Dying younger than we should
by Stephen Bezruchka,
speech delivered at Olympia Community Center
29 May 2010
available from Alternative Radio
Stephen Bezruchka is Senior Lecturer in the Department of Global Health at the University of Washington. He worked for many years as an emergency physician in Seattle. His particular areas of research are population health and societal hierarchy. He has spent over 10 years in Nepal working in various health programs, and teaching in remote regions. He is author of numerous articles and essays. He is a contributor to Sickness and Wealth, a book on the effects of global corporatization on health..
My challenge is how to tell the story about health and distinguish it from what is typically done by doctors and those who work with them, and in hospitals. A Scottish patriot four hundred years ago said: “whoever tells the stories of a nation need not care who makes its laws.” So I will tell some stories, but they are not ones we are familiar with in this country. We need to be if we don’t want to die young.
I want to talk today about vital issues focused on the reality of this country, this society, starting at its origins. I will use the Declaration of Independence as a starting point and come back to it periodically. The Declaration of Independence entitles us to the right to life, liberty and the pursuit of happiness. I want to talk about what these inalienable rights actually mean in our times. I will talk about all three of these; life, liberty and the pursuit of happiness. My perspective is to ask how we are doing as a society when it comes to fundamentals of who we are and where we are going. To do so it makes sense to start at the beginning. Back in 1776 to make this declaration was revolutionary. We were the first in the world to make such a statement. That is what this land was about at that time, breaking new ground. No other nation or political division was anywhere near such progressive thinking. So I want to bring us up to the present and see how we are doing.
What is the right to life? Back in 1776 you could kill with impunity, especially if you were well off meaning having wealth and power. So what about today? The way we kill most people today is very different from then. Today we die from the usual conditions everyone dies from, not gunshot wounds or stabbings, it is just that death rates are higher in the USA than in other rich countries. For the most part, we die not from behavioral violence, the gunshots and stabbings, but from something called structural violence which I will highlight later. Of course our rates of homicide are the highest of all rich nations, so behavioral violence is always in our midst, but the deaths pale to those from structural violence. Does the right to life mean a right to a long life, or just the right to being born? How long should that right exist? That is do we have a right to live as long as possible? What does that mean, live as long as possible? Is that right under our control?
I want to take an examined look at this thing called life, as well as at liberty and at the pursuit of happiness. How well are we doing 234 years after making the Declaration. In evaluating our progress, we should be using the same standards of comparison that were present in 1776, namely how well are we doing compared to other political entities. We were ahead of the pack of nations back then. Our Declaration set us apart. We were number one when we made it. Are we number one today?
I always thought that we enjoyed a long life, but I’ve sadly come to realize that Americans do not live a long life if the standard is comparing ourselves to people in other countries. I want us to face this grim fact and work for achieving what is stated in our Declaration, namely the right to life. A life that is short is not the right to life captured by our Declaration of Independence. We have also given up control of this societal right but it can be won back if we look at the superpowers in the world today.
Not only do we not have a very long life in the U.S., I would offer that we have only the illusion of liberty. By that I mean with a quarter of the world’s prisoners, with almost one in a hundred Americans behind bars, that we don’t have a right to liberty. I believe that liberty is another aspect of our society that is under our control yet for some reason we have decided to abrogate this control, the loss of another societal right, the right to liberty.
Finally, yes, most of us are trying to pursue happiness and also helping others do so with our daily recital of “have a nice day,” a homily we repeat endlessly and hear at almost every encounter, whether it be getting off the bus, buying our groceries, or phoning the city for a replacement recycling container. We didn’t do this forty years ago. So the question is are we having nice days? We are certainly in hot pursuit of nice days, and does wishing someone to have a nice day all the time do it for them? The answer is clearly no. Our happiness levels have been falling slowly over the last forty years, that is we are not having as many nice days as we used to. Since the Declaration clearly states we only have the right to pursue happiness, not the right to happiness, I won’t be quite so critical about our declining levels of happiness. But the attainment of happiness is also under societal control, as are the other two rights. Societies should have the right to a reasonably long life, liberty, and not just the pursuit of happiness, but its attainment.
I want to cover those precepts, life, liberty, and the pursuit of happiness and relate this to health care. Why health care? This country has passed the Patient Protection and Affordable Care Act and some of us may think this legislation will solve some health problems. I will point out that health care is not so important to society, although it ought to be available to all and the new bill will not accomplish that but still leave ten to twenty million people without insurance. Health care isn’t as big a deal as many of us think. That heresy comes from a clinical doctor, me, who has practiced medicine for 35 years.
