PERVERSE POLICY. Study after study shows that early childhood poverty can have lifelong health consequences. Twenty-two percent of American children live in poverty. A new documentary — Unnatural Causes: Is Inequality Making Us Sick? — will be shown at several locations in Multnomah County in March and April. Pictured is an image from part one, "In Sickness and In Wealth." (Photos/California Newsreel)

From The Asian Reporter, V18, #10 (March 4, 2008), page 11.

By Ian Blazina

The United States spends more money on healthcare than any other nation in the world, yet consistently ranks below most other developed nations on the majority of health indicators. We have the greatest socioeconomic inequality in the industrialized world, and the worst health.

The strongest predictor of health is socioeconomic standing, with people at the bottom of the class ladder four times as likely to die an early death as the people at the top. And even accounting for socioeconomic status, people of color have worse health and die sooner than their white counterparts.

While there is no doubt individual lifestyle choices greatly influence health, health behavior is regulated by where we live and work. Access to healthy food, safe places to exercise, clean parks, nontoxic housing, well-financed schools, well-paying jobs, sick leave, and a host of other quality-of-life issues mean more to our health than how often we go to the doctor.

According to a study of health indicators performed by the Multnomah County Health Department on data from 2001 to 2005, the homicide rate for Asian and Pacific Islanders (API) in Portland is nearly twice that of white non-Hispanics; 22 percent of API women do not receive prenatal care in the first trimester of pregnancy, compared with 15 percent of white women; and the percentage of low-birth-weight babies born to API mothers is 17 percent higher than babies born to white mothers. Additionally, breast cancer mortality among API women has more than doubled since the early 1990s, and lung cancer mortality — while decreasing among whites and African Americans — is 34 percent higher than a decade ago.

These disparities correspond to inequality in the socioeconomic realm, where APIs make roughly 60 percent of their white counterparts and tend to live in neighborhoods with limited transit service, restricted park access, low sidewalk coverage, and poorer schools.

Understanding the institutional, systemic nature of health inequality — including the wide range of environmental, economic, and social determinants — it is clear that righting health disparity in the U.S. must involve much more than health savings accounts, single-payer health insurance, or even universal healthcare. Addressing the issues of grossly unequal wealth distribution and the long history and culture of racism and discrimination is fundamental to creating just solutions to this far-reaching crisis.

The Multnomah County Health Department is currently taking part in the nationwide Health Equity Initiative, a multi-year program involving community engagement, assessment, and policy development related to the societal influences on health. The initiative seeks to educate people on the ways social policy affects health policy, highlight efforts to eliminate disparity, and create a dialogue on finding policy solutions.

Part of the Health Equity Initiative includes public screenings of the PBS documentary Unnatural Causes: Is Inequality Making Us Sick?, a seven-part series examining the effect on health disparity of income inequality, neighbor- hoods, acculturation, racism, land use, unemployment, and foreign policy. Screenings are held throughout the county, and are followed by dialogues with community members, organizations, civic and business leaders, and local elected officials.

For more information, including dates, times, and locations of the documentary screenings, call (503) 988-3030, ext. 22068 or visit <www.mchealth.org/healthequity>.