Tuesday, May 14, 2013

Blue Monday (Mens At Work)


POOR BRAIN (POBRE)
POOR EXERCISE
Where once “prosperous” was a synonym for overweight, being fit (and thin with it) is a marker of status...
Exercise is not quite yet a luxury good, but it may be getting that way.
IN OTHER WORDS, POOR PEOPLE CAN'T AFFORD TO BE FIT (SLIM AND TRIM AND HEALTHY) THESE DAYS BECAUSE THEY'RE TOO POOR TO EAT HEALTHY FOOD, JOIN HEALTH CLUBS, AND ASSOCIATE WITH PEOPLE AND LIVE IN COMMUNITIES THAT CHAMPION A HEALTHY LIFESTYLE AND BEHAVIORS.

https://jaymans.wordpress.com/2013/04/30/obesity-and-iq/
POOR GENES, POOR HEALTH!

https://theconversation.com/its-not-a-lack-of-self-control-that-keeps-people-poor-47734
POOR LIFE, POOR DECISIONS
You Live Next To High End High Rises, But You Can't Even Rise Out Of The Gutter Or Your Bed Because You're Too Dam High All The Time!

http://archpedi.jamanetwork.com/article.aspx?articleid=2381542 
You Were Poor When You Conceived That Poor Child, So You Feed Him A Poor Diet. Then He Was Born Into A Poor Environment (Poor Household And Poor Community) And Thus Continued To Eat A Poor Diet And Be Exposed To Poor Stimuli (Environmental Stimuli That Didn't Help His Brain Develop As Well As It Could Have). Now, Because Of All Of These Poor Influences On Him He's Going To Experience A Number Of Poor Quality Of Life Indicators Growing Up, Grow Up To Be Poor, And Repeat The Cycle (Pass On These Poor Genes And Poor Cultural Traits To His Poor Children). Poor You And Him And His Poor Children!

"U NEED TO GROW UP BITCH!" - MR. FREE
Brain Plasticity and Environments of Poverty

Research involving nonhuman animals (where the environment can be experimentally manipulated, controlled, and precisely measured) demonstrates that environmental stimulation, parental nurturance, and early life stress affect brain structure and functioning.12- 14 These kinds of early experiences map adversities characteristic of poverty environments. When compared with their more-advantaged peers, children living in poverty experience less parental nurturance while confronting elevated levels of life stress, increased family instability, and greater exposure to violence. Their homes are more crowded and often provide less-cognitive stimulation.15





Initial efforts to understand the effects of poverty on the human brain structure and development used neurocognitive tests to assay functions associated with specific areas of the brain.16 There is strong evidence that poverty influences language (tied to the temporal lobe) and executive functioning (related to the frontal lobe).17- 19 Deficits in the executive functioning of individuals in poverty have been found during the life course in studies conducted during infancy20 as well as in childhood, adolescence,21 and adulthood.22 Motivated by these findings, a growing number of studies have used neuroimaging and found smaller volumes in the frontal and temporal lobes for children and adolescents living in poverty.23,24 Different facets of poverty, including elevated life stress and less caregiving support,25,26 may uniquely or interactively contribute to such differences in neurobiology.

http://www.fastcoexist.com/3030882/born-behind-the-effects-of-income-inequality-start-while-youre-in-the-womb?partner=rss
Hey, Young Beaner Girls, Young Nigger Girls, And Young White Trash Girls Who Had A Baby At An Early Age, You Have Destined Your Baby (The Male Or Female Offspring That You Had) To A Life Of Disadvantage, Deprivation, And Despair! Why? Because You Got Pregnant (Conceived A Child) And Gave Birth To A Child At One Of The Least Opportune Times In Your Life. Why Was It An Inopportune Time To Have A Child In Your Teens And Early Twenties? Because You Were Psychologically Immature, Physically Immature, Had Little Education, Were Of Low Status And Low Wealth (Or No Wealth). (In Other Words, You Were Of Low Socioeconomic Status!) In Addition To This, You Had Children With Males Who Were Just As Psychologically Immature, Unestablished, And Genetically Inferior. And What Has This Led To? It's Led To The Child You Have Now Inheriting Disadvantageous Genetic Traits And Being Raised In A Poor, Disadvantageous Environment. You Gave Him/Her A Poor Prenatal Environment (Your Lack Of Wealth And Lack Of Status Affected Your Endocrinological System (i.e. Hormones) And Nervous System, Among Other Things) And Are Now Giving Him/Her A Poor Post-Natal Environment (You're Raising Him/Her In The Gutter With Other Gutter Kids/People). (You Should Have Never Been Having SEX Or Even Had The God Damn Kid In The 1st Place!)

11 Feb 2014
Environment starts long before birth. An adverse, stressful environment can leave imprints, can leave scars lasting a whole lifetime.

Children of teen mums tend to have worse life outcomes. A big part of the reason seems to be that teen mums have their kids with lower-quality guys, which may affect kids' outcomes through nature and/or nurture.

http://www.economist.com/news/finance-and-economics/21635477-behavioural-economics-meets-development-policy-poor-behaviour
YOU'RE POOR AND YOU'RE GONNA STAY POOR. "WHERE YOU STAY AT?"

It is well known that the poor have much higher rates of obesity and chronic disease than do the rich. There are many reasons for the difference, and it is difficult to pinpoint one factor that is responsible. In the United States the poor exhibit two separate traits that argue against personal responsibility.

First, there are possible genetic issues. It is well known that African Americans and Latinos in the United States are more economically disadvantaged than their Caucasian peers. These demographic groups have higher rates of obesity than Caucasians - 40 percent of Latinos and 50 percent of African Americans are obese - and are more likely to have associated medical problems, such as metabolic syndrome. Certain genetic variations are more common in specific minority groups. These differences in DNA may, in part, explain the higher rates of obesity and certain metabolic diseases, such as fatty liver (see chapters 7 and 19). Genetic makeup is certainly not a choice.

