Original photo here, taken by NYC-MetroCard / CC BY
Public Health researchers at Columbia’s Mailman School of Public Health released a study last month that estimates the number of deaths in the US in 2000 due to social factors such as poverty, low education, and income inequality. The researchers conducted a meta-analysis of 47 studies and calculated, using Census Bureau data, the prevalence of six social factors, both “individual” and “area-level:” an individual factor would be racism or discrimination, while an area-level factor would be racial segregation. The conclusions are staggering. Galea at al. found that in the US in 2000, 245,000 deaths were attributable to low education, 176,000 to racial segregation, 162,000 to low social support, and 133,000 to individual-level poverty. That year, 4.5% of all US deaths could be attributed to poverty. In their conclusion, the researchers draw parallels to deaths attributed to disease and behavioral factors. For example, heart attacks were the leading cause of death in 2000 in the US, numbered at 193,000. They argue that social factors should be as seriously considered as factors such as lung cancer or obesity.
“In some ways, the question is not ‘Why should we think of poverty as a cause of death?’ but rather ‘Why should we not think of poverty as a cause of death?'”
There are still questions that need to be answered around association vs. causality, but given that the relationship between poverty and poor health outcomes has been well-researched, this is just a step further. Galea et al.’s study really shouldn’t come as a surprise. In a New York Times article, Dr. Galea (who is also the chair of epidemiology at Mailman) says: “…What we did is just as valid as what was done to establish smoking as a cause of death.” He points out: “In some ways, the question is not ‘Why should we think of poverty as a cause of death?’ but rather ‘Why should we not think of poverty as a cause of death?” ” Human rights cannot be granted piecemeal–while the US has a strong democratic process in many ways, its inequality is damaging. The same can be said, of course, for many other places.
I have hope that studies like this will draw more attention to the right to health and the need to improve the social determinants to health that are causing poor health outcomes and death. Along with the social factors mentioned above, Galea et al.’s study also examined health insurance and employment status, early childhood stressors, crime and violence, deteriorating built environment, and availability of open or green spaces. We cannot pin poor health outcomes and death by disease on individual behavior, genetics, and luck alone. There are fixable and preventable social factors that are just as involved (or at least, factors that governments can attempt to fix). It’s time for governments and world leaders to address human rights holistically and to stop avoiding wealth disparity, inequality, and lack of access to healthcare under the excuse of individual “responsibility” or a “pull-yourself-up-by-your-bootstraps” mentality (as I’ve argued in the past). It’s time to see poverty, inequality, low education, and other unfavorable social factors for what they are: killers. And it’s time to do something about inequality, instead of blaming individuals for their behavior, their genes, and their luck as the sole reasons for their poor health.
My apologies for being absent recently. I’ve been in the midst of a relocation from South Africa to California and have only just started to breathe again.