Let’s begin with not living a long life. How short are our lives? What do we know about length of life in the United States as presented by the most reliable sources available? I will use those sources to suggest medicines that we need to not die young. Then I will ask that we all take the first steps towards living longer and more healthy lives. These steps may take us in directions that are unexpected, at least given the new health care reform bill. I ask you to consider rethinking what you believe to be true. I have a new bumper sticker that reads: “Don’t Believe Everything You Think.” I’m always trying to examine critically what I believe to be true.
First the bad news. Despite living in the richest and most powerful nation in history, we Americans die much younger than we should. This has been brought up in many reports over the years including one published by Congress. They pointed out that for someone aged 25, their chances of reaching retirement at age 65 are less than in the other rich nations. How could this be true and be known by our elected officials who not only do not tell us, they don’t do anything about it? A report came out April 30 in The Lancet, the world’s leading medical journal, calculating what are your chances if you are 15 years of age of living to age 60. If some of you have children aged 15, that is not an unreasonable consideration. What is the likelihood of their being around at age 60? Not only do the all the other rich nations have better chances of 15-year-olds living to age 60, but we keep company with Algeria, Armenia, and Macedonia, who have the same chances as our children do. About 45 countries do better–that is, their 15-year-olds live longer than we do. To achieve this, if you believe it is medical care or health care that produces health, we spend half of the world’s health care to die this young. So clearly health care can’t have much to do with health.
Another report published last summer showed that if we are 50 years old, we won’t live as long as people in the other rich nations. That report also pointed out that better health care won’t do it, since, for example, we already outperform the healthier European nations when it comes to five-year survival rates for common cancers. That is, we may have better outcomes in treating many diseases than healthier nations, but still we don’t have a long life. Although we have better treatments, we get more diseases, and that is the key point to be addressed when it comes to our right to a long life. We are too sick to live long and health care won’t make up the difference.
Now many of you here may be thinking that these national data don’t apply to me since I take care of myself and do all the right things to be healthy. I used to think that. But it turns out that we can’t be healthy as individuals unless those around us are also healthy, and that applies to all of us in the United States of America. Earlier this month a study in The Lancet, demonstrated that we are behind about 40 countries that have lower maternal mortality ratios. Our rate of deaths for women has actually increased since 1990. Yet in 1951, we had the lowest death rates in childbirth among all nations. We had life then. What happened? Another study published in The Lancet this month pointed out that looking at deaths of children under five, in 1970 there were only 19 countries which did better than the United States, but by this year there were 41 nations. We are neck and neck with Lithuania and Bahrain. Of course some nations have to be 42 and why not the USA?
There is not a single indicator of health in which we do well, again if the standard is comparing ourselves with people in other nations. Why is our health at all levels declining when the standard is comparing ourselves with others? Although health care can treat illness the lack of health care is not the cause of that illness. How much younger do we die for living here? If we eradicated our leading killer, cardiovascular disease, and kept the other disease death rates the same, we still wouldn’t be the healthiest nation, but we’d be close. So that represents a huge gap. No doctor I know thinks we could eradicate our leading killer, but that would be possible metaphorically, if we took the right medicine which I will prescribe later tonight.
Besides dying young on average, we have huge health disparities within the U.S. meaning that some have pretty good health and some, such as a black man in Harlem lives less long than a man in Bangladesh. But our healthiest are not as healthy as the average in some of the healthier nations. We sit a close distance from Canada and the 49th parallel, the border with British Columbia. People there live much longer than in Washington state. Last year a coalition of communities in BC issued a report: “Healthy Futures for BC Families: Policy Recommendations for Improving the Health of British Columbians” in which they boasted that British Columbians are some of the healthiest people in the world, but work still needed to be done to reduce health disparities so their coalition was working on that. If you take, say working age men, mortality rates in Canada are almost fifty percent lower than for them here. That is a huge health gap. They just don’t die as young in Canada. The undertakers there have less work to do than here.
Our Centers for Disease Control and Prevention, the federal body charged with monitoring and improving our health, points out in its Health United States 2009 report that when it comes to infant mortality, babies dying in their first year of life, 27 countries in their list do better than the United States but back in 1960 only 11 nations were better. The same appears to be true for length of life. That means our health compared to other nations is declining. What it will take to get a better life chance for our babies is not better medical care. Already our levels of care for newborns are the most advanced of all nations. And funding for this is not an issue, since for every premature baby born, for every sick newborn, no costs are spared in treating them. Access to the best possible care is available and paid for, either by the parents, or by health care insurance or by the state, for every newborn with health problems in this country. That they die in much greater numbers than in more than 27 other countries is not a fault of medical care.
