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Health Disparities Interest Group January 2009 Seminar

This HDIG seminar featured the film, Unnatural Causes, Part I: In Sickness and in Wealth. After viewing the film, Dr. Abdul Shaikh of the Health Communication and Informatics Research Branch, Division of Cancer Control and Population Sciences led attendees in a discussion of the film and how it might relate to communicating health disparities concepts. Subsequent parts of this film may be shown at future HDIG seminars.

Photograph of HDIG seminar attendees sitting around a table during the film screening. Photograph of three HDIG seminar attendees sitting side-by-side and discussing the film.

Points Discussed Following the Film

  • The relationships among chronic stress, socioeconomic status, and chronic health effects were explored in the film. Should health disparities be addressed by targeting social conditions (i.e. social determinants of health)?
  • To address health disparities, the focus should not be on individuals or groups of individuals but instead on health control at a larger, broader systemic and structural level. Photograph of HDIG seminar attendees sitting in a row of chairs and discussing the film.
  • An individual's perception of having control over stress may have a greater impact on health than the stress itself. Access to resources strongly influences a person's sense of control over stress.
  • Unlike income, wealth is accumulated over time. In some industrialized countries other than the United States, wealth is taxed at a higher level and those funds are used to fund social programs that serve the country as a whole (i.e., "raise the floor"), rather than only wealthy persons. A social perspective can reduce inequalities and disparities more effectively than a focus on individuals.
  • The concept above, however, seems contrary to the "American way" and American ideals of individualism. Thus this concept is difficult to "sell" at a broad level. Discussion of the middle class and of "helping everyone" may be effective counterarguments.
  • The income and health gap between African Americans and whites had narrowed but recently increased again. Organized advocacy for the poor is currently not very effective.
  • The group noted that the following disparities-related concepts and messages have been under-communicated in the past:
    • The concept of social gradients between groups, in which some groups are more or less well off than others, was introduced in Michael Marmot's Social Determinants of Health. This concept may be highly applicable to the U.S. middle class as a whole and has not been well conveyed in the past. The top 1 percent of U.S. earners has continued to do well, while the socioeconomic standing of other groups has stagnated or declined. People's aspirations to reach the status of the top 1% percent may make them reluctant to support tax increases on the wealthy. Health indicators including diabetes incidence and cancer mortality conform to the concept of a "health-wealth" social gradient, whereas this gradient is less evident for individual cancer sites.
    • Correcting the perception that most poor people are members of racial minority groups may increase the general U.S. population's willingness to pay taxes to fund social programs; in fact, most poor people in the United States are white.
  • Combining the individual and social perspectives may be most appropriate now. Individually tailored interventions should be combined with social policy changes.
  • Until the major social issues can be successfully addressed, individuals need to know how best to live their lives as they are now.
  • The argument for change needs to be transformed from an individually focused one, in which individuals are blamed for their circumstances or feel helpless to improve those circumstances, to an economic one. Instead of framing social change as a redistribution of wealth, it can be framed as an investment: "The cost to all can be reduced if everyone chips in to improve the health of all." This also would help make the true costs of inequality to society as a whole more apparent.

Additional Related Resources Noted During Discussion

  • "The Measure of America: American Human Development Report 2008-2009".
    This report was published in July 2008 by the American Human Development Project.
  • Commission on Social Determinants of Health Final Report: "Closing the gap in a generation: Health equity through action on the social determinants of health".
    This report was published in 2008.
  • Institute of Medicine Report: "State of the U.S.A. Health Indicators".
    This report was published in December 2008.
  • Sir Donald Acheson's "Independent Inquiries into Inequalities in Health Report".
    This report was published in 1998.

Last Modified: 03 Sep 2013