Film Examines Health in Relation to Inequality

On May 6th, the Cross-Cultural Center held a film and discussion event on the PBS documentary series “Unnatural Causes: Is Inequality Making Us Sick”? The event showed the first episode of the series, called “In Sickness and In Wealth,” to highlight the lives of four different individuals with different socio-economic levels. The film revealed how one’s wealth and class could determine their health, showcasing four individuals of different classes to show the sharp contrasts between their lives in Louisville, Kentucky. The individuals were a hospital CEO, a lab supervisor, a janitor, and an unemployed woman.

The film began with the narrator stating, “We spend two trillion dollars per year on medical care. That’s nearly half of all the health dollars spent in the world.”

Surprisingly, even with the investment in health care, human mortality rates are high.

“But we’ve seen our statistics. We live shorter, often sicker lives than almost every industrialized nation. We rank 30th in life expectancy.”

The film explored the question “Why are we getting sick in the first place? Is it our American diet? Individual behaviors?” The answer, however, was shown to be far more complex as the residents in the film showed the great disparity of living standards amongst different classes in the United States.

The first resident, in Council District 16, was Jim Taylor. Taylor is the white CEO of a hospital. Taylor stated, “We’re fortunate that the choices we have may be greater than people who have less means than we do. I have a neighborhood where I can be outside and know that I’m safe and that I can exercise and walk. And I know that not every neighborhood in this country or in this city that’s true.” Statistics have shown that residents living in Council District 16 live fairly long lives, with the life expectancy being around 80 years old.

Tondra Young, the second resident featured lived south of Council District 16 in Council District 24. Young had recently purchased a house and calls herself part of the middle class. Young is a 37-year-old African-American who works in Taylor’s hospital as a lab supervisor. The film stated that she was going to graduate from college soon. Young stated, “I am going to graduate in the spring. I’m very excited about that. I’ve traveled a long way to even get to that point.”

This was significant for Yong not only as a life achievement but as the narrator points out, “Research shows that college graduates live on average two and a half years longer than high school graduates.” The life expectancy for residents in Council District 24 is 75 years, slightly less than the expectancy for residents in Council District 16.

The third resident, Corey Anderson, is an African-American man who works at Jim Taylor’s hospital as a janitor. He and his wife, Angelique Anderson, make a combined income of around $48,000. Life is not as easy for the Andersons as the narrator states, “At 37, Corey has already been diagnosed with hypertension, joining 1/3 of the resident in Council District 21. Average life expectancy here is two years shorter than in Tondra’s council district; six years less than in Jim Taylor’s.”

The last resident, Mary Turner, was in the lowest socio-economic class and a resident of Council District 5. Turner is an unemployed white woman with a disabled husband and three children. As the narrator points out, “Life expectancy in Mary’s Council District is more than three years less than in Corey’s district; nine years less than in Jim Taylor’s.”

Turner is currently unemployed, but finding employment also causes problems for her because of the medical coverage she gets.

“I do feel things are out of control sometimes. Because as soon as you try to better yourself; If I even get a job, you know, then I might lose my medical coverage, and my medical coverage is necessary.” She explained that she had a heart attack several years ago.

S. Leonard Syme, an epidemiologist from the University of California Berkeley and guest lecturer asks the basic, “We know that social class is the most important determinant of health above any other risk factor. But what does social class mean?”

The idea of control comes up, and Syme explains, “What I mean by it is the ability to influence the events that impinge on your life, even if it means not doing anything, but one way or the other, managing those pressures.”

Having control over one’s life does decrease risk of stress because it gives the person influence over the course of one’s life. As such the opposite is also true.

The narrator states, “When we feel threatened or don’t have control in our lives, one critical biological reaction kicks in: the stress response. When the brain perceives and threat, it signals the adrenal glands to release potent stress hormones. Among them, cortisol.”

Cortisol is a stress hormone that, when released for long periods of time in one’s body, can put the body at high risk for heart disease, blood pressure, and depression. Bruce McEwen, a neuroscientist from Rockefeller University states, “We produce too much cortisol. Chronically, cortisol can impair immune function. It can actually inhibit memory and can even cause areas of the brain to shrink.”

The narrator explained that although all four residents have stress, the ones on the higher ladder of class have the power to be able to control it, while those at the bottom of the ladder, like Corey Anderson have considerably less. Race also has an input in this issue, and statistics show that, “African-Americans die earlier and have higher rates than whites of many chronic diseases across the social gradient.” This is in part due to stress from racial discrimination that African-Americans may receive.

In the end the film calls for action and showcases several community programs from across the country dealing with health equity. After the film, two UCI Family Medicine residents hosted a question and answer question. Maria Robles, a second-year, and Eduardo Ramrez talked about their experiences as residents. When asked about why she chose to take part in this program, Robles stated, “I specifically chose this program because it would give me the opportunity to work with patients, particularly with the Latino community. I try to stay positive and every day is a struggle but I go in with the best intentions every single day and try to work with every single patient that I can help as much as possible. I take it one patient at a time and that’s as much as I can do.”

Robles gave her advice in helping decrease this health disparity amongst classes. She stated, “I think that every day I try to learn the most I can, not only about my patients but also try to learn about things like public policy. I’m more involved with this particular program called PRIME which works to educate you to be a leader in a community and I think that really helps us because it teaches us to be leaders so that we can go out there and help initiate, maybe start some of the changes that need to be made to help the communities that have these health disparities.”