Second there are issues of access. There is a difference between the "healthy" diet of the affluent, who can purchase fresh, unprocessed foods that are high in fiber and nutrients and low in sugar, but at high prices, and, the unhealthy diet of the poor, which consists mainly of low-cost processed foods and drinks that do not need refrigeration and maintain a long shelf life. But access does not refer only to what people can afford to buy. Many poor neighborhoods throughout America lack farmers' markets, supermarkets, and grocery stores where "healthy" foods can be purchased. Many supermarkets have pulled out of poor neighborhoods, mainly because of financial decisions based on revenue and fear of crime. The national supermarket chain Kroger, which is headquartered in Cincinnati, in 2007 purchased twenty former Farmer Jack stores in the suburbs of Detroit, Michigan, but none within the Detroit city limits. The nearest branch is in Dearborn, eight miles away from downtown. Many who live in low-income areas also have limited access to transportation. Lower-class urban areas throughout America have been labeled "food deserts" because they are unable to sustain a healthy lifestyle. If the only place you can shop is a corner store for processed food, is what you eat really a choice? In wealthier areas of San Francisco, nearly every block has an organic food store, while in the city's poorer areas, each corner is dotted with a fast food franchise. 

THE REAL 8 MILE

Even when all foods are available at low cost, the poor may not have access to refrigerators or even kitchens. Many SROs (single-room occupancy) hotels have only hot plates and no space for keeping or cooking healthy meals. Further, there is the issue of time. Many poor families are led by parents who work multiple jobs and are unable to come home and prepare healthy meals for their children, instead relying on fast food or pizza.

Lastly, the poor suffer from issues of food insecurity. People experience massive amounts of stress when they don't know where there next meal is coming from (see chapter 6). They eat what is available, when they can - usually processed food. That level of stress is incompatible with the concept of choice. Stressed people can't make a rational choice,  particularly one in which short-term objectives (e.g. sating the hunger) are pitted against long-term objectives (e.g., ensuring good health).

 Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease. Lustig, p. 27-29

The relationship between stress, obesity, and metabolic disease begins with the hormone cortisol, which is released by your adrenal glands (located on top of your kidneys). This is perhaps the most important hormone in your body. Too little cortisol, and you can die. If you're missing any other hormone in your body - growth, thyroid, sex, or water-retaining hormones - you'll feel lousy and your life will be miserable, but you won't perish. But if you're missing cortisol, you can't handle any form of physical stress. As David Williams stated in the 2008 PBS series Unnatural Causes, "Stree helps to motivate us. In our society today everybody experiences stress. The person who has no stress is a person who is dead." The acute rise in cortisol keeps you from going into shock when you dehydrate, improves memory and immune function, reduces inflammation, and increases vigilance. Normally cortisol will peak in a stressful situation (when you're being chased  by a lion or your boss is yelling at you for not getting the memo). Cortisol is necessary, in small doses and in short bursts.

Conversely, long-term exposure to large doses of cortisol will also kill you - it'll just take longer. If pressures (social, familial, cultural, etc.) are relentless, the stress responses remain activated for months or even years. When cortisol floods the bloodstream, it raises blood pressure, increases the blood glucose level, which can precipitate diabetes; and increase the heart rate. Human research shows that cortisol specifically increases caloric intake of "comfort foods" (e.g. chocolate cake). And cortisol doesn't cause just any old weight gain. It specifically increases the visceral fat (see chapter 8), which is the fat depot associated with cardiovascular disease and metabolic syndrome.

 Beginning in the 1970s and lasting more than thirty years, the seminal "Whitehall study" charted the health of twenty-nine thousand British civil servants. In the beginning, the scientists hypothesized that the high-power executives would have the highest rates of heart attack and coronary disease. The opposite proved to be true. Those lowest on the totem pole exhibited the highest levels of cortisol and of chronic disease. This held true not just on the bottom rung: the second person down on the social ladder had a higher likelihood of developing diseases than the person on the top rung, the third had a higher predisposition than the second, and so on. Death rates and illness correlate with low social status, even after controlling for behavior (e.g. smoking).

 The same holds true in America. The prevalence of diseases such as diabetes, stroke, and heart disease are highest among those who suffer from the most stress, namely middle- and lower-class Americans. These stresses are acutely felt in children as well. Almost 20 percent of American children live in poverty. The lifelong consequences of food and housing insecurity are toxic to the brain and alter its architecture early in life. In particular, cortisol kills neurons that play a role in the inhibition of food intake. Whether one builds a strong or weak foundation in childhood is a great determinant of later health and eating patterns. Thus, childhood stress increases the rick of obesity during adolescence and adulthood.

 Some of the factors associated with lower thresholds for stress and higher "cortisol reactivity" are low socioeconomic status, job stress, being female, scoring high in dietary restraint (a measure of chronic eating), and an overall lack of power and confidence. Taking three buses to get anywhere, working two or more jobs, figuring out how to put food on the table, and not knowing whether you will be able to pay the rent - all significantly affect not just your state of mind but also your physiological state. And if you are not Caucasian, the stresses associated with racism will double these health effects. African Americans and Latinos suffer from higher mortality rates of nearly every disease than their white counterparts. While there are certainly genetic influences, stress plays a major role in health disparities among the races.

 Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease. Lustig, p. 65-67.

HEY, NIGGERS, YOU'RE POOR AND YOUR HEALTH IS POOR. BUT YOU'RE MAKING WHITEY RICH BY EATING THE POOR FOOD (SHIT) THAT HE PROVIDES YOU IN YOUR POOR COMMUNITIES. (WHITEY'S GETTIN' WEALTHY AND HEALTHY OFF YOU NIGGERS!)


POOR PEOPLE AND GHETTO PEOPLE (PEOPLE THAT INHABIT LOWER CLASS NEIGHBORHOODS), TAKE THE TIME OUT OF YOUR MEANINGLESS DAY TO GATHER THE PATIENCE TO READ THE FOLLOWING PARAGRAPHS. YOUR LOW INTELLIGENCE, LOW LEVEL OF EDUCATION, LOW INCOME, LOW SOCIOECONOMIC STATUS, LOWER CLASS NEIGHBORHOOD AND LIFESTYLE ASSOCIATED WITH ALL OF THESE LOW QUALITY OF LIFE INDICATORS RESULT IN YOUR POOR HEALTH AND SHORT LIFESPAN. THE WEALTHY (THOSE OF HIGH SOCIAL STATUS) ARE LARGELY TO BLAME FOR THIS. I'M A LIBERAL.

