Don Siegel
Thomas Jefferson wrote in our Declaration of Independence:
We hold these truths to be
self-evident, that all men are created equal, that they are endowed by their
Creator with certain unalienable Rights, that among these are Life, Liberty and
the Pursuit of Happiness.
While many have commented on or written about liberty and the pursuit of
happiness, not much has been written about life, in that most people understand that our government exists, at
least in theory, to protect it’s citizen’s rights, which, in turn, is a
surrogate for protecting their lives. Clearly, we have an extensive and
expensive aggregate of military forces, police forces, and undercover agencies that
do just that. But a new report[1]
from the Center on Society and Health at Virginia Commonwealth University (VCU),
makes one wonder whether the declaration’s guarantee of life, is really being protected. If everyone has the unalienable
right to life, then how do we explain
longevity differences in neighborhoods in New York City of 9 years, in Atlanta
of 13 years, and in Richmond Virginia of 20 years? While we know that “all men”
are really not created equal, longevity differences of these magnitudes suggest
systemic factors that clash with one’s inalienable right to life. That life expectancy is 63 years in Gilpin, a neighborhood in Richmond,
near the state capital of Virginia, and 83 years in Westover Hills, another
neighborhood, 5 miles away, should make us all wonder about what is going on.
I am not really asserting that the government is directly
responsible for these longevity disparities, but our socio-economic system, and
the environments that emerge from them are clearly involved with creating the
conditions that make living in a community more or less healthy. The VCU
project ties longevity to health, and health to income, asserting that “…the relationship between income and health
is a gradient: they are connected step-wise at every level of the economic
ladder. Middle-class Americans are healthier than those living in or near
poverty, but they are less healthy than the upper class. Even wealthy Americans
are less healthy than those Americans with higher incomes.”[2]
The following chart, pretty much, shows compelling data of this health gradient
for 12 different diseases or illnesses.[3]
Clearly, one needn’t be a statistician to conclude that family wealth is highly
correlated to health.
Not surprisingly, major risk factors also follow this pattern,
with data from 2011 showing that ,
… smoking was reported by one out of four
(27.3 percent) adults from families who earn less than $35,000 a year, three
times the rate of those from families who earn $100,000 a year or more (9.2
percent). Obesity rates were also higher (31.9 and 21.2 percent, respectively),
in part because of lower levels of physical activity and higher levels of
caloric consumption. In 2011, the proportion of adults who reported getting
recommended levels of aerobic exercise was 36.1 percent for those living in
poverty compared with 60.1 percent for those with incomes at least four times
higher than the [Federal Poverty Level].
The longevity differentials
previously cited are simply the natural end point for lives lived very
differently. Yet, one cannot help
but ask whether in an advanced country, such as the United States, income
should be so closely tied to health and longevity?
Who Cares about
This?
Although the connections between income, health, and longevity are
quite compelling, I often wonder whether we, as an aggregate, really care that
two babies born into two families at different ends of the income continuum are
destined to have very different lives with regard to their health prospects,
their projected longevity, and most probably, the quality of their days. This
is in stark contrast to the American Dream Ideology, which asserts that where
one starts out in life has little to do with where one winds up, in that
talent, hard work, and perseverance are supposed to be the factors that determine
our destinies. Unfortunately, these health and longevity data do not support
such a Pollyanna view of growing up in America today. Where one starts out in
life is clearly connected to how long one might expect to live, and the quality
of one’s life.
Clearly, there are research groups scattered about that study this
stuff, and many individuals and organizations that are doing good work in
attempting to reduce the relationships among family wealth, health, and general
well-being, but we have really not taken on this issue in a systemic way, to
fulfill our country’s promise of “life” in
its promise of : “…life, liberty, and the
pursuit of happiness.” Arguably, most people may ascribe to the notion that
“…life is not fair”, and be resigned to
endemic inequities. Others, may
attribute differential life circumstances to differential capabilities, and
people’s unwillingness to pursue longer term personal development at the
expense of shorter term satisfaction. While others may simply be indifferent to
the plight of folks very different from themselves, who live “on the other side of the tracks.” But,
these data are too compelling to ignore. A twenty-years longevity difference
between groups of people living five miles apart in a country having great
wealth is really difficult to explain in a society that is based on the notion
that every individual should have an equal opportunity to thrive.
What can be done?
