Tuesday, July 16, 2019

Stephen Bezruchka Talks Inequality, Structural Violence, and the Future of Population Health

This morning I heard an illuminating and excellent talk by Steven Bezruchka on David Barsamiam's Alternative Radio (https://www.alternativeradio.org/ — and, among other places, broadcast on KBOO every Tuesday morning between 9-10:00). Our nation and world would change if most of us were informed by independent resources like this!

Many things were confirmed in this talk that I already knew, and I learned something new, too: 
"People in the U.S. spend more money on health care than the rest of the world combined. Americans die younger than people in the other rich nations. This truth applies even to those of us who are privileged and do all the right things to be healthy, as the most important advisory body on health matters in this country now recognizes. The 47 infant deaths that occur every day happen because of the way society in the United States is structured, resulting in our health status being that of a middle-income country, not a rich country. Only three countries in the world don’t have a policy, at least on the books, for paid maternal leave—Liberia, Papua New Guinea, and the United States. What does that say about our understanding, or concern, about the health of our youth?recent Harvard study estimated that about one death in three in this country results from our very high-income inequality. Inequality, these studies suggest, lurks behind the heart attacks, diabetes, strokes, violence, and cancers that afflict us. Again, inequality kills through structural violence. There is no smoking gun with this form of violence, which simply produces a lethally large social and economic gap between rich and poor. The corporate-dominated media seem oblivious to the impact of inequality and almost never point out our poor health status relative to other nations. We need to change this! To save those 47 infant lives every day, we could take a similar actions taken in other nations, and create a broken record to run throughout the entire range of public spheres, from local and county governments to the national administration, Congress, and the courts, with the message: “Americans Die Younger Than People in All the Other Rich Nations.” If that statement were included in every speech made by governmental leaders and other public figures, repeated over and over, it might stimulate us to invade our own nation to improve its health status. Only widespread understanding of the problem we face will lead us to develop effective solutions."
 
Not only do we need Medicare For All, we need to completely restructure our economy and our nation to one which actually values life rather than greed and profits over people. Predatory venture capitalism, the free market, three human beings owning as much wealth as half our nation, the ongoing immoral redistribution of wealth upwards amidst every growing crushing poverty, suffering, and death, funding endless war instead of all that which nourishes and protects life, all the deadly ways that the climate and ecological crises are fueled — all this and more needs to go! Another world is possible! — Molly



By Fred Zimmerman

Stephen Bezruchka has lectured and written extensively about population health in the U.S. and abroad.  He is the author of the 2012 Annual Review of Public Health article, “The Hurrider I Go the Behinder I Get: The Deteriorating International Ranking of US Health Status.” Since this conversation, Dr. Bezruchka has published a piece in the Harvard Health Policy Review entitled, “Increasing Mortality and Declining Health Status in the USA: Where is Public Health?” which points out that things have gotten worse even since this interview.  Dr. Bezruchka’s work has long argued that health is inherently political.

He was interviewed by Malaika Hill, principal medical writer for MD Writing and Editing Solutions.
Selected excerpts follow, lightly edited for length and clarity.

Malaika Hill: I wanted to ask you about some current issues.  What are your thoughts on whether the ACA will survive, and if not what are some possible outcomes?
Stephen Bezruchka: The key thing that’s happened in the last couple of years is that our life expectancy is declining. So I think we can say that our health may have reached a peak and will start to decline.  So what happened in 2014-2016 [as our life expectancy was declining]? Because of the Affordable Care Act, more people had access to healthcare. So if healthcare were doing such a great job of improving health, we wouldn’t have expected that decline.  So something else is going on. I think that’s the major question that should be at the front and center focus of we as a country want to do.
Malaika Hill: I wanted to talk a little bit about the idea of structural violence. Can you elaborate on this?
Stephen Bezruchka: If we think about violence, usually the behavioral variety is one in which there’s an event that happened, there’s an outcome that is not pleasant, there’s a perpetrator—an individual—who is doing something, be it in a Las Vegas hotel with an arsenal, and the outcome is obvious: people are injured and bleeding to death and so on.  That’s the behavioral variety. It is visible; there’s a perpetrator; and the outcome is obvious.
Structural violence refers also to violence—something that produces bad outcomes—but the perpetrator is not so plainly visible; there’s not a smoking gun, and you don’t die of obvious trauma.  That is, there’s no gunshot wound, collision with a vehicle, or something whose effect is obvious.

I call this the highly toxic gas of inequality. It’s odorless, colorless, invisible. It kills us from the usual conditions we die of, and we’re totally unaware of it. — Stephen Bezruchka 

So the economic and political structure of society—the way it cares and shares, the way it addresses early life—those are made by political choices.  Take the example of our health decline. It’s not because of a shooter in some hotel. It’s also not because of the so-called opioid epidemic, although that’s a part of it. It’s caused by the way we have decided to take the recently passed tax reform that’s going to give all sorts of benefits to the rich. No question the rich will get richer.  So if the relationship between more inequality and worse health is preserved—and all the evidence points to that—we can expect to see more deaths. We will see them from the usual conditions that kill us—cardiovascular disease, cancers—and there’s no smoking gun. There’s nobody pulling the trigger. And we don’t blame anybody.
I call this the highly toxic gas of inequality.  It’s odorless, colorless, invisible. It kills us from the usual conditions we die of, and we’re totally unaware of it.
Malaika Hill: Do you think the inequality also harms the wealthy and powerful and not just people in the lower income bracket?
Stephen Bezruchka: That’s a very good question, and the answer is yes according to the available studies. The richer people, the studies indicate, would be healthier if they were less rich in a more equal society.
Take the 2013 Institute of Medicine report, “U.S. Health in International Perspective: Shorter Lives, Poorer Health.” I always tell my students, craft a title that says everything.  And that’s a brilliant title. On p. 3 they write that those of us who are upper-income, college-educated, have white skin, practice all the best behaviors and access medical care appear to be in worse health than similar groups in comparison countries.

The richer people, the studies indicate, would be healthier if they were less rich in a more equal society. — Stephen Bezruchka


Other Resources:
Inequality Kills by Steven Bezruchka — http://bostonreview.net/us/stephen-bezruchka-inequality-kills
Does Inequality Limit Lifespan or Not? — https://inequality.org/research/inequality-limit-life-span/ 

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