Unnatural Causes

In March of 2008, PBS showed the first of a series of a four hour documentary titled Unnatural Causes: Is Inequality Making Us Sick? The project is funded by the Ford Foundation, CPB-National Minority Consortia, the MacArthur Foundation and the W.K. Kellogg Foundation. The series tries to figure out how inequities, socioeconomic, race and environment in which we live affect us all and influence the outcomes of our health. The team also provides a website as a companion to the documentary. Besides the video clips, transcripts of the interviews, discussion guides and teaching materials for educators, there exists a question-answer section handled by experts (1).

There must exist thousands of scientific researches out there on all aspects of health, genes, brain cells, behaviors and inequalities, but it is hard to find studies on these issues written for the general public. Come producer Larry Adelman and his team. They consult experts in the medical field, public health and scholars and visit communities around the country to investigate, collect scientific data and concepts and try to tell in stories for easy comprehension to the whole mass. (Could this be “further evidence that science as story telling/sharing/revising is indeed engaging, rich, … and productive”) (2). Larry Aldeman said that his team produced "Unnatural Causes" to draw attention to the roots of the causes of health and illness in America. Their goal is to help reframe the national debate about health in America. I was able to watch the last two episodes on TV and caught up with the first two on their website. The documentaries are very well made with stories of real people together with some startling information in an engaging and compelling fashion though depressing and infuriating at times. In this paper, I will give a background on the U.S. health statistic, followed by case studies and, lastly, comments and suggestions.

            Americans are obsessed with health. We spend $2 trillion a year on health care, more than twice per person than the average industrialized nation or as much as the rest of the world combined. We pour money into dietary supplements, spas, sport clubs, exercise equipments and medical technologies to improve health and longevity yet American life expectancy ranks 29th in the world. Among the wealthy nations, U.S. has the highest rates in infant mortality, poverty and homicide with African-Americans and Latinos doubling or tripling in numbers.

The U.S. has the most economic inequality among the industrialized countries. It is highest since the 1920s. We now live in a society where winners take all. A CEO’s income can amount to 200 – 300 times that of an average employee. The top 1% owns more riches than the bottom 90% combined. Globalization and corporate profit sharing constantly threaten the American work class. In the U.S., 21% of our children live in poverty (1 in 5 children) compared with 2.8% in Finland, 3.4% in Norway and 4.2% in Sweden.

            So why is the United States — one of the richest countries in the world — ranks among the least healthy industrialized nations? Does it mean eating right, staying active, stimulating the brain and having "good genes" only part of the equation for a healthy life? Do social policies for good education, affordable housing, a clean environment, freedom from discrimination, and other factors also matter?

In the first episode, “In Sickness and in Health,” the show observes the lives of four residents of Louisville, Kentucky. The show points out that the life span of affluent people is eight years longer than their poor counterparts. Why is it so? We know that health follows wealth. Those at the top of the class pyramid have the mean and resources to get access to top health care, best nutritious food, nicely equipped gym and clean homes. On the other hand, those at the bottom don’t even have enough food to put on the table let alone afford health care. Their days are spent worrying about debts, job cuts, decrease in social program and other uncontrollable familial issues caused by lack of money. Today’s middle class suffers too due to deregulation, outsourcing, globalization, downsizing of union and cut in insurance coverage. The constant exposure to fear and uncertainty trigger severe stress in them, wear them down and make them more susceptible to diseases. We discussed in Neurobiology & Behavior class that stress alters brain cells, brain structure and brain function. Stress can diminish the naturally occurring replacement of brain cells in the hippocampus and the shrinking dendrites or the decrease in the birth of new cells affects brain cell communication and memory function. As a consequence memory problems and the development of some mental diseases, including depression erupt.

“When the Bough Breaks” talks about a successful African-American executive lawyer giving birth to a less than 3 pounds baby despite taking excellent prenatal care. This is a common outcome for black women regardless of their socioeconomic level. At play is the racism factor. Unequal treatment they receive throughout their lifetime causes stress hormones to release in their system and, with constant activation, weaken their body and cause premature labor.

How do racism and class get under the skin? Rick Price, a psychologist who studies the effects of job loss on health, says, “These external life events do get under the skin. They create changes in the way our physiological system operates. They create elevated stressors – stress responses that ultimately lead to both acute and chronic health problems” (3). Consulted for this documentary, Harvard epidemiologist Nancy Krieger says, “We interact constantly with the world in which we’re engaged. That’s the way in which the biology actually happens. We carry our history in our bodies. How can we not? The social, physical and economic environments in which we are born, live and work can actually get under our skin as surely as germs and viruses”(4).