For most of us, it is hard to know how healthy we are as a nation, and it is only by comparing ourselves with others that we can come to this understanding. That is why I call this the Health Olympics since that is why we go to the Olympic events to see how well we do in comparison to other nations. Perhaps some of you went to Vancouver for this year’s Winter Olympics, where the U.S. won the most medals. Health should be an event in those games. If the sport of health were an event in the Olympics, then we wouldn’t be there for the final day’s race in any definition of health, as we would have been disqualified in the trials. That is how bad we play at our health. Yet almost no person in the USA knows this or thinks it credible when presented with the mortal truth. It is not just an inconvenient truth, it is a deadly truth.
Let me point out why more or better health care won’t give us a life with a story that describes the predicament we face today. Not too far from here there was a little- known, isolated town situated on the top of a cliff on a beautiful spot overlooking the water. This town was blessed with a fine natural hot spring. It was likely connected to the steam vents of the volcano nearby, Mount Rainier. People lived there happily. They knew that the spring had remarkable benefits and the local people used it and enjoyed good health. A developer came in and told the townspeople they should make it over into a modern resort where everyone could get jobs and the town would prosper.
The town did this and an exclusive resort was built there attracting the rich and well to do. Now the town was set right on the edge of this high cliff top. The guests drove to the town via the one road that headed directly to the edge of this precipitous cliff before turning left into the town and resort. On occasion, a driver would not be careful and the car would plunge over the cliff wreaking havoc to the occupants. With the periodic car wreck the townspeople feared that if they didn’t do something, they might lose their livelihood. They assembled a committee to look into the matter who hired consultants, the best in the US, to advise them. The consultants worked long and hard, reviewed the situation and wrote their recommendations. The committee reached a decision based on the consultant report that they announced at a town meeting.
The head of the committee reviewed the problem of the road coming close to the edge of the cliff so sometimes a guest car would plunge down to the bottom. They had found the ideal solution. The town would build a hospital with a state of the art trauma center at the bottom of the cliff and, along with the new health care reform bill, this would solve the problem. We need to think of a better solution. Most Americans believe that it is health care that produces health in this country. We thought we had the best health care system in the world, at least when it comes to being the most technically advanced, and doing the best research on treatments. But again, if we look at comparisons of our health care with other nations, it is far from the best.
Yet we spend half of the world’s health care bill. It is not health care that makes us healthy. That is the unfortunate truth divulged by much research. I say this as a medical doctor who has practiced for 35 years. During this period working in the emergency department I have treated heart attacks, motor vehicles crashes, shoulder dislocations and stabbings. I could help many of these people. But when you add up all that medical care does, it still doesn’t make that much of a difference. This gets us into the issue of how do you come to believe something is true. I put this to a grade 8 class in Seattle once. After a long silence, one of the students raised his hand and said: “If our parents tell us when we are very young, if our friends and teachers reinforce that, and if we’ve experienced it then we know it to be true.” I am always surprised at what our children know before we dilute their critical thinking skills with more schooling. What I’ve come to understand is that schooling often stands in the way of my education. Medical school didn’t teach me about health but about diagnosing and treating disease. We focus on diseases and not why we have the problems we do.
Thomas Pynchon wrote in Gravity’s Rainbow: “If they can get you asking the wrong questions, they don’t have to worry about the answers.” Most of the time working as a doctor I was asking what disease my patient had and what treatment was needed instead of why is our society dying so young?
A group of scientists at the University of Michigan in a 2008 book titled Making Americans Healthier wrote, “As dramatic and consequential as medical care is for individual cases and for specific conditions, much evidence suggests that such care is not, and probably never has been, the major determinant of levels or changes in population health.” We should be asking do we want health or health care? Let me repeat that: “do you want health or health care?” I want both, but first I want health since that is what life is all about. With our short lives and our increasingly unhappy times, that we don’t have health in the USA. We deserve both health and health care. We have to ask what produces a long life if not medical care?
As is apparent to you from the story of the remarkable town with the therapeutic hot springs on the edge of the cliff, rather than build a trauma center at the bottom, what they really needed is a guard-rail at the top where the road turned left to enter the town. So what is the guard-rail for America? Exciting research over the last 40 years has come to the conclusion that the nature of caring and sharing relationships in a society are the critical components for its health and well-being. Once everyone has enough to eat, shelter if they need it, a clean environment, then the nature of caring and sharing matters for producing health. But caring and sharing with a few individuals won’t cut the mustard. It has to be for the whole nation. That is the leap of faith I’m asking you to make.
