Is Inequality Making us Sick?
A ground-breaking series recently featured on PBS
A statement from the Executive Producer
LARRY ADELMAN
Series Executive Producer & Co-Director of California Newsreel
It often appears that we Americans are obsessed with health. Media outlets trumpet the latest gene and drug discoveries, dietary supplements line shelf after shelf in the supermarket and a multi-billion dollar industry of magazines, videos and spas sells healthy "lifestyles." We spend more than twice what the average rich country spends per person on medical care.
Yet we have among the worst disease outcomes of any industrialized nation - and the greatest health inequities. It's not just the poor who are sick. Even the middle classes die, on average, almost three years sooner than the rich.
At every step down the socio-economic ladder, African Americans, Native Americans and Pacific Islanders often fare worse than their white counterparts. Interestingly, that’s not the case for most new groups of immigrants of color. Recent Latino immigrants, for example, though typically poorer than the average American, have better health. But the longer they live here, the more their health advantage erodes.
Our international health status has fallen radically in the last few decades. In 1980, we ranked 14th in life expectancy; by 2007, we had fallen to 29th. Our infant mortality rate lags behind 30 other countries. And illness now costs American business more than $1 trillion a year in lost productivity.
Healthy behaviors, molecular research, and of course, universal health care are all important. But evidence suggests they miss the most vital factor of all: how the social circumstances in which we are born, live and work can get under our skin and disrupt our biology as surely as germs and viruses.
We produced UNNATURAL CAUSES to draw attention to the root causes of health and illness and to help reframe the debate about health in America. Economic and racial inequality are not abstract concepts but hospitalize and kill even more people than cigarettes. The wages and benefits we're paid, the neighborhoods we live in, the schools we attend, our access to resources and even our tax policies are health issues every bit as critical as diet, smoking and exercise.
The unequal distribution of these social conditions - and their health consequences - are not natural or inevitable. They are the result of choices that we as a community, as states, and as a nation have made, and can make differently. Other nations already have, and they live longer, healthier lives as a result.
We hope that UNNATURAL CAUSES and its companion tools will help you work towards better health by bringing into view how economic justice, racial equality and caring communities may be the best medicines of all.
Larry Adelman
Executive Producer
March 2008
| A 5-minute clip that introduces the major themes of the series.
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| Episode 1- In Sickness and in Wealth | |
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The U.S. is one of the richest countries in the world, yet we rank 29th for life expectancy. We spent more than twice what other countries spend per capita on health care. Why aren't we healthier?
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Eboni Cochran and her neighbors in Louisville have organized to demand that chemical companies in their area do a better job of monitoring and containing hazardous materials that seep into the soil and air. Across the country, polluting industries are concentrated in communities where the poor and people of color live.
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| Episode 2- When the Bough Breaks | |
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When Atlanta lawyer Kim Anderson was pregnant with her first child, she did everything right: she ate a healthy diet, exercised, and got the best prenatal care. But her baby was born almost three months premature. This excerpt from When the Bough Breaks explores racism's impact on pregnancy outcomes.
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Neonatologists James Collins and Richard David specialize in the care of infants born too soon or too small. Their research on differences in birth outcomes between African American and white American women points to a provocative idea: the cumulative stress of racism is taking a toll on African American families even before they are born.
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UCLA obstetrician and gynecologist Dr. Michael Lu believes that for many women of color, racism over a life time, not just during the nine months of pregnancy, increases the risk of preterm delivery. To improve birth outcomes, Lu argues, we must address the conditions that impact women's health not just when they become pregnant but from childhood, adolescence and into adulthood.
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| Episode 3-Becoming American | |
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Recent Latino immigrants are healthier than the average American, despite being generally poorer. Researchers believe that some aspects of immigrant communities may protect health. But for Latinos, the longer they are here, the worse their health becomes. Why?
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| Episode 4- Bad Sugar | |
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The Tohono O'odham and Pima Indians of southern Arizona have perhaps the highest rate of diabetes in the world. Yet the disease was virtually unknown here 100 years ago. Over the last century, the diversion of river water to upstream white settlements cost the O'odham their crops, livelihood, traditional diet, culture and health. Today, community advocates hope that restoring water and renewing culture can help improve health.
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The Gila Crossing Elementary School in southern Arizona was once operated by the Bureau of Indian Affairs. When the local tribe took it over, community members created a gardening program to teach children about their cultural heritage as farmers, to encourage healthy eating, and to foster their development and future interest in agriculture.
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In some Native American communities, diabetes is so common that people grow up feeling that it is in some ways, inevitable. "I don't have diabetes yet," is what Dr. Warne often hears from his patients. Yet hope for the future is an important factor in preventing and controlling diabetes - something health care practitioners need to take into account when treating patients.
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The U.S. government has spent hundreds of millions of dollars over the past 40 years trying to uncover a biological explanation for why the Pima Indians of southern Arizona have one of the highest rates of diabetes in the world. But as Dr. Donald Warne tells us, diabetes was extremely rare here 100 years ago. What's changed? Not biology but environment.
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Competing agendas drive the distribution of resources when it comes to diabetes care and prevention. We spend most of our dollars on late-stage care, which not coincidentally is highly profitable to companies that provide those services. To reduce diabetes rates among Native Americans and other populations, we have to advocate for policies that will invest more resources in primary prevention and underlying social conditions.
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Historically, federal Indian policies have been destructive to Native American communities - ranging from removal to assimilation and termination. These policies have had a negative impact on health and health-related behaviors. More recent trends towards self-determination and tribal control provide reason to hope.
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Dr. Donald Warne talks about how cultural loss impacts the health of Native American tribes in Arizona. The damming of rivers plunged local tribes into poverty, dependence and ultimately poor health. Deprived of their language, land, livelihood and traditions, many Native Americans have developed a fatalistic view about diseases like diabetes.
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Dr. Donald Warne explains that Native Americans are the only U.S. group born with a legal right to health care. Historically, however, American Indian health care programs have been inadequately funded, especially compared with other federally subsidized health care.
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As Dr. Donald Warne explains, there is a direct biochemical connection between living in poverty and blood sugar levels. The stress of being poor and of having family members die young creates a complicated web of cultural values and beliefs that make controlling diabetes more difficult. Add to that the lack of availability of healthy food and it's no wonder diabetes rates are high.
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