In “Becoming American,” the newly immigrated Mexicans possess better health than the average American despite being less educated, having lower pay and facing the stress of adjusting and assimilating to the new society. But eventually this advantage subsides and after about 5 years they start catching up to the health problems of other American in the same bracket. The reason they have initial health advantage is due to their family oriented culture and the protectiveness of their tight knit family and community that shield them from the negative impact of American culture.

Life of the two Indian tribes Pima and Tohono O’odham of southern Arizona was completely altered after their river waterway was diverted to white settlements. They lost their water right and their farms. Not working and consuming the processed food supplied to them by the U.S. government, the Indians become afflicted by diabetes. Imagine the level of stress accumulated after all these years of losses and the impact on their health. Today, half of their adult population is now diabetics and they hold the highest record of number of the disease in the world.

Why does environment play a very important role in the residents of Richmond, California’s health? The condition and quality of the place where they live, work, play or eat are determinant of their health. Places determine the kind of chemical agents people are exposed to or the pollutant that they breathe in. Long-neglected urban neighborhoods with rundown dwellings, 24 hour liquor stores, tobacco shops and fast food joints at every corner erode their health. They have higher than normal cases of asthma hospitalizations, diabetes and shorter life expectancy. Exposure to violence is a health challenge for children in those areas. The impact of the stress triggers physiological responses that can be harmful to the developing brain. We also learned that malnutrition stunts brain growth and affects the passage of electrical signals in the brain. These effects are linked to cognitive, social and behavioral deficits and the consequences are long term. Children of these poor families are seven times likely to have poorer health than rich children elsewhere.

The segment “Collateral Damage” shows globalization and the American military occupation of the Marshall Islands have disrupted the local populations from their traditional way of life. When the American built the Ronald Reagan Ballistic Missile Testing Site and especially when a miscalculated explosion fell on their islands, hundreds of Marshallese were moved off their home. They now live in poverty in crowded quarters on the island of Ebeye. The stress of dislocation and cultural loss combined with unhealthy food and lack of opportunities create high rates of tuberculosis, diabetes, heart disease, obesity, hypertension and cancer.

The last segment “Not Just a Paycheck” talks about a lot of middle-class Americans in Greenville, Michigan, who lost their jobs when the Electrolux Corporation closed and moved its factory to Mexico to take advantage of cheaper labor. The American workers are only entitled to severance pay and unemployment benefits. Their health deteriorates. The rate of hospital admissions tripled. Cases of domestic abuses, attempted suicide and alcoholism are reported.

Electrolux also laid off its employees in Sweden but these Swedes were not hard hit like the residents in Michigan. Unemployed workers get 80% of their salary in unemployment benefits. Sweden provides economic security to all its citizens by building a political system that distributes wealth to them. This system rewards entrepreneurs and protect workers. Sweden guarantees its citizen free healthcare, college education, five-weeks paid vacation, 16 months paid leaves for new parents. Swedes pay taxes to support these programs but happy Swedes live three year longer than we do.

Through the above compelling personal stories, we realize the inequities and obstacles in our society but we also see signs of these affected individuals trying to find ways to gain control over their life and their health. We need to address these inequalities and find long term solutions to help them. For example, we can advocate the state to give incentive to retail food market investors to open or revitalize grocery stores and markets to offer fresh produce and healthy foods in low income neighborhoods. Harvard epidemiologist David Williams points out in the series, "investing in our schools, improving housing, integrating neighborhoods, better jobs and wages, giving people more control over their work – these are as much health strategies as disease prevention and education efforts" (5).

PBS's ambitious public campaign "Unnatural Causes" is well under way. Hundreds of organizations have begun to use the documentary as a teaching curriculum. Numerous newspapers and internet articles have reviewed the film. Now that the thunder has started, the noise is reverberating and hopefully a tipping point for a swift reform will realize.

References

1. http://www.unnaturalcauses.org/

2. Grobstein, P. (2005). Revisiting science in culture: Science as story telling and story revisiting. Journal of Research Practice, 1(1), Article M1. Retrieved [Date of Access], from http://jrp.icaap.org/index.php/jrp/article/view/9/18
http://www.brynmawr.edu/biology/grobstein.html

3. Krieger, Nancy, Professor of Society, Human Development and Health, Harvard University.

http://www.hsph.harvard.edu/faculty/nancy-krieger/

http://www.unnaturalcauses.org/ask_the_experts.php/

4. Price, Rick. Psychologist, University of Michigan.

http://www.unnaturalcauses.org/assets/uploads/file

5. William, Davis, Department of Sociology, Harvard University

http://www.hsph.harvard.edu/now/20060929/williams.html