Psyche, Science, and Society

PBS series on health disparities: Unatural Causes

Apropos the New York Times article I posted earlier today o increasing health disparities between rich and poor in the US, a friend has just sent this notice of a related upcoming PBS series, Unnatural Causes, which asks “is inequality making us sick?” that starts this week. Here is the series summary that she sent:

UNNATURAL CAUSES sheds light on mounting evidence that demonstrates how work, wealth, neighborhood conditions and lack of access to power and resources can actually get under the skin and disrupt human biology as surely as germs and viruses. But it’s not just the poor who are sick—so are the middle classes. At each descending rung of the socio-economic ladder, people tend to be sicker and die sooner. What’s more, at every level, many communities of color are worse off than their white counterparts. Compelling personal stories—spanning the country—demonstrate how social conditions are as vital to our health as diet, smoking and exercise.  As Harvard epidemiologist David Williams points out, investing in our schools, improving housing, integrating neighborhoods, better jobs and wages, giving people more control over their work, these are as much health strategies as smoking diet and exercise. And these are the stories that UNNATURAL CAUSES tells.

HOUR ONE: In Sickness and In Wealth (56 mins) What are the connections between healthy bodies and healthy bank accounts? In Louisville, Kentucky, the issues faced by a CEO, a lab supervisor, a janitor, and a welfare mother bring into sharp relief how socio-economic status shapes opportunities to lead healthy lives.  People of color face an additional burden. Solutions, public health officials believe, lie not in more pills but in better social policies.

HOUR TWO: When the Bough Breaks (28 mins) and Becoming American (28 min)
Why do African American infant mortality rates remain more than twice as high as white Americans? Researchers are circling in on a provocative hypothesis:  the chronic stress of racism can become embedded in African American mothers’ bodies and take a toll on their children even before they leave the womb.

In contrast, recent Mexican immigrants, though often poorer, tend to be healthier than the average American. But the longer they live here, the worse their relative health becomes. What’s protective about new immigrant communities that we can all learn from? And what erodes this shield over time?

HOUR THREE: Bad Sugar (28 min) and Place Matters (28 min) The O’odham Indians of Arizona suffer one of the highest rates of Type 2 diabetes in the world. But is this due to their genes, or is it part of the body’s response to decades of poverty, oppression and historical trauma? A new approach rooted in the community re-gaining control over its destiny offers hope where medical-only interventions have failed.

Why is your street address such a good predictor of your health? How can your surrounding built and social environment get inside your body like smog and toxic waste? As recent immigrants move into long-neglected African American urban neighborhoods, their health is beginning to deteriorate too. What can be done to create healthy communities?

HOUR FOUR:  Collateral Damage (28 min) and Not Just a Paycheck (28 min)

Globalization and the U.S. military have disrupted the lives of Marshall Islanders. Many have ended up in the unlikely place of Springdale, Arkansas where a legacy of poverty and powerlessness continues to take a toll on their bodies.

In western Michigan, a factory closure undermines the lives and health of a white, working class community. But the same company shut down their Swedish plant with hardly a ripple thanks to very different social policies.

http://www.unnaturalcauses.org/

Add comment March 23rd, 2008

May 3: Torture and the American Psyche

For those in the Boston area, here’s an announcement of a forum that I am both helping to organize and speaking at. A flyer, suitable for printing and posting, is available here:

Torture and the American Psyche:
Blurring the Boundaries Between Healers and Interrogators
Saturday, May 3, 2008,
9:30 am – 12:30 pm

First Parish Unitarian Church,
382 Walnut Street,
Brookline, MA
http://www.firstparishinbrookline.org

admission is free

DESCRIPTION:

Every day the news brings further details about our country’s recent use of torture and other detainee abuse in national security, and of the debates among our leaders and citizens of practical, legal, and ethical implications of this use. We invite concerned citizens and members of the mental health professions to join together in an open discussion of the far reaching human and moral implications of our nation’s use of torture.

We will discuss the emotional and ethical consequences of being members of a society that sanctions torture and that uses psychologists to make sure abuse is medically and “ethically” conducted. We will have three speakers, followed by a discussion among the panelists and with the members of the audience on the diverse aspects of this topic. Our aim is to facilitate a discussion which will include the emotional, ethical and spiritual dimensions of this topic and allow room for all to participate.

We understand that the topic will give pause to all who consider attending and care will be taken to ensure that the discussion will not devolve into a political diatribe or an immersion into a graphic depiction of torture. We hope that some perspective on feasible actions may emerge from the discussion.

