HEALTH CARE/Joan Retsinas

Rich/Poor Gap; Well/Sick Gap

Plop! The middle class has fallen into this country’s “income gap”. Thomas Piketty, the Gini coefficient, the latest census of multi-millionaires – all mark this gap-turned-chasm. Compared to Western European countries, the United States claims the widest gap. Indeed, we are bisecting into two classes: wealthy and struggling. The strugglers work at jobs that barely cover rent, food, transportation, and debts (school, credit card, payday).

Fifty-two years ago, in “The Other America,” Michael Harrington described desperation, often barely visible. Today that desperation is starkly visible: blocks of foreclosed homes, urban slums, unemployed men loitering on corners, crumbling urban schools. A few miles away: McMansions on manicured lawns, SUVs in driveways, executives in high-rise towers, technology-laden schools on leafy campuses.

It is no surprise that the rich live more comfortable lives than the strugglers. But it is also no surprise that the income gap shows up in health. Many diseases – Alzheimer’s, cancer, muscular dystrophy, arthritis, glaucoma — leap across the chasm: rich and poor get them. Mortality remains 100% for all of us. Yet “zip code” nevertheless emerges as a risk factor, (‘Almost death by zip code’: Study suggests link between health and wealth, by Barbara Raab, SeniorProducer, NBC News, July 10, 2013.). The dreary correlations roll forth: for cancer, diabetes, asthma, infant mortality, poorer Americans suffer more, suffer longer. We see more hospitalizations, more amputations, higher mortality rates as incomes plummet.

Analysts have identified the usual suspects: poorer nutrition, poorer preventive services, poorer medical care, poorer rehabilitation, poorer air and water, coupled with the kind of stress that would make Pollyanna scowl. Plus analysts have added some blame-the-victim suspects: “they” (meaning the poor) do not conscientiously take their medications, monitor their weight, exercise, say “no” to drugs and alcohol, avoid unprotected sex. (The blithe assumption is that the well-to-do heed all those precepts.) The implicit conclusion is that poor people need only follow the good-health prescriptions to thrive. It’s “pull yourself up by your boot-straps” health, an analysis popular with conservatives who see government as neither the culprit nor the solution.

Maybe it is time to end the search for blame. Let us simply try to close this health-gap. Some suggestions: universal health insurance. We started on that path with the Affordable Care Act. That Act allowed – not required — states to expand Medicaid to cover more people who were uninsured. To date, 17 states have refused to extend coverage, another 5 are considering it. We built into the Act subsidies, but allowed insurers to institute hefty premiums, co-payments and deductibles. It is time to tweak this law, making it universal and affordable.

Free preventive services. We have vaccines that can waylay, or lessen, a host of diseases, including whooping cough, measles, pneumonia, HPV, and shingles. We have mammograms, Pap smears, and laboratory tests that can alert physicians to problems before they emerge. Let’s disseminate them.

Healthy regimens in schools. Let’s return physical education to the classroom, institute after-school sports (private schools routinely incorporate sports), and get young children outside during recess. Let’s lengthen the school day, to allow for more physical activity (as well as instruction-time). Make lunchtime a nutritious, pleasant interlude, not 15 minutes for soda and pizza.

Let’s clean up all the superfund sites littering the landscape, as well as all the rivers, lakes, and creeks where people play and fish. Let’s reduce air pollution: on those brutally hot smog-filled days of summer, poor people cannot escape to beach houses.

Let’s enforce housing codes, so nobody is forced into dilapidated unsafe housing.

Let’s invest in alcohol and drug rehabilitation: waiting lists deter too many would-be clients.

Will these expenditures decrease the health gap? I don’t know. But if we don’t try, we will soon see a “morbidity” Gini coefficient track yet another gap, this time between healthy and sick.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, July 1-15, 2015

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