http://news.nationalgeographic.com/news/2014/09/140901-american-diet-obesity-poor-food-health/
POOR PEOPLE EAT A POOR DIET. THAT'S WHY THEY LOOK POOR AND HAVE POOR HEALTH.

http://www.overcomingbias.com/?s=luxury+fever
YOU'RE POOR.
Why hierarchy creates a destructive force within the human psyche (by dr. Robert Sapolsky) 

READ MY POSTS IN THE LINKS ABOVE AND BELOW

 
Stress, Portrait of a Killer - Full Documentary (2008)

http://bobsutton.typepad.com/my_weblog/2009/11/the-baboon-troop-that-mellowed-out-after-the-alpha-males-died-the-sapolsky-and-share-study.html 
I'm Sorry, I Made A Mistake. When You Die You Can Leave Behind Something Other Than Your Genes. While You're Alive You Can Use Your Life To Make A Positive Impact On People And Influence Them To Think And Behave As You Do (That Is, If You Think And Behave In A Positive Manner). You Can Subsequently Create A Sub-Culture That Establishes More Moral, Conscientious, Empathetic, Compassionate, Selfless, Fair, Etc. Codes Of Conduct And Leave Behind A Legacy Of Beneficial Work And Behavior That Inspires Others To Do The Same (To Be Like You).


SOCIOECONOMIC STATUS, STRESS, AND DISEASE

If you want to see an example of chronic stress, study poverty. Being poor involves lots of physical stressors. Manual labor and a greater risk of work-related accidents. Maybe even two or three exhausting jobs, complete with chronic sleep deprivation. Maybe walking to work, walking to the laundromat, walking back from the market with the heavy bag of groceries, instead of driving an air-conditioned car. Maybe too little money to afford a new mattress that might help that aching back, or some more hot water in the shower for that arthritic throb; and, of course, maybe some hunger thrown in as well.... The list goes on and on.

Naturally, being poor brings disproportionate amounts of psychological stressors as well. Lack of control, lack of predictability: numbing work on an assembly line, an occupational career spent taking orders or going from one temporary stint to the next. The first one laid off when economic times are bad—and studies show that the deleterious effects of unemployment on health begin not at the time the person is laid off, but when the mere threat of it first occurs. Wondering if the money will stretch to the end of the month. Wondering if the rickety car will get you to tomorrow's job interview on time. How's this for an implication of lack of control: one study of the working poor showed that they were less likely to comply with their doctors' orders to take antihypertensive diuretics (drugs that lower blood pressure by making you urinate) because they weren't allowed to go to the bathroom at work as often as they needed to when taking the drugs.

As a next factor, being poor means that you often can't cope with stressors very efficiently. Because you have no resources in reserve, you can never plan for the future, and can only respond to the present crisis. And when you do, your solutions in the present come with a whopping great price later on—metaphorically, or maybe not so metaphorically, you're always paying the rent with money from a loan shark. Everything has to be reactive, in the moment. Which increases the odds that you'll be in even worse shape to deal with the next stressor— growing strong from adversity is mostly a luxury for those who are better off.

May 17
If we are exposed to some awful stressors early in life, forever after we will be more vulnerable..

Along with all of that stress and reduced means of coping, poverty brings with it a marked lack of outlets. Feeling a little stressed with life and considering a relaxing vacation, buying an exercycle, or taking some classical guitar lessons to get a little peace of mind? Probably not. Or how about quitting that stressful job and taking some time off at home to figure out what you're doing with your life? Not when there's an extended family counting on your paycheck and no money in the bank. Feeling like at least jogging regularly to get some exercise and let off some steam? Statistically, a poor person is far more likely to live in a crime-riddled neighborhood, and jogging may wind up being a hair-raising stressor.

Finally, along with long hours of work and kids to take care of comes a serious lack of social support—if everyone you know is working two or three jobs, you and your loved ones, despite the best of intentions, aren't going to be having much time to sit around being supportive. Thus, poverty generally equals more stressors—and though the studies are mixed as to whether or not the poor have more major catastrophic stressors, they have plenty more chronic daily stressors.

All these hardships suggest that low socioeconomic status (SES— typically measured by a combination of income, occupation, housing conditions, and education) should be associated with chronic activation of the stress-response. Only a few studies have looked at this, but they support this view. One concerned school kids in Montreal, a city with fairly stable communities and low crime. In six- and eight-year-old children, there was already a tendency for lower-SES kids to have elevated glucocorticoid levels. By age ten, there was a step-wise gradient, with low-SES kids averaging almost double the circulating glucocorticoids as the highest SES kids. Another example concerns people in Lithuania. In 1978, men in Lithuania, then part of the USSR, had the same mortality rates for coronary heart disease as did men in nearby Sweden. By 1994, following the disintegration of the Soviet Union, Lithuanians had four times the Swedish rate. In 1994 Sweden, SES was not related to glucocorticoid levels, whereas in 1994 Lithuania, it was strongly related.

Findings like these suggest that being poor is associated with more stress-related diseases. As a first pass, let's just ask whether low SES is associated with more diseases, period. And is it ever.

The health risk of poverty turns out to be a huge effect, the biggest risk factor there is in all of behavioral medicine— in other words, if you have a bunch of people of the same gender, age, and ethnicity and you want to make some predictions about who is going to live how long, the single most useful fact to know is each person's SES. If you want to increase the odds of living a long and healthy life, don't be poor. Poverty is associated with increased risks of cardiovascular disease, respiratory disease, ulcers, rheumatoid disorders, psychiatric diseases, and a number of types of cancer, just to name a few.  It is associated with higher rates of people judging themselves to be of poor health, of infant mortality, and of mortality due to all causes. Moreover, lower SES predicts lower birth weight, after controlling for body size—and we know from chapter 6 the lifelong effects of low birth weight. In other words, be born poor but hit the lottery when you're three weeks old, spend the rest of your life double-dating with Donald Trump, and you're still going to have a statistical increase in some realms of disease risk for the rest of your life.

Is the relationship between SES and health just some little statistical hiccup in the data? No—it can be a huge effect. In the case of some of those diseases sensitive to SES, if you cling to the lowest rungs of the socioeconomic ladder, it can mean ten times the prevalence compared with those perched on top. Or stated another way, this translates into a five- to ten-year difference in life expectancy in some countries when comparing the poorest and wealthiest, and decades' worth of differences when comparing subgroups of the poorest and wealthiest. 

