If you want to be healthy, move to England. That was the message from a study in last week’s Journal of the American Medical Association. The motivation for doing the study as state in the JAMA article was to see whether a society where access to medical care is universal (that is, England) has healthier people than one without universal medical care (that is, the United States). One of the authors was Michael Marmot, a leading figure in the study of the social determinants of health.
The US media made sure to absolve the US medical care system from blame by attributing to Marmot the view that “Britain’s universal health-care system shouldn’t get credit for better health.” But the best that the media could come up with as an explanation was a flaccid reference to American’s suffering from more stress as an inherent part of our culture.
But let’s start at the beginning. In the United States, we spend $5,274 per person per year for medical care. The English spend $2,164 per person per year. That’s not half, as the US media reported, but 40%. What Marmot and his colleagues looked at was the health of white people between 55 and 64 years old—the age when medical conditions come home to roost. They excluded people of color so that the well-known poorer health of those populations would not affect the study. The conditions they looked at were diabetes, hypertension, all forms of heart disease, heart attack, stroke, lung disease, and cancer.
For all of these conditions, people in the US were worse off than people in England. Diabetes: 75% more. Hypertension: 20% more. Heart disease: 50% more. Heart attack: 30% more. Stroke: 65% more. Lung disease: 30% more. Cancer: 75% more.
Is this because we in the US suffer from overdiagnosis and overtreatment? No. Measurements like blood pressure, hemoglobin A1C, C-reactive protein, and other risk markers verified the gap.
A result of the study that was ignored by the mainstream media was that in both countries your health is affected by your social class: those who are more secure have better health. With a very interesting exception: cancer. There was little difference between rich and poor in either the US or England in the incidence of cancer.
That cancer rates do not differ by social class strongly suggests to me what’s going on with the other conditions. Marmot and those who made comments on his report hovered around the issue of stress as the place to look for explaining the difference between the US and England—although Marmot was much more sophisticated in pointing to insecurity from lack of access to medical care as part of more a general insecurity, especially from the growing inequality of income in the US as compared to England where, tattered and battered though it might be, a social security net still exists.
What causes illness? Your body’s response to an environmental stressor. Class difference is an environmental stressor as is exposure to carcinogens. What is the major failing of the US cancer establishment? Their obsession with treatment and their utter failure at identifying carcinogens let alone halting our exposure to them.
My opinion is that the English are healthier than Americans because they haven’t been exposed to the environmental stressors that we’ve been exposed to for as long as we’ve been exposed to them. Want to be as healthy as the English? Don’t move to England. Fight for clean air, water, and soil. Fight for safe and healthy food. Fight for safe and healthy places to live, work, learn, and play. And by all means, fight for social justice.
The issues in this article are developed (with references) in issue #10 of the Progressive Health Observer in the article titled “Health Inequity and Toxic Load.”
Related resources are available on the Environmental Health page.
