gross disparities in income and wealth is simply the most efficient way to improve the nation's health. It also might be a good way for Democrats to distinguish themselves from Republicans and get back to winning some elections.