Findings such as these go back centuries. For example, one study of men in England and Wales demonstrated a steep SES gradient in mortality in every decade of the twentieth century. This has a critical implication that has been pointed out by Robert Evans of the University of British Columbia: the diseases that people were dying of most frequently a century ago are dramatically different from the most common ones now. Different causes of death, but same SES gradient, same relationship between SES and health. Which tells you that the gradient arises less from disease than from social class. Thus, writes Evans, the "roots [of the SES health gradient] lie beyond the reach of medical therapy."

So SES and health are tightly linked. What direction is the causality? Maybe being poor sets you up for poor health. But maybe it's the other way around, where being sickly sets you up for spiraling down into poverty. The latter certainly happens, but most of the relationship is due to the former. This is demonstrated by showing that your SES at one point in life predicts important features of your health later on. For example, poverty early in life has adverse effects on health forever after—harking back to chapter 6 and the fetal origins of adult disease. One remarkable study involved a group of elderly nuns. They took their vows as young adults, and spent the rest of their lives sharing the same diet, same health care, same housing, and so on. Despite controlling for all these variables, in old age their patterns of disease, of dementia, and of longevity were still predicted by the SES status they had when they became nuns more than half a century before.

Mar 7
If you want to increase your chances of avoiding stress-related diseases, make sure you don't inadvertently allow yourself to be born poor.

Thus, SES influences health, and the greater cumulative percentage of your life you've spent poor, the more of an adverse impact on health. Why should SES influence health? A century ago in the United States, or today in a developing country, the answer would be obvious. It would be about poor people getting more infectious diseases, less food, and having an astronomically higher infant mortality rate. But with our shift toward the modern prevalence of slow, degenerative diseases, the answers have shifted as well.

THE PUZZLE OF HEALTH CARE ACCESS

Let's start with the most plausible explanation. In the United States, poor people (with or without health insurance) don't have the same access to medical care as do the wealthy. This includes fewer preventive check-ups with doctors, a longer lag time for testing when something bothersome has been noted, and less adequate care when something has actually been discovered, especially if the medical care involves an expensive, fancy technique. As one example of this, a 1967 study showed that the poorer you are judged to be (based on the neighborhood you live in, your home, your appearance), the less likely paramedics are to try to revive you on the way to the hospital. In more recent studies, for the same severity of a stroke, SES influenced your likelihood of receiving physical, occupational, or speech therapy, and how long you waited until undergoing surgery to repair the damaged blood vessel that caused the stroke.

This sure seems like it should explain the SES gradient. Make the health care system equitable, socialize that medicine, and away would go that gradient. But it can't be only about differential health care access, or even mostly about it.

For starters, consider countries in which poverty is robustly associated with increased prevalence of disease: Australia, Belgium, Denmark, Finland, France, Italy, Japan, the Netherlands, New Zealand, the former Soviet Union, Spain, Sweden, the United Kingdom, and, of course, the U.S. of A. Socialize the medical care system, socialize the whole country, turn it into a worker's paradise, and you still get the gradient. In a place like England, the SES gradient has gotten worse over this century, despite the imposition of universal health care allowing everyone equal health care access.

You could cynically and correctly point out that systems of wonderfully egalitarian health care access are probably egalitarian in theory only—even the Swedish health care system is likely to be at least a smidgen more attentive to the wealthy industrialist, sick doctor, or famous jock than to some no-account poor person cluttering up a clinic. Some people always get more of their share of equality than others. But in at least one study of people enrolled in a prepaid health plan, where medical facilities were available to all participants, poorer people had more cardiovascular disease, despite making more use of the medical resources. 

A second vote against the importance of differential health care access is because the relationship forms the term I've been using, namely, a gradient. It's not the case that only poor people are less healthy than everyone else. Instead, for every step lower in the SES ladder, there is worse health (and the lower you get in the SES hierarchy, the bigger is each step of worsening health). This was a point made screamingly clear in the most celebrated study in the field, the Whitehall studies of Michael Marmot of University College of London. Marmot considered a system where gradations in SES status are so clear that occupational rank practically comes stamped on people's foreheads—the British civil service system, which ranges from unskilled blue-collar workers to high-powered executives. Compare the highest and lowest rungs and there's a fourfold difference in rates of cardiac disease mortality. Remember, this is in a system where everyone has roughly equal health care access, is paid a living wage, and, very important in the context of the effects of unpredictability, is highly likely to continue to be able to earn that living wage. 

A final vote against the health care access argument: the gradient exists for diseases that have nothing to do with access. Take a young person and, each day, scrupulously, give her a good medical examination, check her vitals, peruse her blood, run her on a treadmill, give her a stern lecture about good health habits, and then, for good measure, centrifuge her a bit, and she is still just as much at risk for some diseases as if she hadn't gotten all that attention. Poor people are still more likely to get those access-proof diseases. Theodore Pincus of Vanderbilt University has carefully documented the existence of an SES gradient for two of those diseases, juvenile diabetes and rheumatoid arthritis. 

Thus, the leading figures in this field all seem to rule out health care access as a major part of the story. This is not to rule it out completely (let alone suggest that we not bother trying to establish universal health care access). As evidence, sweaty capitalist America has the worst gradient, while the socialized Scandinavian countries have the weakest. But they still have hefty gradients, despite their socialism. The main cause has to be somewhere else. Thus, we move on to the next most plausible explanation.

RISK FACTORS AND PROTECTIVE FACTORS

Poorer people in westernized societies are more likely to drink and smoke excessively (sufficiently so that it's been remarked that smoking is soon going to be almost exclusively a low-SES activity). These excesses take us back to the last chapter and having trouble "just saying no" when there are few yes's. Moreover, the poor are more likely to have an unhealthy diet—in the developing world, being poor means having trouble affording food, while in the westernized world, it means having trouble affording healthy food. Thanks to industrialization, fewer jobs in our society involve physical exertion and, when combined with the costs of membership in some tony health club, the poor get less exercise. They're more likely to be obese, and in an apple-ish way. They are less likely to use a seat belt, wear a motorcycle helmet, own a car with air bags. They are more likely to live near a toxic dump, be mugged, have inadequate heat in the winter, live in crowded conditions (thereby increasing exposure to infectious diseases). The list seems endless, and they all adversely impact health.