SPEAKERS:

Eric Fair currently a divinity student at Princeton will speak from his experience as a civilian contract interrogator in Baghdad, Fallujah, and Abu Ghraib in early 2004. He will lend his first person account to our conversation.

Leonard Rubenstein, J.D. President of Physicians for Human Rights, a Nobel Prize winning organization, is an attorney and veteran of many human rights struggles. He will speak of the role of torture in our contemporary political culture.

David Sloan-Rossiter, Ph.D. will bring his long standing interest in using a psych oana¬lytic perspective to aid communities to the role of moderator of the program. He is co-chair of the Curriculum Committee at Boston Institute for Psychotherapy and Massachusetts Institute for Psychoanalysis.

Stephen Soldz, Ph.D. a local psychoanalyst, social activist and Professor at the Boston Graduate School of Psychoanalysis, is one of the nation’s leaders in opposing psycholo¬gist participation in torture and abuse. He will speak to the history of that struggle in the context of the broader struggle for human rights.

SPONSORS:

Boston Graduate School of Psychoanalysis, Institute for the Study of Violence
Boston Institute for Psychotherapy
Boston Psychoanalytic Society and Institute
Brookline PeaceWorks
Coalition for an Ethical Psychology
First Parish of Brookline
Massachusetts Association for Psychoanalytic Psychology
Massachusetts Institute for Psychoanalysis
Physicians for Human Rights
Psychoanalytic Institute of New England
Psychologists for Social Responsibility–End Torture Action Committee

Registration is not required but would help us anticipate attendance. If you are interested in attending this program, please email MLoug23@aol.com by Monday, April 28, 2008.

Download flyer here.

CONTINUING EDUCATION

The Massachusetts Institute for Psychoanalysis (MIP) offers Continu¬ing Education for psychologists and social workers. MIP is approved by the American Psychological Association to sponsor continuing education for psychologists. MIP maintains responsibility for this program and its content.
For further information, please contact Mary Loughlin at (978) 692-4790.

Learning Objectives
1. Participants will gain a greater understanding of the way that torture affects all members of a society not just the tortured.
2. Participants will have deeper appreciation of how psychologists’ presence at Guantanamo endorses the United States government stance that torture is morally acceptable.
3 Participants will appreciate the importance of engaging political issues from multiple perspectives including ethical, emotional, spiritual and psychological.

Suggested Readings:
Fair, E. (2007, February 9). An Iraq Interrogator’s Nightmare.
Horton, S., & Rejali, D. (2008, February 13). Six Questions for Darius Rejali, Author of ‘Torture and Democracy’.
Physicians for Human Rights, & Human Rights First. (2007, August). Leave No Marks: Enhanced Interrogation Techniques and the Risk of Criminality.
Soldz, S. (2007, April 13). Aid and Comfort for Torturers: Psychology and Coercive Interrogations in Historical Perspective.

5 comments March 23rd, 2008

Do “free markets” increase life expectancy disparities?

The New York Times today documents that the gap between rich and poor in the US involves not just income, but a growing disparity in life expectancy. Before people start complaining about Bush, not that the main data they present concerns the increase from 1980-1982, the beginning of the Reagan administration, to 1998-2000, the end of the Clinton administration. Presumably, Clinton’s free market ideology and policies contributed to the widening disparities.

Gap in Life Expectancy Widens for the Nation

by Robert Pear

New government research has found “large and growing” disparities in life expectancy for richer and poorer Americans, paralleling the growth of income inequality in the last two decades.

Life expectancy for the nation as a whole has increased, the researchers said, but affluent people have experienced greater gains, and this, in turn, has caused a widening gap.

One of the researchers, Gopal K. Singh, a demographer at the Department of Health and Human Services, said “the growing inequalities in life expectancy” mirrored trends in infant mortality and in death from heart disease and certain cancers.

The gaps have been increasing despite efforts by the federal government to reduce them. One of the top goals of “Healthy People 2010,” an official statement of national health objectives issued in 2000, is to “eliminate health disparities among different segments of the population,” including higher- and lower-income groups and people of different racial and ethnic background.

Dr. Singh said last week that federal officials had found “widening socioeconomic inequalities in life expectancy” at birth and at every age level.

He and another researcher, Mohammad Siahpush, a professor at the University of Nebraska Medical Center in Omaha, developed an index to measure social and economic conditions in every county, using census data on education, income, poverty, housing and other factors. Counties were then classified into 10 groups of equal population size.

