
The Gap Between Rich and Poor Americans' Health Is Widening - Balgair
https://www.npr.org/sections/health-shots/2019/06/28/736938334/the-gap-between-rich-and-poor-americans-health-is-widening
======
denverkarma
It’s really hard for me not to be skeptical of a study that starts with the
premise of measuring everyone else against “the most privileged group,” aka.
white men, and then calling their metric “health justice.”

I don’t know the stats off the top of my head but I’ve heard many times that
men’s health issues are under-studies relative to women’s — ie breast cancer
versus prostate cancer. I’ve also seen that mental health problems affect men
more than women, as well as behavioral problems with youth, and yet there’s no
outcry for “health justice” for all the men with mental issues or men vastly
overrepresented in the prison population.

The study claims that health correlates most strongly with income, and that
the gap between black and white has narrowed - and yet the study author claims
there’s a “stunning lack of progress.”

Most of America’s problems correlate most strongly with income and more weakly
with race and gender, which isn’t surprising when income itself is uneven
between race and gender demographics.

Yet it feels to me like we’re constantly crying out about race and gender
discrimination while paying much less attention to wealth and income which
seem to be the root issue.

Are there racists in the country? Do hate crimes happen? Yes, and we shouldn’t
gloss over them.

But are the country’s problems driven mostly by racial hatred? I don’t think
so. I think the problem is we have done a lot to pull the ladder up behind the
upper-middle class, everyone in the lower income brackets is getting screwed,
and _that_ disproportionately affects minorities and historically
disadvantaged groups. I think if we could get more serious about putting the
ladder back and investing in upward mobility for all, we could make a lot more
progress on all the rest of the issues that are affecting the country.

~~~
save_ferris
Statistically speaking, white men are far and away the highest income earners
in America. They are literally the most privileged group. Until 2008, 44 of 44
of US presidents were white men. White men dominate the Fortune 500, Wall
Street, and leadership in the government.

The paper also explicitly defined health justice as "a measure of the
correlation of health outcomes with income, race/ethnicity and sex; and a
summary health equity metric.", which doesn't sound like much of an
editorialization to me.

~~~
hn_throwaway_99
Consider this:

Who do you think is more privileged, with "privileged" meaning access to
money, support, opportunities and potential for advancement: Will Smith's kids
or a white poor guy who grew up in West Virginia?

I think the point the parent is trying to make is that at any individual's
level income and wealth are a far better measure of privilege than race. Yes,
wealth _is_ highly correlated with race in the US, and a lot of that has to do
with legally enforced racist policies in our past. And there are also
certainly some examples of privilege that do correlate more with race than
income (e.g. racial profiling by law enforcement). But if your headline is
"Gap between rich and poor Americans...", why not just focus on those who are
actually rich and those who are actually poor.

~~~
opnitro
Yes, there are white people are poorer than Will Smith. Unfortunately, if we
want to do analysis of society at large, we need to look at trends. And
leaving race out of class analysis tends to obscure some of the relationships
at play. This is because class and our notions of race are forever entangled,
not least of all because we are society predicated upon slave labor.

------
ndiscussion
Being healthy is cheap as can be, but the gap is indeed increasing. One need
only spend 10 minutes at their favorite discount grocer checkout line to see
why.

I'm not sure what the answer is, but it's very sad. Why are we destroying our
bodies?

edit: this quote is getting at it, but seems to ignore the real problem.

> Research shows that health care accounts for only 10% to 20% of overall
> health outcomes

> when patients living in public housing have problems like pest infestations
> or lead paint, their team finds them attorneys to hold their landlords to
> account.

> Such approaches, Moore says, can address social determinants on a local
> level. But they need to be implemented more widely.

Do we have many people dying from lead and pests nowadays?

To me it seems like we've adopted the uber model for health in the United
States. Free market and damn the externalities. Resulting in a nice profit
transfer from the working class to Mondelez et al.

~~~
hanniabu
Unhealthy foods are cheaper than healthy foods, partially due to sugar
subsidies. This is what happens when corporations run the government. They
lobby for things that are beneficial to their bottom line rather than what's
better for the well being of the population.

~~~
5trokerac3
_Processed_ unhealthy foods are cheaper than _processed_ healthy(er) foods.

Beans and grains are cheap. Staple fruits and vegetables are cheap. Chicken is
cheap (especially dark meat). Eggs are cheap. You can feed a family of 4 a
very healthy diet for ~$100 a month if you're willing to put in the work
sourcing and cooking.

That's the crux of the issue, though. Food deserts combined with a lack of
nutritional and culinary knowledge - maybe a lack of time to prepare healthy
meals - is what's killing the average American diet, middle class and below.

Side note: if you raise your kids on hot dogs, chicken nuggets and soda every
day then you will possibly ruin their palette for life. We now have people
that find drinking water disgusting, because all they've ever drank is Diet
Coke.

