Originally published in JAMA (The Journal of the American Medical Association), April 10th, 2016.
Opportunity—the chance to thrive in health and other aspirations—is unevenly distributed across society. Due to structural changes in the economy and the legacy of biased policies, the poor and people of color face greater barriers to education and economic opportunity. Racial disparities in income are dwarfed by disparities in wealth (eg, assets, net worth), which may be an even stronger health determinant. The net worth of whites is more than 15 times that of blacks ($111 740 vs $7113) and more than 13 times that of Hispanics. Health is shaped not only by household finances but also by neighborhood conditions. Disadvantaged persons often live in segregated, economically marginalized communities that lack resources for good health and are characterized by poor housing, pollution, and crime. Prolonged exposure to these conditions by residents, notably young children, can induce psychological trauma. The accumulated stress can precipitate behavioral and physical complications that last into adulthood.
In an accompanying editorial, Steven Woolf, director of Virginia Commonwealth University’s Center on Society and Health, and Jason Purnell of Washington University in St. Louis noted that the study’s most important implication is that “inadequate income is jeopardizing US life expectancy. ”
They write that this should be a call to action for physicians to not only consider how social status and income may affect their patients’ health, but also to reach beyond medicine and work with others across sectors in order to improve the health of populations.
Inequity, a term that can engender political controversy, is giving way to the language of opportunity and the more positive, bipartisan message that everyone deserves a fair chance at the American dream.
A culture of collaboration across sectors provides a venue for medicine and public health to join forces with business leaders, school systems, the park authority, investors, retailers, the media, and community groups. Each sector can bring their respective skills to the task, together accomplishing more by leveraging resources and talent than any sector could achieve alone. A medical journal article reporting that income is significantly associated with life expectancy is a call to arms, but the answer cannot come from medicine or public health alone but from the health professions working with partners who share an interest in prosperity and good health. Finding common causes, bridging silos, and leveraging talents hold the promise of much deeper influence and benefit than yesterday’s fragmented efforts could achieve.