Speaking of health disparities related to social factors, tonight marks the launch of a PBS series titled "Unnatural Causes: Is Inequality Making Us Sick?" From the promotional materials:

The U.S. already spends twice per person on health care than any other industrialized nation. Yet our life expectancy ranks 30th; Costa Ricans live longer. Infant mortality? We’re tied with Hungary, Poland and Slovakia for next to last among industrialized nations. Illnesses cost American business more than a trillion dollars a year in lost productivity.

Further, research has revealed a gradient to health. At each step down the socio-economic ladder — from the rich to the middle class to the poor — people tend to be sicker and die sooner. It's no surprise that poor Americans die eight years before the rich on average, but middle-class Americans die almost three years sooner than the rich.

UNNATURAL CAUSES looks at what's making us sick in the first place, investigating startling new findings that suggest there is much more to poor health than bad habits, inadequate health care or unlucky genes. The series circles in on a slow killer in plain view: the social circumstances in which we are born, live and work that can affect our risk for disease as surely as germs and viruses.

(Image courtesy of PBS)

Labels: inequality, PBS, poverty, public health, Unnatural Causes

Pundits are working themselves into a dither about whether the U.S. is or isn't officially "in a recession." But for at least one segment of the country, the question is settled: African-Americans are deep in recession, and have been for a while.

In fact, black America is in what should be called a permanent recession.

In January, economist Algernon Austin at the Economic Policy Institute pointed out that even in good times, huge numbers of African-Americans are being left behind:

In the best of times, many African American communities are forced to tolerate levels of unemployment unseen in most white communities. The 2001 recession pushed the white annual unemployment rate up from a low of 3.5% in 2000 to a high of 5.2% in 2003. During the same period, the black unemployment rate shot up from 7.6% to 10.8%.

But the reality of inequality is too often left out of the equation. For example, USA Today ran a feature this week -- "Is your state in a recession?" -- which found that many parts of the country aren't in a recession, and are actually growing.

But is everyone benefiting? USA Today made no reference to another study released this week by the Urban League, which found inequality is stubbornly persistent:

Across a range of economic indicators including measures of employment, poverty, housing, income and wealth, blacks were much worse off than whites. If whites scored 100 percent on such measures, blacks scored just 56.8 percent, a figure unchanged from last year, the National Urban League said. [...]

Three times as many U.S. blacks as whites live below the poverty line, defined as an income of $20,000 for a family of four. The disparity between the races on unemployment narrowed slightly, but blacks were still twice as likely to be jobless.

Inequality is a South-wide story: as we recently reported, 11 of the 15 states with the highest poverty levels are in the South.

Labels: economic policy institute, economy, national urban league, poverty, race and racism, recession

In case you missed it, 60 Minutes reported this week on Knoxville TN based Remote Area Medical and a recent free clinic they conducted in Knoxville. A transcript of the 60 Minutes report is here and following is the video:



Remote Area Medical (RAM) was founded by Stan Brock. If that name sounds familiar, it's because he was the popular co-star of TV's Wild Kingdom. Brock grew up in the Amazon rain forest where he learned first hand about being isolated from medical care. He later managed a ranch in Guyana before moving to Knoxville and founding RAM in 1985.

He lives in an abandoned elementary school which the City of Knoxville leases him for $1 per year. The school doubles as a staging area and warehouse for donated supplies. According to a 2003 interview, he leases a DC3 cargo plane from an Ohio philanthropist for $1 per year, and RAM's only paid employees are the RAM Foundation Director and a part-time bookkeeper. Brock, himself a bush pilot, does not take a salary and all of the work is provided by volunteer doctors, dentists, pilots, and other volunteers.

RAM was started with the idea of providing medical assistance to inaccessible areas such the Amazon rain forests. Brock realized, though, that a similar need existed in rural America, particularly in the Appalachians. RAM has conducted more than 400 two to three day fly-in "medical expeditions" in countries such as Guyana, the Dominican Republic, Haiti, Honduras, Guatemala, East Africa, India, Nepal, and the U.S. Now, 60% of their expeditions are in the U.S., where a weekend no-cost clinic is held each month somewhere in the Southern Appalachians.

