Why Johnny Can’t Breathe: Poverty Is a Disease

[McCamy Taylor]

Shortness of breath is a symptom of a variety of diseases. Some people get short of breath as a sign of stress---i.e. they hyperventilate. Others may experience a single episode of difficulty breathing from some isolated, acute (one time) problem like pneumonia, pulmonary embolism, smoke inhalation. Some common chronic (long term) causes are coronary artery disease (CAD), congestive heart failure (CHF), asthma and chronic obstructive pulmonary disease (COPD). Up until recently, these diseases were treated as failures of a single body organ---sort of like worn out brake pads in your car. Decline in the function of organs like the heart and lungs was considered an inevitable process of aging. Medical science existed to help those old, tired organs squeak by until it was time to replace them. This was the principle behind universal health insurance for the elderly or Medicare. Let people live a “normal” life and then give them the chance to patch themselves up when they reached 65.

Now, we know that “normal” or ordinary American life is not necessarily healthy life, and that many of the things we do or experience in our early years are the direct cause of our sickness in later life. For instance, childhood inactivity and overeating lead to obesity which causes diabetes, high cholesterol and high blood pressure. This leads to premature hardening of the arteries or CAD, which is in turn the main cause of CHF, the single most expensive diagnosis for the Medicare system, at more than $20 billion/year.

One of the situations which we have taken for granted in the United States is wealth disparity. Some of us grow up eating caviar with a silver spoon. Others of us will grow up hungry. Many people accept this as not only inevitable but also beneficial. As U.S. citizens, we are taught that early adversity toughens us up. It makes us stronger. “Pull yourself up by your bootstraps” reflects an American ideal that actually celebrates childhood poverty.

In fact, early deprivation and stress make many of us weaker. Physically weaker. This increases the burden of chronic diseases in our country, which contributes to our inflated health care costs of over $7000/per person per year---- over twice as much as any western European country spends to achieve longevity results which are better than ours. In other words, we spend too much and get less for our money. Part of this stems from the fact that we do not spend our health care dollars wisely. Another factor is the increased incidence of preventable, chronic disease in our country. While lifestyle factors (smoking, overeating etc.) play an enormous role, these lifestyle factors can actually be a symptom of a deeper problem----lingering childhood toxic stress. Unless early toxic stress is reduced, we may find it very difficult to change the lifestyle factors that contribute to chronic diseases---like those which make us short of breath. Worse yet, childhood toxic stress can cause these diseases in later life.

On June 3 of this year JAMA (Journal of the American Medical Association) had an article, “Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities:Building a New Framework for Health Promotion and Disease Prevention” by Jack P. Shonkoff, MD; W. Thomas Boyce, MD; Bruce S. McEwen, PhD . Here is a link to the report online. (You have to pay to gain access).

http://jama.ama-assn.org/cgi/content/short/301/21/2252

You can read about the article at these online sites for free.

http://www.infozine.com/news/stories/op/storiesView/sid/36093/
http://www.jointcenter.org/hpi/news/early-childhood-conditions-lead-adult-health-disparities-identified

From the original article:

"Strong associations have been shown between retrospective adult reports of increasing numbers of traumatic childhood events with greater prevalence of a wide array of health impairments including coronary artery disease, chronic pulmonary disease, cancer, alcoholism, depression, and drug abuse, as well as overlapping mental health problems, teen pregnancies, and cardiovascular risk factors such as obesity, physical inactivity, and smoking."

"Early experiences of child maltreatment and poverty have been associated with heightened immune responses in adulthood that are known risk factors for the development of cardiovascular disease, diabetes, asthma, and chronic lung disease."

This is not new research. In “Unhealthy Societies: The Affliction of Inequality” by Richard Wilkinson, chapter 8 is called “The Symptoms of Disintegration.” You can read an excerpt here.

http://books.google.com/books?id=0VXmcCmojzAC&pg=RA1-PA153&lpg=RA1-PA153&dq=the+symptoms+of+disintegration&source=bl&ots=XNH_X64Uob&sig=em9tVbOIBXWM-ZoQrdtaCzPEAF0&hl=en&ei=C-Y7SvCYCIS0Nc-_5LAO&sa=X&oi=book_result&ct=result&resnum=2

The author describes how death rates from certain diseases are higher in countries which have a higher wealth disparity.

“The strongest relationships with income distributions were found with deaths from chronic liver disease and cirrhosis, traffic accidents, infections and---particularly young men---deaths from injuries other than traffic accidents.”

There is also an increase in the rates of homicide and violent crime in countries with a high degree of wealth disparity. Note that absolute poverty does not cause the same increase. If everyone in a country is poor, people seem to live together more harmoniously. The increases in family violence, drug, alcohol and tobacco abuse, depression and suicide seem to be related to the presence of two classes of citizens, one rich and one poor. Wilkinson proposes a theory that societies which tolerate or encourage disparate treatment are less unified. Individuals do not see themselves as part of a larger group. In their perceived isolation, they are more likely to adopt behaviors that provide short term gains or gratification, without regard to the effect which their actions may have on others.

