Inequality may sicken us — really

Good health is not just about good health care.

No, I'm not going to tell you to eat your veggies and run around Green Lake after work. That might help, but something else is making all of us sicker than we need to be.

Inequality is killing us, Stephen Bezruchka told me Friday.

Bezruchka is not a social worker. He is a doctor and a University of Washington professor.

He was a mathematician once but said he switched to medicine because he wanted to do something really useful.

In the mid-1980s, Bezruchka was working in Nepal when he realized the absence of medical care "didn't mean everybody dropped dead."

He began to question just what medical care does or doesn't do for people. Along the way he learned about the role social status plays in health.

We know poverty can affect diet, living conditions, access to medical care.

But inequality puts stress on people at every level. Poor people suffer most, but so do wealthy people in societies where there are large gaps between rich and poor. High-income white Americans have higher rates of diabetes, cancer and hypertension than poor people in England, according to a study reported in the Journal of the American Medical Association two years ago.

The inequality effect is getting an airing in April on PBS in a documentary series, "Unnatural Causes ... Is Inequality Making Us Sick?"

You can see the first segment at 11 p.m. Wednesday on Channel 9. Among questions the series poses:

• Why is a highly educated African-American woman twice as likely to deliver a preterm and low-birth-weight baby than a white woman who dropped out of high school?

• Why do Latino immigrants enjoy a higher health status than any population when they arrive in the United States but suffer a rapid decline the longer they remain?

Behavior, diet and environment aren't always part of the answer. The stress of living in a win-or-lose society is.

The idea of moving up is ingrained in us, Bezruchka said.

"In the '50s and '60s, the American dream was a reality," he said, "but in the '70s it was washed out."

In the 1920s, he said, the top 1 percent of Americans controlled half the country's wealth. Their share was down to 25 percent by 1968. Now it is back up to more than a third.

Our health reflects our inequality.

This country spends about as much on health care as the rest of the world combined, but our life expectancy is below that of 41 other countries, according to the Census Bureau.

Health is what you have before you need health care. But when it comes to public policies, we spend most of our time talking about health care.

Presidential candidates have elaborate health-care plans but no health plan.

Experts in the PBS series suggest tax changes, education reforms and other policy fixes that have restrained inequality in other countries.

That health message may be a hard sell, but I hope people will at least listen. So eat your spinach at dinner — and then tune in to the series.

Jerry Large's column appears Monday and Thursday. Reach him at 206-464-3346 or jlarge@seattletimes.com.