Dr. Tom Kim, a Knoxville physician who operates a local free clinic, had an op-ed column in the local paper describing his experience as a volunteer at the Knoxville RAM clinic. Dr. Kim, a Korean immigrant, describes the scene as a "Third World emergency room."

Nearly a thousand people received free services, and hundreds more who had lined up out in the cold the night before were turned away. The 60 Minutes images of families peering through chain-link fences in hopes of receiving medical or dental care are heartbreaking.

In the 60 Minutes report, Joanne Ford was hoping to get in to the clinic. When asked what she would do if she couldn't, she said "I don't know. I have a lot of friends and I have a lot of church support. I was very active in my church and I have a lot of friends in church. I just hate to ask. I've worked all my life. I hate to ask."

I hate to ask.

If you would like to support Remote Area Medical's efforts you can make an online donation at their website. Medical professionals and others who would like to volunteer can click here to find out how. There are most likely free or low-cost clinics in your area doing similar work every day, and they could use your help, too.

The state of America's broken health care system is a national disgrace. There is much debate on how to fix it, but one thing is certain -- we shouldn't be leaving it up to the Stan Brocks and Dr. Kims of the world to make up for America's failure to provide for the basic health care needs of all its citizens.

Labels: health care, poverty

John Edwards' presidential campaign bid might be in trouble, but his message about "the two Americas" -- which riffs on Michael Harrington's 1962 classic book, "The Other America" -- is as relevant as ever, especially in the South.

According to new figures released by the U.S. Census Bureau, our country still has a poverty problem: over 38 million U.S. Americans live below the poverty line, 13.3% of the population.

What's striking is how completely the South dominates the list of states ravaged by poverty. Despite all those banks in Charlotte and all that Coke in Atlanta, eleven of the 15 states with the highest poverty rates are in the South:

STATE & PERCENT LIVING IN POVERTY

1 - Mississippi, 21%
2 - Louisiana, 20.2%
3 - New Mexico, 18.4%
4 - District of Columbia, 18.3%
5 - West Virginia, 18%
6 - Texas, 17.5%
7 - Arkansas, 17.2%
8 - Alabama, 16.9%
8 - Kentucky, 16.9%
10 - Oklahoma, 16.4%
11 - Tennessee, 15.6%
11 - South Carolina, 15.6%
13 - North Carolina, 14.9%
14 - Montana, 14.6%
15 - Georgia, 14.5%

Or another way to look at it: every Southern state except Florida and Virginia fall in the bottom 15.

Some say the South is losing its regional distinctiveness in today's homogenized world. But the above statistics may point to another conclusion: the South still has defining features, and one of the big ones is poverty.

The South is "the Other America."

Labels: poverty

Thousands of workers in Mississippi got a pay raise today. No, the state did not pass a new minimum wage law. Nor did Tennessee, Alabama, South Carolina, or Louisiana. Instead, Congress made good on one of their "first 100 hours" pledges, and the new federal minimum wage of $5.85 per hour goes into effect as of today.

This means that minimum wage workers in the five states with no minimum wage laws, all of them in the South, finally get a small increase of $28 per week after waiting nearly a decade.

Minimum wage workers in Kentucky and Virginia, where the state minimum wage is tied to the federal minimum, will also get a raise.

These workers will now make $234 per week, or $12,168 per year (before taxes and other deductions) if they work 40 hours per week, 52 weeks per year. The federal poverty level for a family of three is $17,170.

North Carolina, Florida, Arkansas, and West Virginia had already done the right thing and raised their state minimum higher than the federal.

Minimum wage workers in Georgia who are covered by the Federal Fair Labor Standards Act will also get a raise, but others are left behind.

Labels: economic justice, poverty

A recent study by the Kaiser Family Foundation found that 50% of advertising on television shows for children under 12 is for food.

According to the report:

The study found that tweens ages 8-12 see the most food ads on TV, an average of 21 ads a day, or more than 7,600 a year. Teenagers see slightly fewer ads, at 17 a day, for a total of more than 6,000 a year. For a variety of reasons -- because they watch less TV overall, and more of their viewing is on networks that have limited or no advertising, such as PBS and Disney -- children ages 2-7 see the least number of food ads, at 12 food ads a day, or 4,400 a year.

And as you might expect, the advertising is mostly for not-so-healthy foods -- 34% of TV ads aimed at children are for candy or snacks. Only 15% of the ads depict an active lifestyle. Not one of the nearly 9,000 ads reviewed was for fruits or vegetables.