The article from JAMA expands upon the idea that socioeconomic status can contribute to disease. Besides the obvious ill effects of poverty----lack of preventive health care, increased exposure to pollutants from toxic industries that are often located in poorer neighborhoods, poor childhood nutrition, less access to playground facilities in dangerous/polluted inner city neighborhoods, increased exposure to secondhand smoke----early childhood stress can also cause changes in the body which predispose the child to developing disease when he is older.

“Toxic stress refers to strong, frequent and/or prolonged activations of the body’s stress-response systems in the absence of the buffering protection of adult support. Major risk factors include extreme poverty, recurrent physical and/or emotional abuse, chronic neglect, severe maternal depression, paternal substance abuse and family violence. The defining characteristic of toxic stress is that it disrupts brain architecture, affects other organ systems and leads to stress-management systems that establish relatively lower thresholds for responsiveness that persists throughout life, thereby increasing the risk of stress-related disease and cognitive impairment well into the adult years.”

What does that mean in laymen’s terms? Kids who grow up deprived—especially in a land of plenty, like the U.S.---are more likely to be exposed to stressful situations which cause something like post-traumatic stress disorder. In later life, they may react more negatively to stress that the rest of us would blow off. They may develop depression or they may seek relief in tobacco, alcohol or drugs. They may have problems in their relationships caused by their exaggerated responses to stress. And, since the stress hormones can contribute to high blood pressure and hardening of the arteries, they may develop heart disease and congestive heart failure at an increased rate that is independent of factors like poor nutrition, lack of exercise and exposures to tobacco and pollution.

Universal healthcare will help, but it is not enough by itself. Here is a paper from Canada which examines the effects which increasing wealth disparity has had on the country. Though everyone has access to a medical professional in Canada, diseases like those described above have increased as wealth disparity has increased.

http://www.utoronto.ca/qol/IHpaper2.PDF

Here is another study which suggests a psychosocial factor in disease formation. In “Childhood adversities and health variations among middle-aged men: a retrospective
lifecourse study” by Jon Ivar Elstad the author studied 380 men. He discovered that

Childhood adversities influence later health to a large extent as latent
effects. Stressful relations with parents were relatively important for two of the health outcomes, suggesting that not only ill health and material deprivation during childhood, but also an adverse psychosocial environment contributes to ill health among middle-aged men.

Note that the bad effects on health did not appear to be the direct result a result of adult behaviors associated with poverty, such as smoking or low education.

http://eurpub.oxfordjournals.org/cgi/reprint/15/1/51.pdf

What does this mean for Johnny? Even if his mother gets prenatal care to keep him from being born premature and stuck on a ventilator (which can damage the lungs) and even if he gets to see a doctor who prescribes regular preventive medications like inhaled steroids to keep his asthma under control and even if he is able to get his blood pressure and cholesterol checked so that he can receive early lifestyle intervention or medication and even if he resists the pressures to smoke, he may still have trouble breathing.

If we are going to create true health equality (which is not the same as equal access to health care services) we must work to prevent or treat the problems associated with being poor in the United States. Obviously, one step is to normalize income, raising taxes on the rich and providing more generous deductions or even payments to low income families with young children. In order to do this, Americans will need to change a few basic misconceptions, such as the one which goes something like “Money spent of Johnny means less money for me.” This is true only in the short run. In a broader sense, if Johnny can breathe and get an education and go to work and pay taxes and raise the next generation of workers/tax payers, then the whole of society benefits. As long as we continue to think of our neighbor’s disease as our neighbor’s problem (not our own), we will continue to be plagued by violence, high health care costs, reduced productivity and a reduced tax base.

The authors of the JAMA article have other suggestions. Child welfare services (CPS) which traditionally focus on the physical safety of children could be expanded to include more psychological services. In addition, early childhood intervention education services (such as Head Start) could be modified to address more of the psychosocial problems of children living in poverty. These should be considered necessary health expenditures rather than “luxuries” to be trimmed from federal and state budgets whenever money gets tight. Consider vaccinations. Even when the state is out of money, it does not relax rules about childhood immunizations or cut programs that give necessary vaccines. That is because the connection between immunization and the health of the entire community is obvious. If more people are vaccinated, there are less epidemics. We do not stop purifying our water or take out the fluoride in order to balance the budget, because we know we would see more sickness if we did, and the costs of all that extra disease would add up. The same thing holds true for children living in poverty. Unless their problems are addressed, society will suffer unnecessarily high rates of illness, disability and violence---which makes the overall economy weak.

[Quantess]

1. K & R

[KT2000]

2. Good post!

This does mention the close proximity of polluting industries but another consideration is the disposal of toxic industrial wastes in poor communities. There once was a government organization National Environmental Justice Coalition that addressed such problems but the last administration strangled.

The bottom line is that we need to care about everyone in our society.

[Fire_Medic_Dave]

3. I always thought that was common sense.