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Be Careful What You Choose

Be Careful What You Choose

What is the one factor scientists agree on as a good predictor of being healthy? Maybe genetic predisposition? No. Eating a healthy diet perhaps? No. Living in a country with a socialized medical system? No. The answer appears to be if you want to be healthy, try your hardest not to be poor. Make every effort not to be born poor and most important, try not to spend your fetal life in a womb of a poor stressed out woman.

There is a health related socioeconomic gradient. In Westernized cultures, disease is more prevalent in the socioeconomically disenfranchised. Not only is the incidence of cardiovascular disease, pulmonary illness, rheumatoid arthritis, gastrointestinal maladies and psychiatric disturbances higher, but also the mortality rate from these illnesses is greater. In the United States, there is a ten year difference in the life expectancy between higher income and lower income citizens.

Why does this socioeconomic gradient exist even though as a collective we have the richest country in the world? Perhaps people who become seriously ill do not become Chief Executive Officers of large corporations. Maybe the presence of illness predisposes us towards lower socioeconomic opportunity. Longitudinal studies show that being poor at some point in time is predictive of our health at a later time. In a study of nuns all joining their order around eighteen or nineteen years of age, it was found that the greatest predictor of illness sixty years later was the socioeconomic status of the nuns at the time of taking their vows. Once in the convent, they all had the same diet, the same medical attention, the same living conditions and the same working environment.

Some people think that everyone has the same health and life expectancy until they become poor. It is at that point of becoming poor that someone will experience the biggest drop in health. Multiple studies have disproven this notion over the past twenty years. Other people who are more socially inclined believe that access to healthcare is a major factor, if not the most important factor explaining the difference between the classes. Researchers have looked at population health related demographics in countries that have universal healthcare and socialized medicine. They found that the socioeconomic gradient exists there too. It does not matter how often someone goes to the doctor that determines whether a disease manifests or not. People go to the doctor for treatment after a disease emerges. Very little research goes into preventing illness despite all of the lip service given by doctors, politicians, drug companies and hospital administrators.

Surely lifestyle has something with it. Working in a dangerous job, living next to a toxic waste dump and making a home in an unsafe neighborhood are risk factors that account for about thirty percent of the gradient. Some unknown factor (or factors) is much more important since we cannot account for seventy percent of the gradient.

In the last decade, investigators have taken the effects of stress on our health much more seriously. There is no doubt that our objective socioeconomic status is a good predictor of overall health, but an even better predictor is our subjective socioeconomic status. It is not the lack of wealth that makes someone more susceptible to disease, it is the feeling of being impoverished. Live in a community where there is wide variation of income around an average level associated with the neighborhood and disease lurks everywhere in the shadows. Feeling poor matters.

But in some diseases, the wealthier you are the more likely you are to contract the disease, especially those of an autoimmune nature. One such disorder is Multiple Sclerosis. The wealthier you are in America, the greater the likelihood that you will be diagnosed with melanoma, chronic fatigue syndrome, estrogen sensitive cancer and endometriosis to name a few.

There are conflicting ideas about why certain diseases are found more often in the wealthy. In the early 1900's, the disease of Hospitalism afflicted sick children who were admitted to hospitals to be isolated from the healthy members of their family, not to cure them of their malady. If a child stayed more than two weeks in the hospital, they had a ten-fold increase in their mortality rate. It was eventually determined that isolating a sick child for long periods of time put them at significant risk for death and if they lived, they experienced lifelong morbidity from the complications of their illness and inpatient isolation.

It has been my observation that different parenting styles are associated with different socioeconomic levels. But my observations alone do not explain why feeling impoverished makes some people more ill than others, especially if they come from a wealthy family. There is probably some merit to the idea that feeling economically poor is much less damaging than feeling emotionally poor. A child experiencing one of the two or both may end up later in life with totally different disease profiles. According to Harry Harlow's work, social impoverishment (social isolation) maybe the most severe of the two and maybe the greatest factor in a child's future ailments or a child's origin of adult disease.

There is ongoing rigorous research in the area of fetal origins of adult diseases. Maybe some of the results will help to uncover why the poor are predisposed to overall poor health. In our chemical and germ phobic world, parents with the greatest means tend to be much more committed to making sure that their children eat whatever they desire, maintain the most perfect hygiene and get the best shelter from the elements regardless of the time it takes away from being with their child (or all of their children).

Let us all be mindful that there are both physical and mental health consequences of isolation, loneliness and emotional deprivation regardless of socioeconomic status. The best food, the best education, the best house and the best intentions will not guarantee the best health. Feeling poor had its downsides as well as feeling rich.

Be careful what you choose.

Posted by Amanda Sanders at 9:08 AM
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