One way to measure caring and sharing is by indicators such as the gap between rich and poor. A small gap between rich and poor is the primordial factor that provides good health. A big gap leads to more deaths through the usual diseases we die from. This is the structural violence issue mentioned before. There is no smoking gun. Societies that are more equal have many many good things going for them. For example, they live longer lives, they have fewer teen births and fewer youth homicides. They have better educational outcomes in schools.
Studies show that if a child grows up in poverty, especially poverty in the first year of life, it is like being administered a toxin that irreversibly binds to the brain for which there is no antidote you can take later in life to rid the child of the scourge. Early life lasts a lifetime. Early life begins when we are in the womb, and the more poverty we have in our midst the sooner we will be in the tomb. All of us in this hall started life as a fertilized egg, a zygote, that grew into an embryo and became embedded in our mother’s womb. That ovum, the contribution from our mother, was made in our maternal grandmother’s womb. That is you began your existence in your maternal grandmother so her circumstances affect your health. We’ve demonstrated this with linked birth data sets in Washington State. Our health depends on the health of our forebears.
Most of us believe all men are created equal as stated in the Declaration of Independence. Unfortunately this is not a self-evident truth. People believe it but science doesn’t back it up. Stressful conditions that pregnant women face affect their health, the health of the fetus and the health of the next generation of people. Poorer people are exposed to more stress in our society so the issue of early life reflects poverty in this, the richest and most powerful nation in history that also sports the most child poverty of all rich countries. That is why improving our health will take such a long time. Roughly half of our health as adults is determined before we begin school. The time in the uterus and the first couple of years outside are key periods for laying the foundation for our health as we sit here today. If you consider how we structure early life in the U.S., you get a glimpse of why we die young.
As I said earlier, changing personal behaviors won’t produce a healthy society. We already have the smallest proportion of men smoking of all rich nations, yet we die young. Turns out the longest-lived nation, Japan, has the highest proportion of men smoking. That’s not the reason for Japan’s good health, namely that all the men smoke. It just means that factors other than personal behaviors matter more for our health, yet this is just another aspect of health production ignored by the media in the U.S. that will make it difficult for us to have the right to a long life as our Declaration of Independence entitles us to. Our government tells us that to be healthier we need to change our personal behaviors. Our First Lady says we must eat less. But in the healthier nations they don’t stress personal health related behaviors as much and instead pass legislation that enhances the amount of caring and sharing that takes place and this is the key element to produce a healthier society. It is the vital difference as to why people in other countries have longer lives. It doesn’t help that we have the most child poverty of all rich nations, as well as the most overall poverty. Poverty especially relative poverty is the killer, your standing compared to others, and it is time we faced up to that. Any political attempts to deal with that so far have failed.
Lack of societal caring and sharing, early life disadvantage and poverty are the key killers as well as the ultimate reason why our nation is falling behind others. The gap between rich and poor is a good measure of those lethal agents, lack of societal caring and sharing, of early life disadvantage and of relative poverty. In the 1920s the richest 1% had close to half of all the wealth in this country. By the mid-1970s, their share had shrunk to less than a quarter. The rich had lost half of their wealth, proportionately, and our health then, compared to other nations, was something we could almost boast about just as we could in the more equal 1950s. But now the richest 1% have their wealth share back to close to half and we all die young. The richest one percent of Americans have nearly half of all the wealth in this nation and that leaves the other 99 % of us to share the other half. Once you take out what the next 9% have, there is perhaps a third of all the wealth left for the bottom nine tenths the bottom 90% of us to make do with. The primordial risk factor is the gap between rich and poor. The guard-rail then, the restrainer we need at the edge of the wealth gap cliff, is a small gap between rich and poor.
Researchers at Harvard University came up with a mind boggling estimate of how many people die in this country because of our large gap between the rich and the poor. About 880,000 deaths a year occur in this nation that wouldn’t be there if we had an income gap like the Western European countries. That number represents one death in three. This is like a 400 passenger 747 jumbo jet crashed every 4 hours killing all on board. Or a 911 tragedy happening every 30 hours, continuously. Now the fascinating part of this grim story is that there are no collapsing towers, there are no plane wreckages. People die from the usual causes of death, and don’t blame inequality. They die from heart attacks, strokes, liver disease, and complications of diabetes. There is no smoking gun. Inequality is killing us softly. Paul Farmer, the humanitarian Harvard doctor calls this structural violence. It is violence. But the cause is the capitalistic structure of society that extracts far more than a pound of flesh, but more like a hundred million pounds of human flesh a year in this country. Any human tragedy or disaster in society, Haiti, the Tsunami, wars, pale by comparison to what the Harvard study discloses. But that study did not receive any media attention. The research that gets the media attention is about individuals and their difficulties. We don’t consider societies. The media lead is never about a country without being specifically about some individuals there and this brings us to an individual response. Exposing a nation where all of us push up daisies too soon isn’t newsworthy.
