Thursday, March 8, 2012

Health and Equality

Does social inequality have inherent health impacts? If the gap between rich and poor is wider, does that mean the poor are going to experience distinct biological impacts that negatively impact their health? This question is a growing area of study. A British academic, Richard Wilkinson has built his career conducting studies that address the epidemiological differences of relative equality in different societies. Looking at the health patterns of the more equal societies of Nordic countries and Japan, Wilkinson makes a comparison with the health of populations in the United States and United Kingdom. He draws evidence to suggest that lower levels of oxytocin may be generated by lower neighborliness in a more competitive society. This combined with increased levels of cortisol generated by the resulting stress may increase susceptibility to ill health.

However, his thesis is questioned by some who give other factors greater precedence. For example, a higher murder rate in the US may be more associated with its gun culture than with inequality. They ask how higher divorce and suicide rates in more equal societies should be taken into account. There may be factors related to ethnic homogeneity. Do smaller countries with lower immigration rates manage the health and social cohesion of their populations more effectively than large countries with high diversity? Is the underlying issue a cultural one, drawing from the various pressures individuals experience in the more competitive consumer societies?

This is a serious area of study that should be of particular interest to Christian communities that seek to support the health and well being of their neighbors. However, the obvious challenge with this line of enquiry is its immediate relation to political philosophy. It swiftly becomes caught up in the age-old debate between capitalism and socialism. Nevertheless, if there is a significant health impact caused by inequality, then questions of public policy cannot be avoided. Public health practice suggests that society-wide structural changes are more effective than employing more doctors and nurses to address increased levels of ill health. Witness the example of tougher regulation on smoking.

Christian theorists and activists offer the concept of justice to test public policy choices. Will a certain systemic change bring greater well-being or it will it bring greater harm? This is a good basis for theory, but it is hard to demonstrate relative impacts and hard to express any clear idea of what justice means between those of unequal standing. This debate will roll on, but as Christians we are determined to side with the poor. That is the overwhelming call of our faith and tradition.

At the sidelines of political process is a debate that emerges from psychosocial and biomedical studies of inequality. This is a matter of concern and should inform our thinking on public policy. However, it is not yet clear how the evidence will stack up. And even when that becomes clearer, it will require courage and creativity to find solutions that are best for the health of all.


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