Jonathan Senin
2.19.14
The only undeniable victory of the Occupy movement has been to shift national dialogue and focus onto inequality. Investigations into the structures supporting the growing divide between economic classes have since prompted calls for policy changes like the closure of tax havens, extension of unemployment benefits, and the introduction of incentives to “re-shore” manufacturing processes.
A natural accompaniment to the sober dialogue of policy is public anger and vitriol over the excesses of extreme wealth. Middle and lower class Americans are, understandably, fuming about inflated CEO pay and extravagant pleasure trips to central Europe. Yet, the national chatter obscures some of the darker sides of inequality. Specifically, there is a growing body of evidence that economic inequality, and our perception of it, adversely affects both our mental health and our perception of physical health.
It’s been established that populations on the lower end of the socioeconomic scale correlate with relatively worse health indicators: they die younger, get sick more often and pay more for treatment. The American Journal of Public Health conducted a wide-ranging study using decades of US data: Paula Bravemen writes that those with “lowest income and who were least educated were consistently least healthy.”
The study utilized traditional metrics for health, which exclude the arguably subjective measurements for mental health. Yet, recent evidenced published in 2012 documents “a wide range of mental disorders [that] might originate in a ‘dominance behavioral system.’” Sheri Johnson, from UC Berkeley, discovered that people have very specific brain mechanisms designed to process and internalize social power and hierarchy. These parts of the brain are almost “universal in mammals,” let alone humans. Ms. Johnson concludes that mental conditions like mania and narcissism are associated with our attempts to gain status and dominance, while disorders like anxiety and depression are linked with feelings of subordination. Furthermore, she suggests that the maddening pressures of coping with social stratification aggravate other conditions such as “antisocial personality disorder and bipolarism.”
One of the weird quirks of an inequitable society is that larger levels of inequality actually reinforce the existence of inequality itself. Sociologists at the University of Toronto found that, “although there is always some connection between people’s income and the social class to which they feel they belong, the match between the two is closer in societies with bigger income differences between rich and poor.” In other words, the more unequal a society, the more people associate their social class with their levels of income. The researchers propose that highly unequal societies intensify issues of dominance and subordination, and feelings of superiority and inferiority.
Inequality not only intensifies mental disorders, it also make them more pervasive. A new study by Dublin-based researchers of 34,000 people in 31 countries found that in nations with larger income differences, status anxiety was more common at all levels in the socioeconomic ladder. A 2011 study discovered that “self-enhancement or self-aggrandizement… occurred much more frequently in more unequal societies.”
The findings are troubling, especially for developing countries. As nations get richer, they usually go through a period of economic disparity, with income inequality almost an inevitable product of growth. Whether inequality has and will become a permanent fixture of emerging markets is a debatable future. But the development of negative mental conditions associated with economic inequality is all but certain. Resource-scarce governments and institutions must evolve to solve these new challenges.
So, it is clear that growing inequality makes us all more conscious about “image management” and “social perception,” which can affect our mental health. Worse still, socioeconomic inequality changes our perception of physical health as well. Before the very public shouting matches over Obamacare made both healthcare access and income inequality hot button issues, most Americans were unaware of health disparities, “especially regarding health disparities among groups identified other than by race or ethnicity.” Angela Rohan discovered that, even if Americans knew about health disparities, they varied widely as to its causes and solutions. More crucially, Lynch and Gollust find that, in America, equal access to health care is more important than equality in health outcomes.
In other words, societies that perceive themselves as “equal” are by and large ignorant of health disparities. Even if members of that society are aware of differences in the health of their more/less rich neighbors, equal opportunity is considered to be more important them than equal outcomes. Members of perceived equitable societies rationalize health disparities by citing other health determinants, like age, race and genetic background, rather than economic inequality itself. Whether these factors, or socioeconomic inequality, are more responsible for health disparities is still unclear. But other research suggests that it doesn’t matter. Lewis, Saulnier and Renaud assert that “universal access has done little to change the way health status is distributed across population groups and that health promotion efforts have failed to alter the distribution of health status among group or classes” More importantly, “They suggest that reducing health disparities may depend on political will which in turn is driven by political ideology and perceptions of health inequality.” Angela Rohan agrees: “Lay perceptions of health disparities can serve a valuable purpose in the development and implementation of policies aimed at improving health and reducing inequality.” In other words, the political will necessary to address health disparities may require an admission that our society is unequal in the first place; societies that are premised upon equality, like the United States, may not admit such inequalities at all.