Structural violence goes on continuously and could be likened to a odorless, colorless, invisible gas that kills without mercy, all the time. That is how we need to look at the gap between rich and poor that is increasing as a legacy of capitalism. It is a gas of unfettered greed. It is released by our current putrid variety of market fundamentalism that has eroded our human and societal rights. So much for our right to a long life. What about the right to liberty?
Societies with a smaller gap between rich and poor don’t need to house the threatening population in prisons because egalitarian communities foster relationships of trust and less violent behaviors. Criminologists and sociologists have known this for decades. It is just that the general public has been taught to fear others, something helped by our mainstream media who want to commodify us into gated communities while they present the fearful evening news. If you work in the news media, you know the motto “if it bleeds it leads,” meaning that sensational stories of crime and disaster and misfortune are the ones that get the headlines. We hover there afraid and unwilling to send our children into the streets to play with other children, so instead they play violent video games to vent their hormone energies or get into chat rooms trying to find friends. We accept curtailing our freedoms to keep undesirable people off the streets. Just think of this the next time you go to the scareport and have to take off your shoes, watch and belt. America is the scareport and takes away your right to liberty. More equal societies do not need to lock everyone up. Trust is much higher there. Incarceration rates among nations pattern the gap between rich and poor. The same is true for prisoners within the states. The bigger the income gap the more people in those states are behind bars because there is less trust. If we bring back social and economic rights, then we can cast off the illusion of liberty and be entitled to live free as the Declaration of Independence exhorts. We will no longer be the world’s incarceration nation.
What about happiness and well being? We are in hot pursuit of happiness. Are we attaining it? As a nation we certainly are not the happiest country by far. Are all the little having a nice day endless refrains doing their job? How would we know how happy we are, or how many nice days we are having? What does the hedonimeter say? People measure happiness and well-being levels by a variety of means. Scoring a question about today, “how are things” indicates happiness. And for measuring well- being they ask: “over all how would you say your life is going?” Then these ratings of population samples are aggregated to give an overall estimate. It is an imperfect measure, of course. It is not like health which I like to measure by how long we live, since as a doctor the easiest thing for me to diagnose is death. Harder to diagnose unhappiness. Yet as an ER doc, I’ve had people come in the middle of the night and say “I’m not happy and I want to be admitted to the hospital.” That is what the emergency department represents. It is the final common pathway for all sorts of society problems that it can’t fix.
The most common prescription drugs in this country are happy pills. They are not erector set drugs, the viagras, but are the SSRI anti-depressants class typified by Prozac and Paxil. Americans take more of those than statins for example which might prolong life. We take half of all the antidepressants consumed in the world, much more than in any other nation. So we are pursuing happiness with a vengeance. Are we attaining it? No the hedonimeter shows that happiness in the USA has been slowly declining for about the last forty years and the decline has been biggest in women. We used to see our happiness increasing with our economy, with the measure of the GDP, until the 60s but since then happiness has no longer improved while the economy has grown immensely. We have more stuff, more luxuries, more gadgets to make life easier, but they do not make us feel better. Coca Cola is now the Happiness Factory. With a bottle of Coke you can open happiness. How much happier can you be? Coca Cola reports that in 2008 a billion and a half bottles of happiness were opened every day on the planet! Wow! That means everyone in the world must be having happy days!
We are having fewer and fewer nice days as we make more and more progress. Studies on Americans show that in 2004 for a family, with incomes in the $50,000 to $90,000 range, comparing it to those with $90,000 or more did not make them happier if they had more. Below incomes of $50,000 having a bigger paycheck produces more happiness and well-being. But having more after $50,000 doesn’t. As a whole if a nation becomes richer, individuals in it are no happier. Surveys around the world show that Forbes magazines’ richest Americans are about as happy as the Amish, the traditional Mennonite group in Eastern United States and those two have the same happiness as Inuit or Eskimos in Greenland. Many other rich nations have seen happiness plateau despite their country gaining enormous amounts of wealth. Japan is an example with no increases over the last 50 years. Russia has seen its happiness plunge as they underwent shock therapy after 1991 yet now they have the third largest number of billionaires in the world. We of course have almost half of the world’s richest and that hasn’t made us or them very happy.
