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Being Poor and Sick in the U.S.

Posted on | May 20, 2008 | No Comments

Health system reform for the “Two Americas”

Since I started medical school nearly 40 years ago, I’ve seen a lot of changes in health care. Not all of them have been for the better. A recent study by Dr. Majid Ezzati and colleagues at Harvard, for example, lays out some sobering facts about the inequities in our U.S. health care system. Dr. Ezzati’s key finding is that, while U.S. life expectancy is up for the country overall, the gap in health between rich and poor in America has widened over the last several decades. We appear to have two tiers of health – in essence, two Americas.

This newest report documents what global and national public health experts have been stating about American health care for more than a decade.

In 1999, the U.S. health care system received a shot across the bow from the World Health Organization, which ranked the United States a dismal 37th worldwide in the overall quality of its health care. One of the reasons for our low ranking is the disparity of health outcomes and access to care by class and race.

As stated by health policy experts Stephen Isaacs and Steven Schroeder in the New England Journal of Medicine in 2004, "Race and class are both independently associated with health status, although it is often difficult to disentangle the individual effects of the two factors."

A few simple numbers illustrate this point. Whites have a median net worth in the United States that is 10 times greater than blacks. While 11 percent of whites live below the poverty line, 27 percent of blacks struggle with poverty. The life expectancy of blacks is seven years less than that of whites. And blacks suffer higher rates of cardiovascular disease, diabetes, hypertension, infant mortalities, homicides, and a variety of cancers.

What contributes to the inequity more, race or class? Hard to say, but socioeconomic status, which is often a byproduct of racial discrimination, may be the dominant contributor to poor health. Factors previously associated with low socioeconomic status and poor health include poor nutrition, increased smoking, decreased exercise, increased stress and fear, unsafe neighborhoods with high crime levels, substandard housing, inaccessible and expensive services, environmental hazards, and poor schools.

The Harvard study above dramatically links health to poverty. With the 2008 election just around the corner, we need to remember John Edwards’ emphasis on "two Americas" and understand that we will not be able to successfully address health care in America without simultaneously addressing poverty.

To learn more, watch the video embedded with this blog post, or read the full transcript, below. Then share your thoughts on what you think we should do about our country’s growing health inequities.

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