Prescription for better health: give the have-nots a hand up (?)

Leftist economist Ross Gittins has got his facts pretty right below but really has no clue about how to explain them. Let me offer a sorites that even an economist might understand:

* Rich men tend to have a wider choice of women than poor men do

* Men tend to prefer attractive women

* Rich men are more likely to marry attractive women

* Attractive women tend to have better health.

* Health is highly hereditary

* Therefore rich men will tend to have healthier children.

Which item in that sorites do Leftists aim to abolish? -- JR

It's a well established fact and most of us have at least heard of it. It's also a surprising fact. But it's a fact that doesn't get nearly as much attention as it deserves - not from our politicians, the media or the public.

It's known to social scientists and medicos as the "social gradient" or the "social determinants of health". And it means there's a strong correlation between socio-economic status and health. The higher your status, the better your health.

To put it the other way, the lower a person's social and economic position, the worse their health. And the health gaps between the most disadvantaged and least disadvantaged socio-economic groups are often very large.

One organisation that's taken a great interest in the phenomenon is Catholic Health Australia. It has commissioned the national centre for social and economic modelling (NATSEM) at the University of Canberra to produce two reports on the subject, one of them released this week. It has also produced a policy paper of its own. I'll be drawing on all three documents.

You may think the explanation is pretty obvious: the more money you've got, the better health care you can afford. You can also afford a more nutritious diet. And the better educated you are, the more aware you're likely to be of the risks to health from smoking, excessive drinking and insufficient exercise.

These things are part of it, no doubt, but it's not that simple. Medicare is, after all, free or cheap to all. And who doesn't know that smoking damages your health?

There's growing evidence that status and power affect health. The lower you are in the hierarchy, the worse your health is likely to be. A fair bit of it seems to be psychological.

A study of men in England found life expectancy of 78.5 years for a professional worker, 76 years for a skilled non-manual worker and 71 years for an unskilled manual worker.

According to a paper by the American College of Physicians, job classification is a better predictor of cardiovascular death than cholesterol level, blood pressure and smoking combined. And non-completion of high school is a greater risk factor than biological factors for the development of many diseases.

The earlier report from NATSEM found that if people in the most disadvantaged areas of Australia had the same death rate as those in the most advantaged areas, up to two-thirds of premature deaths would be prevented.

Among Australians aged 25 to 44, only 10 per cent of those who are least disadvantaged report having poor health, whereas for those who are most disadvantaged it's up to 30 per cent. Among Australians aged 45 to 64, the most disadvantaged are up to 40 per cent less likely to have good health than the least disadvantaged.

Early high school leavers and those who are least socially connected are 10 per cent to 20 per cent less likely to report being in good health than those with a tertiary education or a high level of social connectedness.

Those Australians who are most socio-economically disadvantaged are twice as likely as those who are least disadvantaged to have a long-term health condition. More than 60 per cent of men in jobless households report having a long-term health condition or disability, and more than 40 per cent of women.

The socio-economic factors best at predicting whether people smoke are education, housing tenure (whether you rent, are paying off your home or own it outright) and income. Less than 15 per cent of individuals with a tertiary education smoke.

Among women aged 25 to 44, less than 20 per cent of those in the most advantaged socio-economic classes are obese, compared with up to 30 per cent of those in the most disadvantaged classes. The likelihood of being a high risk drinker for younger adults who left school early is up to two times higher than for those with a tertiary qualification.

See what this is saying? There are two ways to improve the nation's health. One way is to spend a lot more taxpayers' money on health care. That's the solution we're always hearing about, especially from doctors.

The other way is to reduce socio-economic disadvantage; to narrow the gap between the top and the bottom, not just in income but also in educational attainment (completing secondary education), housing tenure (more affordable rental accommodation) and the way people are treated at work.

This is the solution we rarely hear about. It too would cost money, of course. But it would make more people happy as well as healthy. And it would also save taxpayers money. Just how much is what NATSEM attempts to estimate in this week's report.

If the health gaps between the most and least disadvantaged groups were closed (an impossible ideal, but one we could work towards), up to 500,000 Australians could avoid suffering a chronic illness. Up to 170,000 people could enter the labour force, generating up to $8 billion a year in extra earnings.

That would produce savings in welfare payments of up to $4 billion a year. Up to 60,000 fewer people would need to be admitted to hospital annually, producing savings of $2.3 billion. Up to 5.5 million fewer Medicare services would be needed each year, saving up to $275 million. And up to 5.3 million fewer prescriptions would be needed each year, saving the pharmaceutical benefits scheme up to $185 million a year.

But the real point is that when we choose to allow the gap between rich and poor to widen each year - including by allowing the dole to stay below the poverty line - we're casting a blind eye to the ill health it causes.

SOURCE

Posted by John J. Ray (M.A.; Ph.D.).