Sick of poverty

December 27, 2007

—Nina Pierpont, MD, PhD

Everyone knows that poor people are, on average, sicker than well-off people. This is true even where there is universal health care, as in Great Britain and Scandinavia. It’s not just a difference between the top and the bottom of the wealth ladder, but a stepwise gradient from level to level of socio-economic status (SES).

A study of the British civil service, for example showed that for heart health, administrators did better than professionals, who did better than clerical staff, who did better than porters and messengers.  Death rates from heart and vascular disease were about double in the lowest SES group what they were in the highest.

Surprisingly, only a third of this gradient was explained by life style differences, like smoking and amount of exercise, writes Dr. Robert Sapolsky in the journal Scientific American (Dec. 2005, pp. 92- 99).  A larger fraction of the gradient (about half) was explained by autonomy in the workplace.  The more a person made his own decisions at work, the better his cardiovascular health.

Other research also suggests the role that psychological factors, particularly stress, play in generating the SES gradient in health.

Dr. Sapolsky provocatively titled his article, “Sick of Poverty.”  In addition to the points above, he demonstrates that where health issues are concerned, one’s perception of being poor is as important as objective indicators of socio-economic status.  In other words, when it comes to predicting health outcomes, one’s SES, as measured by the usual criteria of income, education, profession, and housing, is matched just by asking people where they think they are on the ladder of society.

Further research shows that the feeling of being poor has a stronger impact on health in places where there are big differences between rich and poor in society—as in the United States (which, incidentally, is first in health care spending in the world, and twenty-ninth in how long people live).  Indeed, when there are big wealth disparities, even the health of the well-to-do suffers.

Studies at Harvard have shown that income disparity has its effect on health by undermining the trust, social support, willingness to protect and invest in community resources, and sense of effectiveness that people feel in communities.  Income and status disparities erode these community values, and increase stress—in everyone.

The most stress-provoking feelings and thoughts are:  1) the sense that one has no control over the stressful situation; 2) being unable to predict how long the stress will last; 3) feeling things are getting worse; 4) lack of social support; and 5) having no outlets for frustrations caused by the stress.

I suspect everyone knows or remembers a person who had very little money but wasn’t “poor.”  How can people get this back—the spirit and independence which isn’t wealth or poverty?  It’s also better for health, this research shows.

One suggestion is to stop gauging success by comparing oneself to the ridiculously wealthy, even at an unconscious level.  At the risk of sounding like your minister, I would say don’t envy them and the fake images of happiness they present on TV and in magazines, or think that satisfaction comes from their millions or the products they advertise.

Another thought:  make as many things for yourself as you can.  This is a North Country virtue.  Make sure children learn all the skills:  building, repairing, machining, welding, carving, painting, sewing, knitting, crocheting, cooking, food preserving, growing gardens, farming, tapping trees, making quilts, and so on.  Involve children in these important family survival activities from the age of 2 or 3, when they are most eager to imitate everything their parents are doing.

I’ve seen some marvelous enterprises undertaken by people who have little.  For example, I know a father and son who salvage derelict bicycles, fix them up, and give them to people who, like them, don’t have cars.

Another boy, featured in this paper in the last several weeks, isn’t exactly rich himself, but saw that he could do something to help little children by knitting hats and giving them away.  The community has pitched in with gifts of leftover yarn.

Likewise, a man in the community, not regularly employed, uses his truck to collect and stockpile scrap wood and lumber, giving them away for winter heat.

All these acts are autonomous and show control.  They provide outlets for frustrations.  They make things better in concrete, palpable ways, and increase community and social support.  They counter all the stress-inducing feelings listed above.

Now, science suggests there may be another benefit:  living and thinking this way can also, literally, improve long-term health.