Americans think they will be happy at some future date in contrast to many rich countries. We just need to be wished to have a nice day a few more times each day and we’ll make it, to the promised land, the utopia of wealth and happiness. Our country suffers from the Lake Wobegone Syndrome. We are all above average. And if we are just a tiny bit below average today, wait until tomorrow when we open happiness.
What can we do to realize the precepts in our Declaration of Independence, namely life, liberty and pursuit of happiness. We don’t have life, since we don’t live that long. We don’t have liberty since one in a hundred Americans is locked up. An even greater proportion is in the criminal justice system. I might add that the real criminals, the banksters that hijacked tens of trillions of our dollars over the last years are not in the criminal justice system, but are still the recipients of our generosity. They should be locked up but their role in the prison industrial complex is to make profits off it.
In one sense we do have liberty. I can stand here and say all these things and it is very unlikely that people will come to the stage, put me in a strait jacket and carry me off to a gulag. We do have freedom of expression, but since most Americans don’t realize that we don’t have a long life or happiness, maybe that is a false freedom. If it were mainstreamed in the commercial media, then we might get together and do something to produce better health. Happiness, well, the declaration never said we were entitled to happiness, just the pursuit of it. I’ll leave you to ponder over whether that is enough.
The way we Americans try to solve problems today is just plain wrong. Let me start with an example. We have many unhoused families and long lines at the food banks today. I used to call them homeless but these people have places they have called homes, it is just that they don’t have them today. They are unhoused. This is not healthy for us. We have students come to UW in our global health department from all over the world. They are shocked when they arrive and see all the unhoused, something that is never portrayed about the U.S. in their media back home. They are shocked to see beggars and long lines at food banks. We are not longer shocked, we’ve become used to it, just like we are used to dying young and not thinking it abnormal.
In the 1970s there were a few hundred missions throughout the nation that were feeding the few destitute and unhoused. Then in the 1980s the unhoused numbers grew immensely. By 2005 there were over 40,000 agencies providing food for various groups. These food banks have become a thriving institution in our country and are very organized. There is the California Association of Food Banks helping members collect truckloads of fruits and vegetables that are too small, too ripe or misshapen for supermarkets to sell. A national network, Feeding America, through its members, supplies food to over 25 million Americans. Their website helps you find a food bank by zip code. What is going on here?
We started with a situation forty years ago, a time when we were much healthier as a country compared to other nations, and we didn’t depend on charity to feed people. Societies that don’t depend on charity with food banks to feed its population, care more for them in meaningful ways so that those who have less don’t feel the humiliation and disrespect of having to ride the shame train to the food banks. Now most of the food pantries provide food for people living in homes, that is those who are housed, who use the food to feed their families. I’m not suggesting that we let these families go without food, like we do with countless people in Africa and India where starvation is a real problem. We don’t ask why we need over 40,000 agencies doling out food? We now have more people on food stamps than ever before. The reason is that this country resembles a failed state, the sort we have invaded in the last decade.
We have unhoused all over the place. Not just old men down on their luck, but unhoused school children by the hordes. The estimates of homelessness in the 1970s suggested this was not a problem. But by the 1980s they were there in droves. Why? I asked that question to a group of unhoused seniors in Seattle. “When did homelessness become a problem?” Their chorus came back “Reagan.” What did Reagan do? He cut funding for low cost housing and mental health services. So they took to the streets and we have our problems today.
Why can’t we create a society where people have jobs and the dignity to live? We have to face up to the fact that not only do we die young, but in many other ways, we are a society in decline. If we are not careful, we may become like the Sumerians, the Romans, or the Incas who vanished and little is known about the reasons why. To date our solution, rather than to address the fundamental problem, to cure it, is to tide it over, to cover it with some bandages. With the food banks it is like putting a trauma center at the bottom of the big cliff. Is this the way the richest and most powerful country in history should behave?
By fixing inequality, I’m not suggesting we need to all be on a perfectly equal footing. We just need more equality than we have had for many years. Our increasing inequality has resulted from various political choices we made that were really not very informed choices. These choices cut taxes, but mostly for the rich. We deregulated many institutions and their policies that had protected us. We deregulated banks in 1999 by repealing an act from the 1930s that separated investment banking from keeping our savings secure and that led to the great recession that we are in today. There are a whole host of policies that changed, and we were sleeping at the switch. We did not realize the repercussions of our political choices. We did not consider the structural violence that would come to kill us. We did not think that it would be the U.S. variety of capitalism that turns out to be the odorless, colorless, highly toxic lethal gas.