Being poor is statistically likely to come with another risk factor-being poorly educated. Thus, maybe poor people don't understand, don't know about the risk factors they are being exposed to, or the health-promoting factors they are lacking—even if it is within their power to do something, they aren't informed. As one example that boggles me, substantial numbers of people are apparently not aware that cigarettes do bad things to you, and the studies show that these aren't folks too busy working on their doctoral dissertations to note some public health trivia. Other studies indicate that, for example, poor women are the least likely to know of the need for Pap smears, thus increasing their risk for cervical cancer. The intertwining of poverty and poor education probably explains the high rates of poor people who, despite their poverty, could still be eating somewhat more healthfully, using seat belts or crash helmets, and so on, but don't. And it probably helps to explain why poor people are less likely to comply with some treatment regime prescribed for them that they can actually afford—they are less likely to have understood the instructions or to think that following them is important. Moreover, a high degree of education generalizes to better problem-solving skills across the board. Statistically, being better educated predicts that your community of friends and relatives is better educated as well, with those attendant advantages.

However, the SES gradient isn't much about risk factors and protective factors. To show this requires some powerful statistical techniques in which you see if an effect still exists after you control for one or more of these factors. For example, the lower your SES, the greater your risk of lung cancer. But the lower your SES, the greater the likelihood of smoking. So control for smoking—comparing only people who smoke—does the incidence of lung cancer still increase with declining SES? Take it one step further—for the same amount of smoking, does lung cancer incidence still increase? For the same amount of smoking and drinking, does... and so on. These types of analyses show that these risk factors matter—as Robert Evans has written, "Drinking sewage is probably unwise even for Bill Gates." They just don't matter that much. For example, in the Whitehall studies, smoking, cholesterol levels, blood pressure, and level of exercise explain away only about a third of the SES gradient. For the same risk factors and same lack of protective factors, throw in poverty and you're more likely to get sick.

So differential exposure to risk factors or protective factors does not explain a whole lot. This point is brought home in another way. Compare countries that differ in wealth. One can assume that being in a wealthier country gives you more opportunities to buy protective factors and to avoid risk factors. For example, you find the least pollution in very poor and very wealthy countries; the former because they are nonindustrial and the latter because they either do it cleanly or farm it out to someone else. Yet, when you consider the wealthiest quarter or so countries on earth, there is no relationship between a country's wealth and the health of its citizens. This is a point heavily emphasized by Stephen Bezruchka of the University of Washington, in considering the United States—despite the most expensive and sophisticated health care system in the world, there's an unconscionable number of less wealthy nations whose citizens live longer, healthier lives than our own.

 So out go major roles for health care access, and risk factors. This is where things get tense at the scientific conferences. Much of this book has been about how a certain style of "mainstream" medicine, overly focused on how disease is exclusively about viruses, bacteria, and mutations, has grudgingly had to make room for the relevance of psychological factors, including stress. In a similar way, among the "social epidemiologists" who think about the SES/health gradients, the mainstream view has long focused on health care access and risk factors. And thus, they too have had to make room for psychological factors. Including stress. Big-time.

RaceIncome Per CapitaConversion to GDP (PPP)
All US30,24057,436
“Asian”34,39965,358
“White”32,91062,529
Pacific Islander21,16840,219
Black20,27738,526
Amerindian18,08534,362
Other16,58031,502
http://thealternativehypothesis.org/index.php/2017/07/04/us-racial-income-inequality-compared-to-other-countries/

STRESS AND THE SES GRADIENT

As discussed, the poor certainly have a hugely disproportionate share of both daily and major stressors. If you've gotten this far into this book and aren't wondering whether stress has something to do with the SES health gradient, you should get your money back. Does it? 

In the last edition of this book, I argued for a major role for stress based on three points. First, the poor have all those chronic daily stressors. Second, when one examines the SES gradient for individual diseases, the strongest gradients occur for diseases with the greatest sensitivity to stress, such as heart disease, diabetes, Metabolic syndrome, and psychiatric disorders. Finally, once you've rounded up the usual suspects—health care access and risk factors—and ruled them out as being of prime importance, what else is there to pin the SES gradient on? Sunspots?

Kinda flimsy. With that sort of evidence, the social epidemiologists were willing to let in some of those psychologists and stress physiologists, but through the back door, and—Cook, find them something to eat in the kitchen, if you please.

So that was the stress argument a half decade back. But since then, striking new findings make the stress argument very solid.

BEING POOR VERSUS FEELING POOR

A central concept of this book is that stress is heavily rooted in psychology once you are dealing with organisms who aren't being chased by predators, and who have adequate shelter and sufficient calories to sustain good health. Once those basic needs are met, it is an inevitable fact that if everyone is poor, and I mean everyone, then no one is. In order to understand why stress and psychological factors have so much to do with the SES/health gradient, we have to begin with the obvious fact that it is never the case that everyone is poor thereby making no one poor. This brings us to a critical point in this field—the SES/health gradient is not really about a distribution that bottoms out at being poor. It's not about being poor. It's about feeling poor, which is to say, it's about feeling poorer than others around you.

Beautiful work regarding this has been carried out by Nancy Adler of the University of California at San Francisco. Instead of just looking at the relationship between SES and health, Adler looks at what health has to do with what someone thinks and feels their SES is—their "subjective SES." Show someone a ladder with ten rungs on it and ask them, "In society, where on this ladder would you rank yourself in terms of how well you're doing?" Simple.

First off, if people were purely accurate and rational, the answers across a group should average out to the middle of the ladder's rungs. But cultural distortions come in—expansive, self-congratulatory European-Americans average out at higher than the middle rung (what Adler calls her Lake Wobegon Effect, where all the children are above average); in contrast, Chinese-Americans, from a culture with less chest-thumping individualism, average out to below the middle rung. So you have to correct for those biases. In addition, given that you're asking how people feel about something, you need to control for people who have an illness of feeling, namely depression.

Once you've done that, look at what health measures have to do with one's subjective SES. Amazingly, it is at least as good a predictor of these health measures as is one's actual SES, and, in some cases, it is even better. Cardiovascular measures, metabolism measures, glucocorticoid levels, obesity in kids. Feeling poor in our socioeconomic world predicts poor health.