In 1980-82, Dr. Singh said, people in the most affluent group could expect to live 2.8 years longer than people in the most deprived group (75.8 versus 73 years). By 1998-2000, the difference in life expectancy had increased to 4.5 years (79.2 versus 74.7 years), and it continues to grow, he said.

After 20 years, the lowest socioeconomic group lagged further behind the most affluent, Dr. Singh said, noting that “life expectancy was higher for the most affluent in 1980 than for the most deprived group in 2000.”

“If you look at the extremes in 2000,” Dr. Singh said, “men in the most deprived counties had 10 years’ shorter life expectancy than women in the most affluent counties (71.5 years versus 81.3 years).” The difference between poor black men and affluent white women was more than 14 years (66.9 years vs. 81.1 years).

The Democratic candidates for president, Senators Hillary Rodham Clinton of New York and Barack Obama of Illinois, have championed legislation to reduce such disparities, as have some Republicans, like Senator Thad Cochran of Mississippi.

Peter R. Orszag, director of the Congressional Budget Office, said: “We have heard a lot about growing income inequality. There has been much less attention paid to growing inequality in life expectancy, which is really quite dramatic.”

Life expectancy is the average number of years of life remaining for people who have attained a given age.

While researchers do not agree on an explanation for the widening gap, they have suggested many reasons, including these:

¶Doctors can detect and treat many forms of cancer and heart disease because of advances in medical science and technology. People who are affluent and better educated are more likely to take advantage of these discoveries.

¶Smoking has declined more rapidly among people with greater education and income.

¶Lower-income people are more likely to live in unsafe neighborhoods, to engage in risky or unhealthy behavior and to eat unhealthy food.

¶Lower-income people are less likely to have health insurance, so they are less likely to receive checkups, screenings, diagnostic tests, prescription drugs and other types of care.

Even among people who have insurance, many studies have documented racial disparities.

In a recent report, the Department of Veterans Affairs found that black patients “tend to receive less aggressive medical care than whites” at its hospitals and clinics, in part because doctors provide them with less information and see them as “less appropriate candidates” for some types of surgery.

Some health economists contend that the disparities between rich and poor inevitably widen as doctors make gains in treating the major causes of death.

Nancy Krieger, a professor at the Harvard School of Public Health, rejected that idea. Professor Krieger investigated changes in the rate of premature mortality (dying before the age of 65) and infant death from 1960 to 2002. She found that inequities shrank from 1966 to 1980, but then widened.

“The recent trend of growing disparities in health status is not inevitable,” she said. “From 1966 to 1980, socioeconomic disparities declined in tandem with a decline in mortality rates.”

The creation of Medicaid and Medicare, community health centers, the “war on poverty” and the Civil Rights Act of 1964 all probably contributed to the earlier narrowing of health disparities, Professor Krieger said.

Robert E. Moffit, director of the Center for Health Policy Studies at the conservative Heritage Foundation, said one reason for the growing disparities might be “a very significant gap in health literacy” - what people know about diet, exercise and healthy lifestyles. Middle-class and upper-income people have greater access to the huge amounts of health information on the Internet, Mr. Moffit said.

Thomas P. Miller, a health economist at the American Enterprise Institute, agreed.

“People with more education tend to have a longer time horizon,” Mr. Miller said. “They are more likely to look at the long-term consequences of their health behavior. They are more assertive in seeking out treatments and more likely to adhere to treatment advice from physicians.”

A recent study by Ellen R. Meara, a health economist at Harvard Medical School, found that in the 1980s and 1990s, “virtually all gains in life expectancy occurred among highly educated groups.”

Trends in smoking explain a large part of the widening gap, she said in an article this month in the journal Health Affairs.

Under federal law, officials must publish an annual report tracking health disparities. In the fifth annual report, issued this month, the Bush administration said, “Over all, disparities in quality and access for minority groups and poor populations have not been reduced” since the first report, in 2003.

The rate of new AIDS cases is still 10 times as high among blacks as among whites, it said, and the proportion of black children hospitalized for asthma is almost four times the rate for white children.

The Centers for Disease Control and Prevention reported last month that heart attack survivors with higher levels of education and income were much more likely to receive cardiac rehabilitation care, which lowers the risk of future heart problems. Likewise, it said, the odds of receiving tests for colon cancer increase with a person’s education and income.

1 comment March 23rd, 2008