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10 Questions About Health
Unnatural Causes...is inequality making us sick? 
Unnatural Causes is a seven-part documentary series  exploring racial and socioeconomic inequalities in health.

1. Health is more than health care. Doctors treat us when we’re ill, but what makes us healthy or sick in the first place? Research shows that social conditions – the jobs we do, the money we’re paid, the schools we attend, the neighborhoods we live in – are as important to our health as our genes, our behaviors and even our medical care.

2. Health is tied to the distribution of resources. The single strongest predictor of our health is our position on the class ladder. Whether measured by income, schooling, or occupation, those at the top have the most power and resources and on average live longer and healthier lives. Those at the bottom are most disempowered and get sicker and die younger. The rest of us fall somewhere in between. On average, people in the middle are twice as likely to die an early death compared to those at the top; those on the bottom, four times as likely. Even among people who smoke, poor smokers have a greater risk of dying than rich smokers.

3. Racism imposes an added health burden. Past and present discrimination in housing, jobs, and education means that today people of color are more likely to be lower on the class ladder. But even at the same rung, African Americans typically have worse health and die sooner than their white counterparts. In many cases, so do other populations of color. Segregation, social exclusion, encounters with prejudice, the degree of hope and optimism people have, differential access and treatment by the health care system – all of these can impact health.

4. The choices we make are shaped by the choices we have. Individual behaviors – smoking, diet, drinking, and exercise – matter for health. But making healthy choices isn’t just about selfdiscipline.  Some neighborhoods have easy access to fresh, affordable produce; others have only fast food joints, liquor and convenience stores. Some have with nice homes, clean parks, safe places to walk, jog, bike or play, and well-financed schools offering gym, art, music and after-school programs, and some don’t. What government and corporate practices can better ensure healthy spaces and places for everyone?

5. High demand + low control = chronic stress. It’s not CEOs who are dying of heart attacks, it’s their subordinates. People at the top certainly face pressure but they are more likely to have the power and resources to manage those pressures. The lower in the pecking order we are, the greater our exposure to forces that can upset our lives – insecure and low-paying jobs, uncontrolled debt, capricious supervisors, unreliable transportation, poor childcare, no healthcare, noisy and violent living conditions – and the less access we have to the money, power, knowledge and social connections that can help us cope and gain control over those forces.

6. Chronic stress can be deadly. Exposure to fear and uncertainty trigger a stress response.  Our bodies go on alert: the heart beats faster, blood pressure rises, glucose floods the bloodstream – all so we can hit harder or run faster until the threat passes. But when threats are constant and unrelenting, our physiological systems don’t return to normal. Like gunning a car, this constant state of arousal, even if low-level, wears down our engines over time, increasing our risk for disease.

7. Inequality – economic and political – is bad for our health. The United States has by far the most inequality in the industrialized world – and the worst health. The top 1% now owns as much wealth as the bottom 90%. Tax breaks for the rich, deregulation, the decline of unions, racism and segregation, outsourcing and globalization, as well as cuts in social programs destabilize communities and channel wealth and power – and health – to the few at the expense of the many. Economic inequality in the U.S. is now greater than at any time since the 1920s.

8. Social policy is health policy. Average life expectancy in the U.S. improved by 30 years during the 20th century. Researchers attribute much of that increase not to drugs or medical technologies but to social reforms – for example, improved wage and work standards, universal schooling, and civil rights laws. Social measures like living wage jobs, paid sick and family leave, guaranteed vacations, universal preschool and access to college, and guaranteed health care can further extend our lives by improving our lives. These are as much health issues as diet, smoking and exercise.

9. Health inequalities are not natural. Health disparities that arise from our racial and class inequities result from decisions we as a society have made – and can make differently. Other industrialized nations already have, in two important ways: they make sure absolute inequality is less (e.g., Sweden’s relative child poverty rate is 4%, compared to our 22%), and they guarantee that everyone has a chance for prosperity and good health regardless of a family’s personal resources (e.g., good schools and health care are available to everyone, not just the affluent). As a result, they live healthier, longer lives than we do.

10. We all pay the price for poor health. It’s not only the poor but also the middle classes whose health is suffering. We already spend $2 trillion a year to patch up our bodies, more than twice per person than what the average industrialized country spends, and our health care system is strained to the breaking point. Yet our life expectancy is 30th in the world, infant mortality 31st and lost productivity due to illness costs businesses more than $1 trillion a year.  


Produced by California Newsreel with Vital Pictures. Presented by the National Minority Consortia.  Public Engagement Campaign in Association with the Joint Center for Political and Economic Studies Health Policy Institute.    


Adapted from the four-hour PBS documentary series UNNATURAL CAUSES: Is Inequality Making Us Sick?

To learn more about the series and find out how you can make a difference, please visit www.unnaturalcauses.org.


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