This really isn't all that surprising. We can be an immensely competitive, covetous, invidious species, and not particularly rational in how we make those comparisons. Here's an example from a realm unrelated to this subject— show a bunch of women volunteers a series of pictures of attractive female models and, afterward, they feel in a worse mood, with lower self-esteem, than before seeing the pictures (and even more depressingly, show those same pictures to men and afterward what declines is their stated satisfaction with their wives).

So it's not about being poor. It's about feeling poor. What's the difference? Adler shows that subjective SES is built around education, income, and occupational position (in other words, the building blocks of subjective SES), plus satisfaction with standard of living and feeling of financial security about the future. Those last two measures are critical. Income may tell you something (but certainly not everything) about SES; satisfaction with standard of living is the world of people who are poor and happy and zillionaires who are still grasping for more. All that messy stuff that dominates this book. And what is "feelings about financial security" tapping into? Anxiety. So SES reality plus your satisfaction with that SES plus your confidence about how predictable your SES is are collectively better predictors of health than SES alone.

This is not a hard and fast rule, and Adler's most recent work shows that subjective SES is not necessarily that great of a predictor in certain ethnic groups—stay tuned for more, no doubt. But overall, this strikes me as immensely impressive—when you're past the realm of worrying about having adequate shelter and food, being poor is not as bad for you as feeling poor.

POVERTY VERSUS POVERTY AMID PLENTY

In many ways, an even more accurate tag line for this whole phenomenon is, It's about being made to feel poor. This point is made clearer when considering the second body of research in this area, championed by Richard Wilkinson of the University of Nottingham in England. Wilkinson took a top-down approach, looking at the "How are you doing?" ladder from the societal level.

Let's consider how answers to "How are you doing?" can be distributed along the ladder. Suppose there is a business with ten employees. Each earns $5.50 an hour. Thus the company is paying out a total of $55/hour in salary, and the average income is $5.50/hour. With that distribution, the wealthiest employee is making $5.50/hour, or 10 percent of the total income ($5.50/$55).

Meanwhile, in the next business, there are also ten employees. One earns $l/hour, the next $2/hour, the next $3, and so on. Once again, the company pays a total of $55/hour in salary, and the average salary is again $5.50/hour. But now the wealthiest employee, earning $10/ hour, takes home 18 percent of the total income ($10/$55).

Now, in the third company, nine of the employees earn $l/hour, and the tenth earns $46/hour. Again, the company pays a total of $55/ hour, and the average salary is $5.50/hour. And here, the wealthiest employee takes home 84 percent of the total income ($46/$55).

What we have here are businesses of increasingly unequal incomes. What Wilkinson and others have shown is that poverty is not only a predictor of poor health but, independent of absolute income, so is poverty amid plenty—the more income inequality there is in a society, the worse the health and mortality rates.

This has been shown repeatedly, and at multiple levels. For example, income inequality predicts higher infant mortality rates across a bunch of European countries. Income inequality predicts mortality rates across all ages (except the elderly) in the United States, whether you consider this at the level of states or cities. In a world of science often filled with wishy-washy data, the effect is extremely reliable—income inequality across American states is a really strong predictor of mortality rates among working men. When you compare the most egalitarian state, New Hampshire, with the least egalitarian, Louisiana, the latter has about a 60 percent higher mortality rate. Finally, Canada is both markedly more egalitarian and healthier than the United States—despite being a "poorer" country.

Amid extraordinary findings like that, the relationship between income inequality and poor health doesn't seem to be universal. Note how flat the curve is for Canada—moreover, you don't find it when considering adults throughout Western Europe, particularly in countries with well-established social welfare systems like Denmark. In other words, you probably can't pick up this effect when comparing individual parishes in Copenhagen because the overall pattern is so egalitarian in a place like that. But it's a reasonably robust relationship in the United Kingdom, while the flagship for the health/income inequality relationship is the United States, where the top 1 percent of the SES ladder controls nearly 40 percent of the wealth, and it's a huge effect (and persists even after controlling for race).

These studies of nations, states, and cities raise the issue of whom someone is comparing themselves to when they think of where they are on a how-are-you-doing ladder. Adler tries to get at this by asking her question twice. First, you're asked to place yourself on the ladder with respect to "society as a whole," and second, with respect to "your immediate community." The top-down Wilkinson types get at this by comparing the predictive power of data at the national, state, and city levels. Neither literature has given a clear answer yet, but both seem to suggest that it is one's immediate community that is most important. As Tip O'Neil, the consummate politician, used to say, "All politics is local."

This is obviously the case in traditional settings where all people know about is the immediate community of their village—look at how many chickens he has, I'm such a loser. But thanks to urbanization, mobility, and the media that makes for a global village, something absolutely unprecedented can now occur—we can now be made to feel poor, or poorly about ourselves, by people we don't even know. You can feel impoverished by the clothes of someone you pass in a midtown crowd, by the unseen driver of a new car on the freeway, by Bill Gates on the evening news, even by a fictional character in a movie. Our perceived SES may arise mostly out of our local community, but our modern world makes it possible to have our noses rubbed in it by a local community that stretches around the globe.

Income inequality seems really important for making sense of the SES/health gradient. But maybe it isn't that important. Maybe the inequality business is just a red herring built around the fact that places with big inequalities tend to be poor places as well (in other words, back to the key thing being "poverty," instead of "poverty amid plenty"). But, control for absolute income, and the inequality data still stand.

There's a second potential problem (warning: skip this paragraph if you're math-phobic—as a synopsis of the plot, the income inequality hypothesis is menaced by math villains but is saved in a cliffhanger finish). Moving up the SES ladder is associated with better health (by whatever measure you are using) but, as noted, each incremental step gets smaller. A mathematical way of stating this is that the SES/health relationship forms an asymptote—going from very poor to lower middle class involves a steep rise in health that then tends to flatten out as you go into the upper SES range. So if you examine wealthy nations, you are examining countries where SES averages out to somewhere in the flat part of the curve. Therefore, compare two equally wealthy nations (that is to say, which have the same average SES on the flat part of the curve) that differ in income inequality. By definition, the nation with the greater inequality will have more data points coming from the steeply declining part of the curve, and thus must have a lower average level of health. In this scenario, the income inequality phenomenon doesn't really reflect some feature of society as a whole, but merely emerges, as a mathematical inevitability, from individual data points. However, some fairly fancy mathematical modeling studies show that this artifact can't explain all of the health-income inequality relationship in the United States.