Other healthier nations, have a different variety of capitalism, one that is kinder, that doesn’t kill us softly. Western Europe is a great example of another way of doing business. They have amazing social safety nets. If you are out of a job, you get generous benefits and schooling for a new job. Most higher education is free in Europe. If you have a baby, you get time off to spend with your baby. Dad’s too. Europeans have shorter work weeks and take longer vacations. Yes, they are having economic problems right now, but they will solve them.
Earlier I talked about our life, liberty and happiness being under our control and by that I meant that in the U.S. we the people have the power. But we have sold our power to the rich for very little. It was almost like a fire sale. We have given both our power as well as our wealth and resources to the rich. We didn’t ask them to share their wealth for taking our power. Instead we have government of Goldman Sachs by Microsoft for The Gap. We could take our power back since the Constitution gives we the people the power. The rich and powerful are few and we are many.
What needs to be done? We need to take back some of the wealth we have given to the rich. One of my public health students said: “We can’t make the rich less rich!” There lies the problem. Most of us believe that the rich taking everything is beyond our control. We are just in a period of time when we’ve lost the means to take back what is ours. That will change and the new health care reform legislation is a baby step with a tiny increase in the taxes the rich pay.
Earlier I mentioned two superpowers. The word was plural. Only two superpowers remain in the world. Yes, one is the United States of America, with its military might and concentrated economic wealth. Who is the other superpower? The other superpower, ladies and gentlemen, girls and boys, is sitting in front of our noses. It is you. Together we are the most powerful force in the world today. Much more powerful than the United States of America. Much more powerful than Coca Cola and its Happiness Factory. We are over six billion strong, while the rich and politically powerful around the world today number less than a million. There are six thousand times more of us. How do we exercise our superpower status? That is the challenge we, you and I together, face.
We can exercise our superpower status in many ways. One would be to boycott the open happiness campaign and not drink sodas. What if Coca Cola’s one and a half billion bottles were to sit there un-drunk every day. What if we didn’t open happiness that way, but sought it in our collective strength? What if we didn’t focus on consumption as a way to achieve well-being. Remember consumption was the 19th century word for tuberculosis. What if we stopped the consumption of stuff that didn’t actually open happiness?
Another way to exercise our superpower status is politically. Remember that the power of those few on top of the hierarchy depends on the obedience of the other superpower which is huge. Do we have to obey and indulge their avarice? We need to consider the difference between the have-nots in the world of which there are billions and the have-yachts who are very few. They can have their yachts only because we, the other superpower, let them sail.
We need policies that have been proposed before. Policies that narrowed the gap and some that would have if they had been put in place. Then we need some very innovative policies that we have never considered before. They are policies that exist in the healthier countries, and may need to be duplicated here. Americans don’t like to do that, but why not use tested medicines that work? I’ll detail the prescription.
Economic and social policies fostering economic rights produce health in a society. The kinds of policies we need are those that presidents have proposed and tried to enact not long ago. They are health policies but we would not recognize them as such. An important health policy was proposed by President Nixon in 1969, namely his Family Assistance Plan. This legislation would have provided a guaranteed income to every American family with children. Our children are our future yet today we have the most child poverty of all rich countries, and we should be ashamed of that. So we need similar legislation that President Nixon managed to get passed through the House of Representatives back in the early 1970s, a period when our health as a nation was much better, compared to other countries.
A Democratic president, Franklin Delano Roosevelt, proposed legislation in 1942 that would tax those who are wealthier in this country. He wanted a hundred percent tax on incomes above $25,000 at that time. What passed was a 94% tax, not quite 100 but close enough. What might be good today is the same tax President Roosevelt proposed on incomes above half a million dollars. Let $500,000 be the maximum wage. That is about what $25,000 in 1942 represents today. Many of us could live on that if we had to. While many Americans may shudder at limiting the incomes of those who make more than a half a million dollars a year, the studies demonstrate that it is not good for our health and contributes to our dying younger. FDR also proposed an economic bill of rights but he died before he could make progress there. Dr. Martin Luther King Jr. was all about an economic bill of rights but he was assassinated.
Good policies need to be supported so policies whether proposed by Republicans or Democrats that make healthy sense today need to be enacted. What will we do with the revenue from increasing taxes? They would fund the Family Assistance Plan that President Nixon proposed. Decreasing poverty, especially child poverty, is the first step. Specific policies would provide paid maternity/paternity leave for every family in the U.S. Sweden for example, makes it mandatory to have a full year’s paid maternity leave. The leave is combined, meaning that if the mother takes the whole year, the father also has to take 3 months. They recognize the importance of both parents being involved in the care of the newborn. You get your full pay from the government. The second year’s leave is optional but at only 80% pay. In the third year if you go back to work, you can put your child in a free Swedish government run day care. To work in a Swedish daycare center, you have to have an advanced degree in play. That is what daycare is all about, socializing the child and we need experts there.