In contrast, the report says that teens see only 47 public service ads per year promoting fitness or nutrition.

The report makes no finding with regard to the effect of such advertising on children's eating habits or the growing epidemic of child obesity. But according to the Department of Health and Human services:

•Overweight in children and adolescents is generally caused by lack of physical activity, unhealthy eating patterns, or a combination of the two, with genetics and lifestyle both playing important roles in determining a child's weight.

• Our society has become very sedentary. Television, computer and video games contribute to children's inactive lifestyles.

• 43% of adolescents watch more than 2 hours of television each day.

In a report on the causes and prevention of obesity, the Centers for Disease Control and Prevention recommends among other things:

• Reduce time spent watching television and in other sedentary behaviors

• Build physical activity into regular routines

• Ensure that the school breakfast and lunch programs meet nutrition standards

• Provide food options that are low in fat, calories, and added sugars

• Provide all children, from prekindergarten through grade 12, with quality daily physical education

So, a common theme is television and nutrition. It doesn't take a PhD to figure out there might be a connection between ads for unhealthy foods children are exposed to from watching too much TV and developing unhealthy lifestyle and eating habits at an early age.

As with many social indicators of health and wellbeing, the problem of obesity, and childhood obesity, is more prevalent in the South. The CDC's 2005 Youth Risk Behavior Survey studied child obesity in 39 participating states. At the top of the list for overweight teens are:

• Kentucky (16%)
• Alabama (15%)
• Indiana (15%)
• Oklahoma (15%)
• Arkansas (15%)
• Tennessee (15%)
• West Virginia (15%).

Other Southern states in double digits include North Carolina (14%), South Carolina (13%), Georgia (12%), and Florida (11%). This does not include teens at risk for becoming overweight (18% in Tennessee and Alabama, for example).

Among the factors cited for Tennessee, which are similar for other states:

• 85% ate fruits and vegetables less than 5 times per day during the past 7 days

• 68% did not meet currently recommended levels of physical activity

• Only 21% of school canteens have fruits or vegetables available for purchase

Some might argue that Southern Cuisine such as fried-chicken and biscuits and gravy are part of the problem, but another possible reason for the prevalence of obesity in the South is the connection to poverty, which may not sound logical at first.

Contrary to Rush Limbaugh's assertion that obesity proves that poverty and hunger are not a problem, studies show a strong link between poverty and poor nutrition, and not necessarily a lack of nutrition but rather the wrong kind of nutrition.

A report published in the American Journal of Clinical Nutrition says "the highest rates of obesity occur among population groups with the highest poverty rates and the least education." Unfortunately, that includes much of the South.

The study looks at food energy-density v. cost, among other things, and concludes:

Consumer food choices are driven by taste, cost, and convenience, and to a lesser extent by health and variety. Research has linked growing obesity rates with a growing consumption of snacks, fast foods, and soft drinks and with the consumption of high-energy-density diets. What energy-dense foods have in common is low energy cost, due in part to the presence of added sugars and fat. Some nutrition professionals have already noted that diets consumed by groups with a lower [socio-economic status] provide cheap, concentrated energy from fat, sugar, cereals, potatoes, and meat products but very little intake of vegetables, fruit, and whole grains. [..] Our central hypothesis is that limited economic resources may shift dietary choices toward an energy-dense, highly palatable diet that provides maximum calories per the least volume and the least cost.

And back to the original theme, the report also notes that eating habits, healthy or othwerwise, are developed at an early age, and:

Television advertising has been cited as a factor contributing to higher energy and fat intakes and so has the marketing of energy-dense foods. [..] Studies suggest that some of this advertising may be targeted at children and at low-income consumers. As indicated above, such foods provide energy at a much lower cost than do fresh vegetables and fruit, which are perceived as luxury items and are not always easily accessible.

So in addition to improving education and continuing the fight against poverty, maybe we should watch less TV, enjoy more active pursuits in the beautiful Southern outdoors (and reduce your kids' exposure to TV ads for unhealthy foods in the process) and consume more Grainger Co. tomatoes, Vidalia onions, South Carolina peaches and Florida citrus along with our fried-chicken and biscuits and gravy.

Labels: poverty, public health