Hope and health care

I'm pretty skeptical about most public health studies. The more complex the subject of interest, the more variables you can't control for, and it doesn't get much more complex then human health and society. However, its hard to ignore the results of the Whitehall study. For one, there's the magnitude. The original study had a cohort of over 10,000 English civil servants. Second, the results, from a correlation standpoint, are almost perfect.

"The Whitehall studies found a strong association between grade levels of civil servant employment and mortality rates from a range of causes. Men in the lowest grade (messengers, doorkeepers, etc.) had a mortality rate three times higher than that of men in the highest grade (administrators)."

(Thats from Wikipedia so feel free to change it if you disagree with anything I say). Basically, the study showed a near linear correlation between rank and susceptibility to a variety of illness, ranging from cardiovascular disease to stroke. Are the factors that DON'T correlate to disease. Obviously, one would expect rich people to be better off than the poor. They can afford better food, better health care, etc. But the only problem is there isn't enough economic spread between, say, a level 3 and a level 6 civil servant to explain away the MAJOR differences in health outcome. Plus, while some private health care is availability to the wealthy in England, the vast majority of the civil servants was eligible to receive identical health care from the NHS.

So, whats responsible? Many have come to conclude its one's working conditions that plays the biggest role in health. Some people, such as Nancy Adler at UCSF, have gone further, claiming that stress is a major connection between socio-economic status and health (check out the link for a great interview). Its clear how a grim sense of futility developed at the bottom of the food chain can lead to disaster. Both common sense and science have shown that a sense of powerlessness is intimately linked to depression and other psychiatric disorders.

So where am I going with this? Well, there's been a lot of discussion this election year about equality and coverage. While you can make the argument that a baseline level of care is an absolute necessary, it will only get you so far. The fact of the matter is, if you're low on the ladder and don't have opportunity for self-direction, chances are you're going to succumb to some bad habits. The majority of smokers are towards the bottom of the socio-economic chain; are they going to stop smoking just because they have a doctor to tell them to? How helpful will it be to have a health care plan jammed down there throat? These are not liberating ideas; they just feed into the cycle of powerlessness and the resulting poor health.

There's no easy solution when it comes to equality and health care. No presidential platform will give people the impetus to become self-reliant, healthy individuals. It takes hope, something that can't simply be peddled from a Washington office.