COVID-19 has made clear the crucial links between inequality and poor health. [See, for example, Max Fisher and Emma Bubola, “As Coronavirus Deepens Inequality, Inequality Worsens Its Spread,” New York Times, March 15, 2020, updated March 16, 2020; and Linda Villarosa, “‘A Terrible Price’: The Deadly Racial Disparities of Covid-19 in America,” New York Times, April 29, 2020, updated May 20, 2020.] But in December 2019, well before the United States began to grapple with the pandemic, Fernando De Maio reported for Truthout that the “true root causes of illness extend beyond the health care system” to the social determinants of health. As documented in several recent research studies, some of those social determinants can be clearly discerned in the links between income inequality and life expectancy and between racial segregation and premature mortality.
As the World Socialist Web Site reported, an August 2019 Government Accountability Office (GAO) report concluded that poor Americans are nearly twice as likely as their rich counterparts to die before reaching old age; while Truthout reported on 2018 data from the US Census Bureau that showed the gap between the richest and poorest households in the United States is now the largest it has been in more than fifty years, with wealth more concentrated than ever before. “Democrats and Republicans may have different interpretations of these facts,” De Maio wrote, “but in public health, decades of research are coming to a consensus: Inequality kills.”
Understanding the links between inequality and poor health requires examining data at the levels of cities and communities, De Maio reported. “Without this kind of data,” he wrote, we maintain the “mirage” that “the economy is great because macroeconomic indicators say so.” Across the five hundred largest cities in the United States, income inequality correlates with premature mortality. For example, the Chicago Health Atlas has documented a nine-year gap between the life expectancy of Chicago’s Black and white residents, where the Black residents have a higher degree of economic hardship than their white counterparts. As De Maio reported, this gap in life expectancy results in more than 3000 “excess deaths”—deaths that likely would not have occurred if Black residents had similar incomes to white residents. Heart disease, cancer, stroke, diabetes, and kidney disease account for premature mortality among Chicago’s Black residents, researchers determined. “All of these are conditions that an equitable health care system would address,” De Maio noted.
A separate 2018 study of Chicago, which De Maio co-authored, found a “strong relationship” between racial and economic segregation and premature mortality. As he wrote for Truthout, “decades of disinvestment” provide the foundation for current patterns of segregation, which public health experts identify as one form of “structural violence,” a term for social and political arrangements that harm populations. From this perspective, lowering premature mortality requires more than healthcare reform; “it requires concerted action to limit the concentration of wealth and power,” De Maio wrote.
In Chicago, West Side United (WSU), a coalition of healthcare institutions, residents, community-based and nonprofit organizations, and government agencies, has formed to tackle the sixteen-year life expectancy gap that exists between the city’s downtown Loop and West Side communities. Focused on healthcare, neighborhood and physical environment, economic vitality, and education, WSU works to address the root causes of poor health by increasing hiring from West Side neighborhoods, supporting business development, and expanding the use of community health workers, De Maio reported.
As Patrick Martin noted in his report for the World Socialist Web Site, the damning GAO report “was not actually commissioned . . . to expose the connection between poverty and premature death.” Instead, Congress called for the GAO to examine how changes in life expectancy might affect Social Security and Medicare programs, “to assist congressional efforts, supported by both parties, to cut spending on these ‘entitlement’ programs,” Martin wrote. He noted that, with stagnant incomes and the disappearance of traditional pension plans, Social Security and other safety net programs “are increasingly the lifeline on which millions depend,” and politicians’ efforts to shrink or eliminate them “could run into widespread opposition.”
The poorest Americans are also more likely than their rich counterparts to face illness or premature death due to the inherent dangers of low-wage work. From delivery drivers to home care providers, low-paid workers face increasing pressures to work faster and longer, making their jobs more stressful—and, ultimately, deadly, María José Carmona reported for Inequality.org in September 2019. Carmona reported on a 2019 International Labour Organization (ILO) study, which found that less than 14 percent of the 7500 people who die “due to unsafe and unhealthy working conditions every day” die from occupational accidents. Instead, the ILO determined, the vast majority of work-related deaths are due to stress-related illnesses or accidents that take place when workers are off-duty.
“Today’s greatest workplace risk isn’t falling or infectious agents . . . but increasing pressure, precarious contracts, and working hours incompatible with life, which, bit by bit, continue to feed the invisible accident rate that does not appear in the news,” Carmona wrote.
The ILO report noted that excessive working hours are associated with “chronic effects of fatigue which can lead to cardiovascular disease and gastrointestinal disorders, as well as poorer mental health status, including higher rates of anxiety, depression and sleeping disorders.” Workers employed on temporary or casual bases are most vulnerable, Carmona reported; temporary and casual workers “have a harder time asserting their rights” and they consistently face having to choose between health and work, “between enduring pain [and] running the risk of not being called back.”
When focusing on work-related stress, “we have to be careful with labels,” José Antonio Llosa, a professor of psychology based in Spain, warned. “It’s not the fault of the worker who doesn’t know how to deal with the stress,” Llosa told Inequality.org, and the solutions are not individual anti-anxiety drug prescriptions, exercise programs, or meditation routines, but rather “changing the way that work is organized.”
While noting that protecting workers is “impossible in a market that is unrestrained and insecure,” Carmona concluded that curbing competition, better regulating work hours, and slowing down work processes could all help to improve workers’ health and safety, on and off the job.
As of May 2020, Project Censored has not been able to identify any corporate news coverage on the GAO or Census Bureau reports on inequality and premature mortality, or on the ILO report about work-related illnesses, accidents, and deaths that take place when workers are off-duty.
Fernando De Maio, “We Must Address the Roots of Inequality to Keep It from Killing Us,” Truthout, December 21, 2019, https://truthout.org/articles/we-must-address-the-roots-of-inequality-to-keep-it-from-killing-us.
Patrick Martin, “US Study Shows: Poverty and Social Inequality are Killers,” World Socialist Web Site, September 12, 2019, https://www.wsws.org/en/articles/2019/09/12/pers-s12.html.
María José Carmona, “Stress, Overwork, and Insecurity are Driving the Invisible Workplace Accident Rate,” Inequality.org (Institute for Policy Studies), September 13, 2019, https://inequality.org/research/invisible-workplace-accident-rate/.
Student Researchers: Maria Meyer (San Francisco State University) and Marco Gonzales (Sonoma State University)
Faculty Evaluators: Kenn Burrows (San Francisco State University) and Peter Phillips (Sonoma State University)