Ichiro Kawachi
Director, Harvard Center for Society and Health
It's official. For the first time in a decade, the economy is in recession.
The longest period of expansion in U.S. history is over. Between July and September
of this year, the economy shrank at an annual rate of 1.1 percent. The Labor
Department announced that the unemployment rate rose from 5.4 percent in October
to 5.7 percent in November.
Recessions inevitably spell trouble for public health, whether in the form of
more Americans losing health insurance or growing queues at community food banks.
But while our politicians busy themselves devising an economic stimulus package
that will lift us out of the recession, this is a timely moment to reflect on
our nation's health achievement during the prolonged boom that just ended. It
is a dismal record.
For despite being the richest country in the world, our nation ranks 12th overall
on 16 different indicators of health status compiled by the Office for Economic
Co-operation and Development (OECD)--behind Japan, Sweden, Canada, France, Australia,
Spain, Finland, the Netherlands, the United Kingdom, Denmark, and Belgium. Among
specific indicators, we rank 13th (at the bottom) for percentage of low birthweight
babies, 13th for infant mortality, 13th for years of potential life lost due
to premature causes of death, and 11th for life expectancy at age one for females
(12th for males).
To put it bluntly, our nation's health performance has not matched our economic
performance. A major explanation for our lamentable health record lies in the
huge racial and socioeconomic disparities that persist in this country. For
example, an African-American male born in Washington, D.C., can expect to live
on average 57.9 years--which is lower than the average life expectancy of the
male citizens of Ghana (58.3 years), Bangladesh (58.1 years), and Bolivia (59.8
years). Disparities in health status are in turn mirrored by disparities in
living conditions. Even before the economic downturn, 12 million of our nation's
children were going hungry each year, upwards of two million individuals were
homeless, and 43 million Americans went without health insurance.
It is no secret that the U.S. pattern of economic growth during the past two
decades has been a very uneven one. While the rich got richer and healthier
(for example, the average life expectancy of an Asian woman living in Westchester
County was 90.3 years), the rising tide of prosperity hasn't done much to narrow
our health gaps.
If our abysmal international ranking happened in sports rather than health--let's
say at the Winter Olympics--there would be a public outcry, and our politicians
would immediately pump hundreds of millions of dollars into athletic programs
to correct this source of national shame. Now is the time, more than at any
other moment in recent history, to root for a stimulus package for our nation's
health. I don't mean just investing in bioterrorism response capability, important
as that is. As Congress weighs the merits of alternative economic stimulus packages,
consisting of tax cuts and spending increases worth billions of dollars, it
is time for public health to lend our support to investments that will lift
all boats--not just the luxury yachts--and that will eliminate health disparities,
thereby improving the health of all of our citizens.
Harvard Public Health Review Winter 2002/text version
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