But, alas, there might be a third problem. Suppose in some society the poor health of the poor was more sensitive to socioeconomic factors than the good health of the rich. Now suppose you make income distribution in that society more equitable by transferring some wealth from the wealthy to the poor. Maybe by doing that, you make the health of the wealthy a little worse, and the health of the poor a lot better. A little worse in the few wealthy plus a lot better in the numerous poor and, overall, you've got a healthier
society. That wouldn't be very interesting in the context of stress and psychological factors. But Wilkinson makes an extraordinary point—in societies that have more income equality, both the poor and the wealthy are healthier than their counterparts in a less equal society with the same average income. There is something more profound happening here.

HOW DOES INCOME INEQUALITY AND FEELING POOR TRANSLATE INTO BAD HEALTH?

Income inequality and feeling poor could give rise to bad health through a number of routes. One, pioneered by Ichiro Kawachi of Harvard University, focuses on how income inequality makes for a psychologically crappier, more stressful life for everyone. He draws heavily upon a concept in sociology called "social capital." While "financial capital" says something about the depth and range of financial resources you can draw on in troubled times, social capital refers to the same in the social realm. By definition, social capital occurs at the level of a community, rather than at the level of individuals or individual social networks.

What makes for social capital? A community in which there is a lot of volunteerism and numerous organizations that people can join which make them feel like they're part of something bigger than themselves. Where people don't lock their doors. Where people in the community would stop kids from vandalizing a car even if they don't know whose car it is. Where kids don't try to vandalize cars. What Kawachi shows is that the more income inequality in a society, the lower the social capital, and the lower the social capital, the worse the health.

Obviously, "social capital" can be measured in a lot of ways and is still evolving as a hard-nosed measure, but, broadly, it incorporates elements of trust, reciprocity, lack of hostility, heavy participation in organizations for a common good (ranging from achieving fun—a bowling league—to more serious things—tenant organizations or a union) and those organizations accomplishing something. Most studies get at it with two measures: how people answer a question like, "Do you think most people would try to take advantage of you if they got a chance, or would they try to be fair?" and how many organizations people belong to. Measures like those tell you that on the levels of states, provinces, cities, and neighborhoods, low social capital tends to mean poor health, poor self-reported health, and high mortality rates.

Findings such as these make perfect sense to Wilkinson. In his writing, he emphasizes that trust requires reciprocity, and reciprocity requires equality. In contrast, hierarchy is about domination, not symmetry and equality. By definition, you can't have a society with both dramatic income inequality and lots of social capital. These findings would also have made sense to the late Aaron Antonovsky, who was one of the first to study the SES/health gradient. He stressed how damaging it is to health and psyche to be an invisible member of society. To recognize the extent to which the poor exist without feedback, just consider the varied ways that most of us have developed for looking through homeless people as we walk past them.

So income inequality, minimal trust, lack of social cohesion all go together. Which causes which, and which is most predictive of poor health? To figure this out, you need some fancy statistical techniques called path analysis. An example we're comfortable with by now from earlier chapters: chronic stress makes for more heart disease. Stress can do this by directly increasing blood pressure. But stress also makes lots of people eat less healthfully. How much is the path from stress to heart disease directly via blood pressure, and how much by the indirect route of changing diet? That's the sort of thing that a path analysis can tell you. And Kawachi's work shows that the strongest route from income inequality (after controlling for absolute income) to poor health is via the social capital measures.

How does lots of social capital turn into better health throughout a community? Less social isolation. More rapid diffusion of health information. Potentially, social constraints on publicly unhealthy behaviors. Less psychological stress. Better organized groups demanding better public services (and, related to that, another great measure of social capital is how many people in a community bother to vote).

So it sounds like a solution to life's ills, including some stress-related ills, is to get into a community with lots of social capital. However, as will be touched on in the next chapter, this isn't always a great thing. Sometimes, communities get tremendous amounts of social capital by having all of their members goose-step to the same thoughts and beliefs and behaviors, and don't cotton much to anyone different.

Research by Kawachi and others shows another feature of income inequality that translates into more physical and psychological stress: the more economically unequal a society, the more crime—assault, robbery, and, particularly, homicide—and the more gun ownership. Critically, income inequality is consistently a better predictor of crime than poverty per se. This has been demonstrated on the level of states, provinces, cities, neighborhoods, even individual city blocks. And just as we saw in chapter 13 when we looked at the prevalence of displacement aggression, poverty amid plenty predicts more crime—but not against the wealthy. The have-nots turn upon the have-nots.

Meanwhile, Robert Evans (University of British Columbia), John Lynch, and George Kaplan (the latter two both of the University of Michigan) offer another route linking income inequality to poor health, once again via stress. This pathway is one that, once you grasp it, is so demoralizing that you immediately want to man the barricades and sing revolutionary songs from Les Miz. It goes as follows:

If you want to improve health and quality of life, and decrease the stress, for the average person in a society, you do so by spending money on public goods—better public transit, safer streets, cleaner water, better public schools, universal health care. The bigger the income inequality is in a society, the greater the financial distance between the wealthy and the average. The bigger the distance between the wealthy and the average, the less benefit the wealthy will feel from expenditures on the public good. Instead, they would derive much more benefit by spending the same (taxed) money on their private good—a better chauffeur, a gated community, bottled water, private schools, private health insurance. As Evans writes, "The more unequal are incomes in a society, the more pronounced will be the disadvantages to its better-off members from public expenditure, and the more resources will those members have [available to them] to mount effective political opposition." He notes how this "secession of the wealthy" pushes toward "private affluence and public squalor." And more public squalor means more of the daily stressors and allostatic load that drives down health for everyone. For the wealthy, this is because of the costs of walling themselves off from the rest of society, and for the rest of society, this is because they have to live in it.

So this is a route by which an unequal society makes for a more stressful reality. But this route certainly makes for more psychological stress as well—if the skew in society biases the increasingly wealthy toward wanting to avoid the public expenditures that would improve everyone else's quality of life... well, that might have some bad effects on trust, hostility, crime, and so on.