Yet, what could be done, if we were really committed to tackling
the longevity inequity problem? The answer is clearly not simple, but lies in
“connecting dots”, that have been identified as representing separate issues by
different interest groups.
First, we need to do a much better job in getting poorer kids educated.
While education may be perceived as the route out of poverty, as we see from
health data, income is also highly correlated to longevity and well-being. This
is a complex relationship, as the connection between education and health may,
at first, be perceived to be mediated by health education, which is a factor. But
the more powerful connection probably comes from the interaction between income
and lifestyle. This is so because the more education one gets, the higher the
income that people are projected to have, and the higher one’s income, the more
likely they are to be able to live in safe neighborhoods, to gain access to
higher quality food, to live in homes not contaminated by lead or asbestos, to
have jobs in safe work environments, to be less likely to smoke, to get more
exercise, to incur less stress, to obtain higher quality health insurance, and
to more easily access doctors, dentists, optometrists, physical therapists, psychologists,
and other health providers. As a
profile, it becomes apparent that healthy living is very much a function of the
environment in which one lives. In turn, this is largely determined by one’s income,
which is connected to one’s occupation, which is tied to one’s education. Consequently,
as I argued in my last post, we must do more to provide high quality education
in general, but especially to children at the bottom of the income continuum.
Supporting the education of Project Coach participants entails
working with them on a day to day basis to make certain that they are engaged
in their classes, do homework assignments thoroughly, study effectively for
exams, and master coursework. It also means helping students plot future
trajectories for post secondary school education. This might entail everything
from counseling students on selecting the best middle and high schools to
attend, to helping them create a “future self” that includes higher education.
Taking college trips, providing opportunities to prepare for the SATs/ACTs,
assisting with college applications and financial aid forms, and any other
activities that make higher education a natural progression would be in order.
It may also entail helping youth explore and prepare for post secondary school
employment in vocations not requiring a college degree.
The second approach that Project Coach takes to helping youth fulfill
their potential entails community development. Recent research shows that
future income, especially for children coming from families in the lower income
quartile, is very much a function of where they grow up. In a nutshell this
research found that:
For children
growing up in families at the 25th percentile of the income distribution, each
year of childhood exposure to a one standard deviation (SD) better county
increases income in adulthood by 0.5%. Hence, growing up in a one SD better
county from birth increases a child’s income by approximately 10%[4].
Given that mass migrations of poor people to wealthier communities
is probably not in the cards, an alternative strategy that Project Coach is
pursuing is to help develop the community in which it exists in order for it to
become more like those communities where upward mobility and healthy lifestyles
are more likely to occur. We have already been part of One Spr1ngfield, which
is engaged in antiviolence, clothing, and food security initiatives in the
North End. As well, we provide educational and recreational programs during the
after school hours and summer vacation period for children in grades 3-5. Project
Coach also has an intensive, multi-year, youth development and jobs training
program for 50-60 adolescents. Healthy communities also are cohesive
communities in that they are made up of people who actually know and care about
one another, and who support building and maintaining high quality living
conditions. With our contingent of teenagers, we are currently exploring ways
for how to diversify their involvement in sports, and deploy some of their vast
talents and emerging leadership skills to maintain and expand such community
development initiatives. Our emerging plans include engaging a broader array of
community members in projects that encompass education, health, recreation, and
the environment.
[1] Virginia Commonwealth University, Center on Society and
Health,
http://www.societyhealth.vcu.edu/work/the-projects/mapping-life-expectancy.html
[2] Woolf, S. H et al. How are income and wealth linked to
health and longevity?, Center on Society
and Health, http://societyhealth.vcu.edu/media/society-health/pdf/IHIBrief1.pdf
[3] J. S., Schiller, J. W. Lucas, and J. A. Peregoy,
“Summary Health Statistics for U.S. Adults: National Health Interview Survey,
2011.” Vital and Health Statistics 10, no. 256 (2012): 1–207, tables 1, 4, 8,
and 12. http://www.cdc.gov/nchs/data/series/sr_10/sr10_256.pdf
[4] Raj Chetty and Nathaniel Hendren. (2015) The Impacts
of Neighborhoods on Intergenerational Mobility: Childhood Exposure Effects and
County-Level Estimates.
Harvard University and
NBER. http://scholar.harvard.edu/files/hendren/files/nbhds_paper.pdf
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