The Lack of Aspirin Causes Fever?- In Sickness and in Wealth

For this week's session we took a look into a documentary called in Sickness and in Wealth. The documentary focuses on the social determinants of health such as race and class which we touched upon last class. It also talks about the effects of chronic stress from a medical perspective. Rather than focusing on  how we can fix the healthcare system, which is more of a reactive measure, it highlights more of how people get sick in the first place and why some people are more likely to have ill-health than others. Coming from a medical background, it was interesting to see a documentary like this which explained social determinants of health in a more digestible format for the public to have access to that kind of knowledge. The documentary compares the lives of a CEO, a lab supervisor, a janitor, and an unemployed mother and specifically draws the connection between how resources, opportunity, power, and wealth contributes to one’s health. It argues that with less resources, opportunity, power and wealth comes ill-health outcomes. 

When diving deeper into the stories of the case studies of the documentary, the audience can see the factors of wealth, power, and opportunity at play. The white male CEO, lives in a neighborhood where he is able to exercise freely and has the income in order to spend money on healthy foods. He also admittedly understands this privilege that he has but says little about what to do for those that do not have the same resources. When it comes to the lab supervisor, she is in a high stress environment and is able to have a middle class lifestyle but is burdened by loans and a mortgage  from pursuing higher education. She however has some control and benefits with her supervising job. When it comes to the janitor that is constantly being dragged all over the hospital responding to pages all day. His work environment is stressful and he has little control over his schedule. Additionally ,he is a male person of color which means he will have a higher chance of having negative health outcomes. This chronic stress over time can lead to negative health outcomes such as high blood pressure. For the last case study, we have an unemployed mother who is afraid of losing medical coverage because she is reliant on certain medicines that help her function. If she were to get a job, she could risk losing this coverage and other benefits still not enough to support her and her families needs. She estimated a total of $200 on groceries for her family that includes three teenagers which is a very small budget. This leads her to making more economical rather than healthy food choices for her family which in the long term could lead to diabetes or heart disease. It is clear that for all these case studies, there are a multitude of levels that affect their health. 

Looking at the bigger picture of these stories, there are three main themes in this documentary focus around a few issues. Firstly, our socioeconomic environment affects our health outcomes.Those with high or middle class have more power and wealth and will have better health. Those in the lower class will experience more stress over longer periods of time and will also be presented with more health threats. Secondly, that persons of color will tend to have worse health outcomes compared to white persons even if we control for wealth and occupation. And lastly, that there is a way to change this disproportionality. Other countries have done so, not by fixing their healthcare system but rather fixing their education system, unemployment benefits, or other aspects of their social systems. However, in the United States capitalism reign’s and companies still push fixing instead of preventing. I do see some hope in the healthcare system as physicians are recognizing that the issues they face everyday expand to outside of the exam room but like all issues, we need all sectors to play a role in order for change to take place on this social issue. For many cases, it not an individual patient issue (personal issue) but rather a social issue. We must all focus on preventive measures and thus facing and battling the inequities. Let’s take a note from Dr. Kawachi and not assume that “the lack of healthcare is the cause of illness and disease” because “this is like saying since aspirin cures fever, that the lack of aspirin must be the cause of fever”.

The image below is a visual of the different social components that can effect health. This is by no means comprehensive but even then we can visualized the sheer amount of factors at play. Note the overlapping.