Social and Economic Causes of Disease
Many of us are aware that the leading cause of death in the U.S. during the first half of the 20th Century was due to infectious diseases. On the other hand there is a general lack of understanding that these diseases were eliminated for the most part, by Public Health disease prevention strategies, such as clean water, sewage treatment and food safety. We can correctly call these killers “social diseases”—defined by Merriam-Webster Dictionary as “diseases whose incidence is directly related to social and economic factors.”
Today, many of us are unaware that our modern epidemic killer diseases, which developed in the second half of the 20th century, are also social diseases: cancer, heart disease, unintentional injuries, diabetes, and obesity. The magnitude of this epidemic can be appreciated by a study of the top two causes of death from the age of four through sixty-four. In 2013 this age group suffered approximately a quarter of a million deaths! That is only one year of an ongoing epidemic. Such senseless death is preventable through social and economic change. Our present epidemics cannot be prevented by visits to the local medical doctor or hospital. Recent studies have identified more specific social determinants of disease and have pointed the way to the necessary social changes needed to create a healthy society and eliminate the epidemics of the 21st Century.
During the 1854 Cholera epidemic in London, Dr. John Snow discovered that the public drinking water was polluted and convinced the local council to disable the public well pump by removing the handle. The epidemic promptly ended. Dr. Snow is considered the father of modern Public Health. Epidemics of pneumonia, tuberculosis and diarrheal diseases were the leading killers in 1900. By 1940 the death rate had dropped by 75 percent. This remarkable reduction in death rates occurred before the introduction of antibiotics and vaccines, and was the result of major Public Health policy involving sewage disposal, water treatment, food safety, public education, chlorination and pest control. Today the Center for Disease Control, “CDC 24/7 Saving lives, Protecting People,” states “chronic diseases and conditions, such as heart disease, stroke, cancer, obesity and diabetes…are among the most common, costly and preventable of all health problems.”
According to the Bulletin of the World Health Organization, 2011, “Action on Social Determinants of Health is Essential,” “Eighty percent of non communicable diseases could be prevented through primary prevention.” These diseases “arise from exposures throughout the life course, starting in utero.” Poor quality diets filled with fats, chemicals, along with toxins in our air, water, food and job sites are known to be responsible for the majority of the present cancer epidemic. (See The Politics of Cancer Revisited, Dr. S. Epstein 1998.)
In 2003 the World Health Organization (WHO) published their “social determinants of health.” A partial list includes: social inequality/ hierarchy, race, gender, lack of control over stress, unemployment, education, income inequality, working conditions, job security, and food. These are John Snow’s modern water pumps of our society. Multiple studies have supported the crucial role of inequality in causing diseases. Greater inequality means higher mortality, “When you compare the highest versus lowest rungs of the socioeconomic ladder, the risk of some diseases varies ten-fold” (Scientific American, December 2005).
Social inequality is also correlated with life expectancy. “High levels of inequality, most notable the United States, experience worse overall health than do countries that are more egalitarian.” This knowledge is well documented by Harvard Public Health Professors in their 2001 book, The Health of Nations: Why Inequality is Harmful to Your Health. The more egalitarian a society is, the better the health of the people and the longer they live. Unequal society has clearly been documented to cause shorter and unhealthier lives. The proof of shorter lives down the social ladder has been documented throughout Western societies. Soaring death rates over the last decade for middle age white women is a deadly reflection of accelerating inequality in the U.S.
Despite John Snow’s success in ending the cholera epidemic in London in 1854, cholera later returned due to Public Officials refusal to clean up the cesspools and sewers. Similarly today, vested interests in the status quo refuse to make the necessary changes. This becomes apparent when we examine funding for Public Health Measures, which have largely failed to control the modern epidemics, such as deaths from cancer and heart disease. Only three percent of the $2 trillion spent on health in the USA in 2009 went to Public Health activities. Public Health Policy has not been robust given the power of the super rich. The more hierarchy and income inequality that exists in society, “the more incentive the wealthy will have to oppose public expenditures benefitting the health of the community.” (Scientific American, December 2005). This reality is vividly seen in the massive power of lobbying in Congress. Dennis Raphael, states, in Beyond Policy Analysis (2014), if “a nation’s political economy is dominated by the business and corporate sector, they are generally opponents of developing public policy that equitably distributes the social determinants of health.”
Despite the power of the corporate sector, the Public Health Department of Finland, during the late 1960s, was able to lead a large coalition of health workers, and educators along with strong community involvement to change a number of socio economic factors, including: the food industry, dairy industry, agriculture, schools, along with cigarette and alcohol consumption. These changes resulted in dramatic health improvement. The mortality rate from heart disease for men was reduced by 73 percent along with major reductions in all causes of mortality in just 25 years.
Ending the present U.S. epidemic, that is claiming a quarter of a million lives every year, will require social and economic transformation that moves our society as close to egalitarianism as possible. Social diseases require social solutions. Our scientific knowledge is a guide to action. Overwhelming evidence indicates that only a society that is profoundly egalitarian has the potential to eliminate our modern disease epidemics. In the words of the famous Dr. Rudolph Virchow (1821-1902), “Medicine is a social science, and politics is nothing else but medicine on a large scale.” What would Dr. John Snow do now?
Dr. Gordon is a Family Physician who has practiced in the San Francisco Bay area for over thirty years. He has written articles in the past on health related issues.