~~~
johnsimer
> Beans and grains are cheap.

Side note: grains are not a healthy food.

~~~
triceratops
Whole grains aren't _unhealthy_ as part of a balanced diet. Bread or rice
makes vegetables more palatable, adds some protein, carbs, fiber, and
minerals. Carbs are vital if you're doing physical labor. Grains are more
calorie dense than veggies, cheaper, and store longer, than veggies - all big
pluses for low-income households.

~~~
nightski
Carbs are vital? I've been living for 7 years on a sub-20g net carb diet. I'm
relatively active and participate in several century bike rides throughout the
year. I don't seem to be missing out?

Actually, carbs are the only macro-nutrient your body can completely do
without.

~~~
triceratops
I feel utterly miserable performing heavy exercise on insufficient carbs.
People have different physiologies.

------
oneepic
We Americans are living in a pretty stressful time as well (i.e. politically,
financially, among other things). I can't name the study(ies) to show it, but
psychology has told us that stressful environments correlate with poverty and
other awful factors, which also cause even more stress, so people tend to go
down and stay down in a vicious cycle, unless they make a significant effort
to turn it all around.

(for example, say your job stresses you out so much and takes so much time out
of your day that you can't cook, then suppose you feel pressured enough that
you settle for fast food, and exercise less. So you gain weight over time. Now
your weight might just stress you out too; now you have to deal with the
detriments of that, on top of your shitty job. Sounds hard...)

So it makes sense to me that poor Americans's health is getting worse. For
rich people, I'd have to assume they have the time/resources (possibly chefs)
to get the healthy food and such that they need, so it's not changing much.

EDIT: Oh, and from my experiences growing up in a pretty conservative
environment: lots of Americans honestly feel there's too much confusing info
out there about diets, workouts, etc. It's always in the news, so you get
tired of hearing about it and how you're going to die at 40 because of the
terrible things you're doing to your body (McDonalds every week, or whatever).
Plus, we've seen so many diet/fitness program commercials on TV and heard so
many stories of them _not_ working. I think people are well aware they
_should_ make a change, but how to do so is such a noisy topic with mixed
success, that it stresses them out just thinking about it. Even if you were to
provide them a new, easier way to get fit, it would look exactly the same as
all those fake diets and exercise programs they saw on TV. Who knows if your
new shit's gonna work or not? They'd rather not even bother.

------
kingkawn
Keep pushing against the poor means the pendulum swing only gonna be more
drastic

~~~
e40
That's what I believe. Maybe it won't be a French Revolution type reaction,
but it will continue to radicalize people, as the gap widens and magnitude and
time.

~~~
kingkawn
Except this time the whole population of the planet is connected in near real-
time, and the movement won’t be confined to one country.

------
malandrew
Why are we looking at self-reports instead of outcomes?

If self reports remained constant since 1993 for the most privileged group and
dropped for other groups, then all things being equal, outcomes should have
dropped on average when you look at the entire population, but when you look
at data about actual outcomes, they don't support this:

[https://www.healthsystemtracker.org/chart-collection/how-
has...](https://www.healthsystemtracker.org/chart-collection/how-has-the-
quality-of-the-u-s-healthcare-system-changed-over-time/)

Maybe people feel worse even though they are doing better but don't remember
how things were 25+ years ago.

------
mensetmanusman
America is set up like a strange satire.

If you get unhealthy, you literally become poor to the song of 6 digits.

A six digit reduction in wealth is enough to make over 90% of America poor.

~~~
TheOtherHobbes
It's enough to bankrupt hundreds of thousands of Americans - every year.

Your ill health and bankruptcy become someone else's yacht or private jet.

It's pure vampirism. There is no other word for it.

~~~
mkr-hn
Vampires at least have a good reason to suck people dry.

------
anonuser123456
Unpopular hypothesis: Executive function is causally correlated with health
and wealth.

~~~
jhayward
This isn't an actual contribution, it's trolling.

Future executive function is highly correlated with high socio-economic status
of childhood.

~~~
anonuser123456
Since it is also herritable, why would that be surprising?

~~~
jhayward
The correlation is environment, not heredity. Twin studies.

