The COVID-19 pandemic shined a bright spotlight on the poor state of health in America. The United States has more money than any other country — and more COVID cases and deaths. How did that happen? In his new book “Inequality Kills Us All: COVID-19’s Health Lessons for the World,” Dr. Stephen Bezruchka explains how America became the unhealthiest of all rich countries in the world, resulting in not only more than a million COVID-19 deaths but also terrible health outcomes across the board as well.
After his 30 years of experience as an emergency physician, as well as a highly awarded associate teaching professor at the University of Washington’s School of Public Health, Bezruchka concluded that “attention must be drawn to Americans being dead first.” In “Inequality Kills Us All,” Bezruchka explains how we got here, why we remain here and what is needed to reverse America’s poor health status.
Back in the 1950s, America ranked among the best health of all nations. Today, America spends more on health care than any other country yet ranks last among rich nations (as well as below many not-so-rich nations) in key health indicators. These include infant mortalities (ranked 50th), women dying during childbirth (ranked 55th) and life expectancy, where America ranked 46th before COVID-19. Post-COVID-19, the Center for Disease Control reported that life expectancy in the U.S. dropped 1.8 years in 2020 and a further 0.9 years in 2021, even while other countries have bounced back from COVID-19.
Why has this happened?
Bezruchka provides extensive data showing how inequality is the biggest driver of America’s poor health. “Economic inequality is the equivalent of a nuclear weapon. Its impact on the population is devastating and deadly.” Inequality escalates stress and frustration, leading to increased chronic illness and heart failure. Coping tactics, such as comfort foods and smoking, can be very unhealthy. Bezruchka writes, “Inequality kills many more people than gunshot wounds, car crashes, and drug overdoses,” and “is a form of structural violence or social murder.”
The twin to inequality — poverty — seriously limits people’s ability to meet their basic needs. “Poorer people, in general, are more likely to suffer from various diseases and tend to respond less well to treatments.” Poorer people are more likely to live in unhealthy environments. They are less likely to get needed treatment for diseases. Their cancer rates and death rates are higher. Poverty “excludes and isolates people from the rest of the community.” Being poor in a wealthy society is extraordinarily difficult, and “being poor in early life is the worst tragedy that can befall us.”
Bezruchka writes that America’s lack of support for early life is the second key reason for America’s poor health. One’s early life situation affects their health for their entire lifetime. Studies have shown that “around half of adult health is determined in the first seven years” of life. For better health in America, “societal responsibility needs to begin at birth, conception or even earlier.” Birthweight is a key factor for good health in adulthood. Stress and poverty impact birthweight, and low birthweight is a major factor in many adult diseases. “Diseases of the lung (including cancer), kidney, diabetes, high blood pressure, obesity, decreased immunity to infections” have their origins in early life.
Bezruchka writes that “child abuse is the major hidden epidemic of our time” and explains how trauma from child abuse lasts for a lifetime. Bezruchka also shares data that shows how “poverty in infancy is a type of toxic stress for which there is no cure later in life.” As impoverished infants age, brain development and their immune systems are compromised. The adult immune system reflects the stress experienced in early life. UNICEF ranked the United States dead last in child wellbeing among rich countries.
Poor health has become normalized in the U.S. Thus, we accept and don’t question our poor health. Many Americans reject the reality of America’s inequality because it conflicts with their belief in American exceptionalism, just as they reject science if scientific findings challenge their beliefs. Americans tend not to be interested in what happens in other countries so will likely scoff at the extensive data that Bezruchka shares. American culture directs us to focus on individual rights, not our social responsibilities. Americans tend to believe that people are poor because they are lazy and resist governmental efforts to improve public health or to support the impoverished.
So, how can we fix this? Bezruchka writes, “The primary determinants of disease are mainly economic and social,” so “our health depends on political choices.” Yes, investment in health care is important, and Bezruchka supports universal health care and is appalled that “unlike most rich nations, the US does not provide access to health care as a fundamental right.” But more investment in health care won’t address inequality, which is the key driver of our poor health. The medical-industrial complex has been structured as a growth industry, focused on making money, not providing good health. All other rich nations have lower health care costs and longer lives.
If America is to reverse this trend, we need to successfully educate Americans about inequality’s impact on our health decline. We need to convince Americans to support policies addressing inequality and supporting early life. For example, the U.S. can no longer be one of only two nations in the world that does not have a national policy of paid parental leave. Bezruchka hopes that COVID-19 will be the trigger to affect the changes needed to make our society more equal, trusting and cooperative.
Bezruchka closes the book with many specific suggestions for individuals to get active and work politically for policies that will lead to better health in America. These policies include less incarceration, stronger civil rights and increased gun safety, as well as investment in education, affordable housing, paid parental leave and childcare. Also, he suggests that returning to the progressive tax rates of the 1950s to raise revenue for social spending will extend our lives. Many other countries have proven these policies work.
We can spend far less on health care and have far better health, or America can remain exceptional at living in poor health and dying young.
Read more of the Mar. 1-7, 2023 issue.