You might respond and say, “Hey, I don’t want the government to pay me when I have a baby. That is something we should only ask charities to do with the very poor. Otherwise it would be socialism!” But think just a moment and consider that we have paid the rich about ten trillion dollars in various ways over the last year just as Newsweek highlighted in its February 16th issue last year with the red hand clasping the blue hand and the bold headline: WE ARE ALL SOCIALISTS NOW. Of course what they meant was that we are all socialists for only the rich now. The poor have to face market discipline but not the rich. They rich can have socialism, but not the rest of us. Socialism for the rest of us is the most important part of our prescription for health, the medicine that will keep our children from dying young. Canada does it, England does it. France does it. In fact only the United States, Swaziland, Liberia and Papua New Guinea do not have a mandated paid maternity leave. So we get what we pay for. We deserve better.
We need a paid prenatal leave policy. The other rich countries mandate a minimum number of days of paid leave when you are pregnant. Chile, which is as healthy as the U.S., despite being much less wealthy, mandates six weeks of paid prenatal leave and twelve weeks of paid maternity leave no matter how long the mother has worked. Cuba, which is healthier than we are, guarantees 18 weeks of paid prenatal leave and 40 weeks of paid maternity leave. Those two policies, generous paid prenatal leave and paid maternity/paternity leave are the medicines that will do the most for our health. This is the guard rail we need at the edge of the cliff.
Healthier parts of the world are aware of these issues. Last year, Time February 3 European issue had Karl Marx on the cover and a long story inside about the relevance of his ideas today. The U.S. edition had the inauguration on the cover and not a word about Karl inside. Marx is a four-letter word in this country. We need to utter this kind of profanity in the United States of America if we are ever going to get ourselves out of the current capitalistic mess. Capitalism has this incredibly amazing ability to adapt to every new situation. Many of us no longer work together, face to face, and organize. Instead we are the typing left. We sit there alone, in front of this idol we call a computer, and make mystical motions with our fingers and create the click and clack of how we want to make our way ahead. This typing left, blogs, emails, and does endless mouse work. Mouse work is the spiritual motion most of us do with our right hand in a highly ritualized fashion. Mouse work is our religion. We have all become mouse workers. This is how capitalism wants us to behave. This is killing us. We are all in the mouse family, a little like lemmings, running to the edge of the precipice. In the USA we are disposable mice. Some 880,000 of us are recycled every year.
I’m asking you to take first steps, not as lemmings or doing mouse work, not as part of the typing left, so we don’t all die young. These would get us in the direction of policies proposed by presidents of both Republican and Democratic parties and be the non-partisan way of getting us the health we deserve.
Understanding how our health as a nation has declined when the standard is comparing ourselves to others is critical to living more healthy, happy and fulfilling lives. Our children and our grandchildren, our future generations, will long remember the steps we took to ensure their long lives.
So let us take the freedom of expression we all have. We don’t have to be afraid that by talking about our health and advocating for it, that we will be harmed. Recognize that we have a choice between charity or solidarity. Take the ideas I’ve presented and research if they are true or not. Do we die young? Is health care what will make us healthier? Is giving everything to the rich good for the rest of us? If we had a more egalitarian society where there was a maximum wage of $500,000 a year, would we have a longer life, true liberty, and be better off as a nation? If you agree with me, talk to your family, talk to your friends, talk to your co-workers and start prescribing the medicine we need for this nation. Health begins by organizing baby steps. Not by mouse clicks. Those organized steps lead to walking which leads to organizing one another to work together. We need to organize or die. Once we, the other superpower, recognize our collective strength, we are hundreds of millions in this country, the rich are only tens of thousands, then we can get the economic justice policies that turn out to be the best health policies.
If you give me a fish, you’ve fed me for a day. If you teach me to fish then you’ve fed me until the river is contaminated or the shoreline seized for development. But if you teach me to organize then whatever the problem, I can work together with my peers and we will fashion our own solution. As the world’s other superpower, let’s organize for the right to a long life in the United States. Thank you.
For information about obtaining CDs, MP3s, or transcripts of this or other programs, please contact:
P.O. Box 551
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Other AR Stephen Bezruchka programs:
Health & Wealth
From the Womb to the Tomb
Is America Driving You Crazy?