Please do not push any further toward the underlying message of white/western
supremacy.

~~~
anonuser123456
Your underlying arguement here is truly loathsome.

To argue that genetics plays an insignificant role in executive function is to
pervert the science so far as to basically be a lie.

As for my white Western supremecy message, I'll try to pass along your
recommendation to my biracial children.

------
dakna
I would like to encourage people to join a local community garden program and
also let others know this option might exist in their hometown. I found it to
be an invaluable way to grow healthy food and meet people from all walks of
life. We grow veggies in our backyard too, but the public gardens are where
you actually meet nice people outside of your economic class, which is far
more rewarding on a personal level to me than driving around in an expensive
car to an expensive mall to buy expensive stuff.

------
uwuhn
Where are the actual income brackets? I clicked through the NPR article to the
study itself and still can't find them.

I also don't understand how self-reported health can be objectively valid for
a study like this.

E.g. if you believe you are healthy and never visit the doctor because you
don't see a need to do so, but you have an undiscovered heart condition that
causes your death a year after participating in the study.

It also seems like the headline is somewhat deceiving given that the study
does not differentiate between mental and physical health. I don't assign the
same weight to missing work because you are sick or injured to missing work
because you feel depressed that day(I have admittedly had plenty of the latter
at my old job).

------
Giho
From article: "But, Ramirez-Valles says, the study does a good job of showing
that when it comes to health outcomes, "it's not always [immediately] about
health." He says the study's findings indicate a need for two broad policy
recommendations: a revision of the minimum wage and a rethinking of our
current taxation system.

"Income inequality is at the bottom of this," he says. "We need to target and
attack [it] aggressively. Not only in this country, but worldwide." "

When I read this I think of Thomas Pikettys research.
[https://en.m.wikipedia.org/wiki/Capital_in_the_Twenty-
First_...](https://en.m.wikipedia.org/wiki/Capital_in_the_Twenty-
First_Century)

This concentration of wealth haven't happened over a night. I don't think the
income difference is the only problem but also the accumulation of capital.
The article seem to forget the difference between income versus spending in
addition to start capital.

How is the health of people with a lot of capital and a low income and high
spending? Or is it not possible to have low income with a lot of capital?

The rethinking of the taxation system, I do think Ramez has a point as income
has higher taxation compared to capital. The amount of capital matters more
than the amount of income.

------
binichgross
What? Again?

------
flahgd
> Limitations of the study include the fact that the authors were not able to
> look at factors like immigration status

Into the trash it goes.

~~~
dang
Would you please stop posting unsubstantive and/or flamebaity comments to HN?

------
holbrad
EDIT: Apologies for the rant, went a little overboard oh well.

For the overwhelming majority of heavy hitting chronic diseases (Diabetes T2,
Obesity, Heart Attacks, even likely cancer). They are completely preventable
though diet and other lifestyle changes.

Good food, grass fed meat, fish and fresh vegetables aren't that expensive
people could afford it if they thought it was an actual priority. For those
suffering from weight problems (In the UK the obesity rate is 27%! [1] Not
even the overweight) I'd recommend for them to cut down on their frequency of
meals and ensure that the one or two meals they have are healthy (Very low
fructose, nutrient dense, keeps insulin low e.t.c.)

It's the same with exercising, a gym membership isn't that much money cheap
gyms exist. But you don't even need any money to do some simple body weight
exercises, depending on what you do and your fitness level it can literally
take 10 minutes.

So it's not a lack of time or money for anyone but the absolute poorest,
people just don't seem to care that much. I really don't know why ?

[1] [https://files.digital.nhs.uk/publication/0/0/obes-phys-
acti-...](https://files.digital.nhs.uk/publication/0/0/obes-phys-acti-diet-
eng-2018-rep.pdf)

~~~
MuffinFlavored
> They are completely preventable though diet and other lifestyle changes.

Does this mean that some of those Americans are to blame due to living such an
unhealthy lifestyle?

~~~
holbrad
Personally I think they do shoulder some blame. But I certainly think things
could be made significantly easier for the average person to do the right
thing.

Nutrition science is very complicated with very strong biases and conflicting
results. It makes it difficult to actually know what to eat, the media doesn't
help by regurgitating every single crappy study that has a catchy or
provocative conclusion. (The rubbish getting published and the peer review
process is another can of worms)

There are many companies with a vested financial interest in selling appealing
but unhealthy food. People are effected by advertising and what is easy, that
isn't their fault.

Exercises for staying reasonably healthy doesn't really get taught. Things
could certainly be made easier, for the average person.

~~~
MuffinFlavored
> Personally I think they do shoulder some blame. But I certainly think things
> could be made significantly easier for the average person to do the right
> thing.

Here is a good example. I'm not poor. $30 on a meal means very little to me.

I'm not aware of many low calorie, healthy, quick food options, even if price
isn't an issue.

I think that's the problem. You can get $0.99 cheeseburgers + fries +
milkshakes quickly, but you can't get a $9.99 salad quickly. I know fast food
chains sell salads but... I feel like that's a guaranteed way to _not_ get the
full nutrition of what a salad is really supposed to offer.

What are your thoughts?

