OrangeClouds115 has a diary on the Rec list that reminded me to post some additional relevant data indicating why socioeconomics, the distribution of wealth, has significant ramifications for the General Welfare. My thesis is not entirely novel: Economic and social inequality contributes to stress, which leads to health problems. If these inequalities are a consequence of government policy, they violate the purpose of our government, which is broadly outlined in the preamble of the Constitution:
We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.
While I would argue the current Republican Party is actively and perniciously subverting all of these principles at an alarming rate, this diary focuses on the idea that the Constitution promotes good health through liberty and egalitarianism.
(disclaimer: I'm not an epidemiologist, just a person who does some basic research involving stress, motivation, and obesity.)
Let's start with OrangeClouds115's obesity map. That map is not graded in detail but shows that the Midwest and much of the Southeast have higher incidences of obesity, indicated by the darker blue regions compared to the lighter blue regions.
Now let's see a map for rates of mortality from cardiovascular disease (in white males) from about the same part of the decade. In this map, red indicates higher rates, whereas green indicates lower rates. While greater in detail, clearly the rates of heart disease deaths largely correspond to the rates of obesity. No big surprise. Maps of many other diseases would also look like the heart disease death map.
Now, let's take a look at a map showing percentages of the population living in poverty. Like the heart disease deaths map, red shows higher poverty rates, whereas green shows lower rates.
Holy Shittake! It's almost hard to tell which map is which! They are largely substitutable. Now I wish I had a more finely detailed map of body mass index distributions, but I'll press on confidently without one, because we do have causal evidence for a relationship between stress and obesity.
The following two graphs show what happens to body fat when you control stress hormone levels. In this case, the endogenous stress hormones were removed from rats and replaced with nothing, low stress hormones, or high stress hormones (top graph). The bottom graph shows how stress hormones dose-dependently increased the fattiness of the rats. More stress = more fat.
Now, just by artificially controlling stress hormone levels, we increase the risk for all kinds of other diseases, as well, including diabetes, stroke, cancer, etc. Let's not get into shit-loads of data, though the data come in shit-loads.
Let me tell you something else stress does: When the hormone gets into the brain, which it does within minutes, it makes you start squirting all kinds of motivational juices that make you want to do things, like eating fats and sugars, abusing and/or relapsing to drugs, and escaping from further un-pleasurable things that made you stressed to begin with, such as an aversive work place. Engaging in stress-related behaviors frequently reduces stress temporarily, but clearly, there are some viscous cycles involved and heavy penalties to pay in the long-term. Simply put, stress causes you to live a generally unpleasant, immoderate, and unhealthy life, and you die earlier.
What causes stress in humans? Just about everything, but the number one thing appears to be something called "Status Syndrome." Listen to this epidemiologist, Michael Marmot, MBBS, MPH, PhD, FRCP, FFPHM, who I hope is as well-dressed as he is mo' fo' credentialed:
In rich countries, such as the United States, the nature of poverty has changed--people do not die from lack of clean water and sanitary facilities or from famine--and yet persistently, those at the bottom of the socioeconomic scale have worse health than those above them in the hierarchy.
Katrina victims aside, this is largely true. The US enjoys relatively abundant, and life-sustaining basic needs. Access to health care is a different story. We suck as the only leading industrial nation to have 40 million people without healthcare, but that is not the whole story, as Marmot notes:
The Whitehall II study of British Civil Servants showed that the lower the position in the occupational hierarchy, the more cardiac investigations and the more interventional procedures for coronary artery disease were performed. The higher rates of interventions in lower grades match, proportionally, the higher rate of disease. There was no evidence of undertreatment of the less privileged.
Thus, the social gradient in disease cannot be entirely attributed to lack of healthcare, as the civil servants had equal access and treatment. They also controlled for differences in lifestyle. Robert Sapolsky, Stanford primatologist and neuroscientist, has found similar social gradients in disease rates among baboons, and the effect appears to be general among primates.
Let me cut to the chase: Status itself, which is a relative concept that can be independent of absolute income level and health care opportunities, but which is frequently a consequence of economic status, is one of the primary determinants of stress levels and disease in humans.
Why status? Because status reflects more fundamental things such as personal control, agency, autonomy. Marmot turns his attention to black sub-populations:
It is not what a person has that is important, it is what he or she can do with what he or she has. By that scale, blacks in the United States have about 4 times the income of men in Costa Rica or Cuba, but about 9 years' shorter life expectancy...the ways that blacks in the United States are worse off have little to do with absolute income. They have much more to do with 2 fundamental human needs: autonomy and full social participation. Deprived of a clean, safe neighborhood, meaningful work, opportunities for children's education, freedom from police harassment and arrest, and freedom from violence and aggression, it is harder to have control over one's life or be a full social participant.
In other words, the vision of life outlined in the preamble of our Constitution is an optimization of healthy living. The more egalitarian, the better. George Bush and the Republican Congress are literally bad for your health. If they don't physically kill you, they will kill you emotionally.