Thankfully, there is room for hope. Providing there is political will, egalitarian policies directly lead to more equitable health outcomes. Vincente Navarro’s huge study of OECD countries over a 50-year period shows that “political parties with egalitarian ideologies tend to implement redistributive policies aimed at reducing social inequalities.” It should be no surprise that Democrats have and will be in favor of universal health care. Navarro’s contribution was to show a historical, and almost universal, correlation between ideology and welfare policy.
That inequality can adversely affect health is one of those intractable problems that development economists despise. While inequality can cause of bad health, health improvements are also crucial in reducing income inequality and in constructing a more equitable society, generally.
Developing-country governments are in a tough spot. Strapped for resources, they often prioritize economic growth over public health. This is dangerous. Obviously, a sick public is not very productive, nor innovative; economic growth suffers in the face of declining public health. Secondly, institutions, both public and non-governmental, gain resources and prestige by promoting economic growth above other concerns. Even when more resources become available, institutional momentum is so far “down the line” that it is difficult to redistribute funds to their most efficient destination. In additional to organizational focus, public health is politically dangerous. As China is learning, anger over health scares can spread quickly, creating politically toxic environments. Worse, health scares are geographically universal. While economic growth promotes one region of a country over another, health concerns can affect an entire nation.
But the most dangerous facet of inequality is public ignorance of health inequality itself. Only large amounts of political will motivate governments, and unwilling publics, to accept the fact that disparities do exist. As developing governments learn about the value and use of political capital, hopefully they will learn about the value of spending it on the public’s health.
References:
Braveman, Paula A., Catherine Cubbin, Susan Egerter, David R. Williams, and Elsie Pamuk. “Socioeconomic Disparities in Health in the United States: What the Patterns Tell Us.” American Journal of Public Health 100, no. S1 (April 2010): S186–S196. doi:10.2105/AJPH.2009.166082.
Dankwa-Mullan, Irene, Kyu B. Rhee, David M. Stoff, Jennifer Reineke Pohlhaus, Francisco S. Sy, Nathaniel Stinson, and John Ruffin. “Moving Toward Paradigm-Shifting Research in Health Disparities Through Translational, Transformational, and Transdisciplinary Approaches.” American Journal of Public Health 100, no. S1 (April 2010): S19–S24. doi:10.2105/AJPH.2009.189167.
Kronenfeld, Jennie Jacobs. Social Determinants, Health Disparities and Linkages to Health and Health Care. Emerald Group Publishing, 2013.
Lewis, Steven, Marcel Saulnier, and Marc Renaud. “Reconfiguring Health Policy: Simple Truths, Complex Solutions.” In Handbook of Social Studies in Health and Medicine. SAGE Publications Ltd, 2000.
Lynch, Julia, and Sarah E. Gollust. “Playing Fair: Fairness Beliefs and Health Policy Preferences in the United States.” Journal of Health Politics, Policy and Law 35, no. 6 (December 1, 2010): 849–887. doi:10.1215/03616878-2010-032.
Navarro, V, and L Shi. “The Political Context of Social Inequalities and Health.” International Journal of Health Services: Planning, Administration, Evaluation 31, no. 1 (2001): 1–21.
Navarro, Vicente, Carles Muntaner, Carme Borrell, Joan Benach, Agueda Quiroga, Maica Rodríguez-Sanz, Núria Vergés, and M Isabel Pasarín. “Politics and Health Outcomes.” Lancet 368, no. 9540 (September 16, 2006): 1033–1037. doi:10.1016/S0140-6736(06)69341-0.
“Physician, Heal Thyself.” The Economist, February 1, 2014. http://www.economist.com/news/china/21595431-medicines-are-over-prescribed-and-overpriced-physician-heal-thyself.
Rohan, Angela Marie Kempf. Public Awareness and Perceptions of Health Disparities. ProQuest, 2008.
Wilkinson, Robert, and Pickett. “How Inequality Hollows Out the Soul.” New York Times, February 2, 2014. http://opinionator.blogs.nytimes.com/2014/02/02/how-inequality-hollows-out-the-soul/.
No comments:
Post a Comment