Paul Krugman: America’s Greatest Public Health Champion?

Last week the New York Times reported on a study which documents a reversing trend in life expectancy for the least educated whites in the US. The study shows that since 1990, life expectancy for white Americans without a high school diploma has fallen by five years for women and three years for men. Reading this article, one is likely to deduce that these declines are largely the result of individual health behaviours and life style choices.

Per the NYT,  reasons offered by researchers for this decline include “a spike in prescription drug overdoses among young whites, higher rates of smoking among less educated white women, rising obesity, and a steady increase in the number of the least educated Americans who lack health insurance”.

A range of public health experts are also quoted in the piece and offer roughly the same type of behavioural explanations. At the end of the article, Lisa Berkman, director of the Harvard Center for Population and Development studies, at least begins to shift the focus further up the causal chain and notes that the reversal in life expectancies “should be seen against the backdrop of sweeping changes in the American economy and in women’s lives”, highlighting the deleterious impact of low-wage jobs on women’s health.

Two days later it is Paul Krugman, an economist, not a public health expert, who highlights that worsening trends in life expectancies have taken place in the context of increasing income inequality (see also Katherine Greir’s  piece on Alternet, which Krugman cites).

Is this surprising? Not really. Krugman has noted the corrosive impacts of income inequality before; he’s even made direct references to the Spirit Level, a book which systematically outlines how income inequality is related to societies’ physical and mental health, as well as their levels of drug abuse, education, violence, and community life.

Unfortunately, Krugman’s easy receptivity to the political determinants of health is not mirrored in the work of national public health campaigns. In 2010, the US Department of Health and Human Services launched Healthy People 2020, a 10-year agenda for improving the health of Americans. However, despite its stated goal of achieving health equity by 2020, nowhere in its description of the social determinants of health is attention drawn to income inequality. Moreover, attention is scantily paid to the socio-political factors responsible for unequal distributions of resources important for health: resources like income, food, transportation options, social support, etc.

It is now well evidenced that in places where income inequality is greater, population health outcomes, like life expectancy and infant mortality, are worse. Unfortunately American public health professionals, and health journalists alike, continuously fail to acknowledge and translate the implications of this evidence.

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