So we've got income inequality, low social cohesion and social capital, class tensions, and lots of crime all forming an unhealthy cluster. Let's see a grim example of how these pieces come together. By the late 1980s, life expectancy in Eastern Bloc countries was less than in every Western European country. As analyzed by Evans, these were societies in which there was a fair equity of income distribution, but a highly unequal distribution of freedoms of movement, speech, practice of beliefs, and so on. And what has happened to Russia since the dissolution of the Soviet Union? A massive increase in income inequality and crime, a decline in absolute wealth—and an overall decline in life expectancy that is unprecedented in an industrialized society.

One more grim example of how this works. America: enormous wealth, enormous income inequality, high crime, the most heavily armed nation on earth. And markedly low levels of social capital— it is virtually the constitutional right of an American to be mobile and anonymous. Show your independence. Move across the country for any job opportunity. (He lives across the street from his parents? Isn't that a little, er, stunted?) Get a new accent, get a new culture, get a new name, unlist your phone number, reboot your life. All of which are the antitheses of developing social capital. This helps to explain something subtle about the health-income inequality relationship. Compare the United States and Canada. As shown, the former has more income inequality and worse health. But restrict your analysis to a subset of atypical American systems chosen to match the low inequality of Canada—and those U.S. cities still have worse health and a steeper SES/health gradient. Some detailed analyses show what this is about: it's not just that America is a markedly unequal society when it comes to income. It's that even for the same degree of worsening income inequality, social capital is driven down further in the United States.

Our American credo is that people are willing to tolerate a society with miserably low levels of social capital, so long as there can be massive income inequality ... with the hope that they will soon be sitting at the top of this steep pyramid. Over the last quarter-century, poverty and income inequality have steadily risen, and every social capital measure of trust, community participation, and voter participation has declined. And what about American health? We have disparity between the wealth of our nation and the health of our citizens that is also unprecedented. And getting worse.

This is pretty depressing stuff, given its implications. Adler, writing around the time when universal health insurance first became a frontpage issue (as was the question of whether Hillary's hairstyle made her a more or less effective advocate for it), concluded that such universal coverage would "have a minor impact on SES-related inequalities in health." Her conclusion is anything but reactionary. Instead, it says that if you want to change the SES gradient, it's going to take something a whole lot bigger than rigging up insurance so that everyone can drop in regularly on a friendly small-town doc out of Norman Rockwell. Poverty, and the poor health of the poor, is about much more than simply not having enough money It's about the stressors caused in a society that tolerates leaving so many of its members so far behind.

This is relevant to an even larger depressing thought. I initially reviewed what social rank has to do with health in nonhuman primates. Do low-ranking monkeys have a disproportionate share of disease, more stress-related disease? And the answer was, "Well, it's actually not that simple." It depends on the sort of society the animal lives in, its personal experience of that society, its coping skills, its personality, the availability of social support. Change some of those variables and the rank/health gradient can shift in the exact opposite direction. This is the sort of finding that primatologists revel in—look how complicated and subtle my animals are.

The second half of this chapter looked at humans. Do poor humans have a disproportionate share of disease? The answer was "Yes, yes, over and over." Regardless of gender or age or race. In societies with universal health care and those without. In societies that are ethnically homogenous and those rife with ethnic tensions. In societies in which illiteracy is widespread and those in which it has been virtually banished. In those in which infant mortality has been plummeting and in some wealthy, industrialized societies in which rates have inexcusably been climbing. And in societies in which the central mythology is a capitalist credo of "Living well is the best revenge" and those in which it is a socialist anthem of "From each according to his ability, to each according to his needs."

What does this dichotomy between our animal cousins and us signify? The primate relationship is nuanced and filled with qualifiers; the human relationship is a sledgehammer that obliterates every societal difference. Are we humans actually less complicated and sophisticated than nonhuman primates? Not even the most chauvinistic primatologists holding out for their beasts would vote for that conclusion. I think it suggests something else. Agriculture is a fairly recent human invention, and in many ways it was one of the great stupid moves of all time. Hunter-gatherers have thousands of wild sources of food to subsist on. Agriculture changed all that, generating an overwhelming reliance on a few dozen domesticated food sources, making you extremely vulnerable to the next famine, the next locust infestation, the next potato blight. Agriculture allowed for the stockpiling of surplus resources and thus, inevitably the unequal stockpiling of them—stratification of society and the invention of classes. Thus, it allowed for the invention of poverty. I think that the punch line of the primate-human difference is that when humans invented poverty, they came up with a way of subjugating the low-ranking like nothing ever before seen in the primate world.

 http://g2gfitness-mma-ccoach-sthqld.com/resources/Sapolsky%20why%20Zebras%20don%27t%20get%20ulcers.pdf

When Mr. Price chose $70,000 as the eventual salary floor, he was influenced by research showing that this annual income could make an enormous difference in someone’s emotional well-being by easing nagging financial stress.

He might have also considered the parable of the workers in the vineyard from the Gospel of St. Matthew, where the laborers hired at sunup were upset that their pay was the same as those who showed up right before quitting time. Early adopters and latecomers may be equally welcomed in the Kingdom of Heaven, but not necessarily in the earthly realm, where rewards are generally bestowed in paycheck form.

SPREAD THE WEALTH. LEVEL OUT THE PLAYING FIELD. IT'LL BE BETTER FOR ALL OF US. I'M A SOCIALIST!
http://democracyjournal.org/magazine/31/capitalism-redefined/
  
23h23 hours ago
Why Is Socialism So Damned Attractive? Because evolution wired our brains for it.
 JUST KIDDING! I'M ACTUALLY A LIBERTARIAN CAPITALIST! WHATEVER THAT IS. ACTUALLY, I DON'T KNOW WHAT I AM! BUT READ THE LINK BELOW. IT'LL TELL YOU WHY YOUR HIPPIE, HIPSTER, CRACCA ASS IS A SOCIALIST!
 http://reason.com/archives/2016/09/16/why-is-socialism-so-damned-attractive

 https://www.amazon.com/Problem-Socialism-Thomas-DiLorenzo/dp/1621575896/ref=pd_sim_14_3/156-8520249-8727945?ie=UTF8&pd_rd_i=1621575896&pd_rd_r=B40J3A4181ZQCN72PM4V&pd_rd_w=yRehR&pd_rd_wg=huQVt&psc=1&refRID=B40J3A4181ZQCN72PM4V
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