Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, July 8, 1993 TAG: 9307080094
SECTION: NATIONAL/INTERNATIONAL PAGE: A8 EDITION: METRO
SOURCE: From The Washington Post and The Associated Press
DATELINE: LENGTH: Medium
Researchers found that Americans who are less educated or have low incomes suffer substantially higher death rates, adjusted for age, than those who are better educated or better off financially. And although overall U.S. death rates have declined substantially for 30 years, the gap between socioeconomic groups has widened.
The study, by Gregory Pappas and three others at the federal National Center for Health Statistics, is one of several published in the Journal suggesting a strong correlation between ill health and social deprivation or lack of education.
"Access to health care is clearly part of the problem," Pappas said, "but we also have to begin to appreciate the importance of prevention." His study suggested that "it may be that people of higher socioeconomic status have adopted healthy lifestyles more rapidly," including increased exercise and reduced drinking and smoking.
Vincente Navarro, professor of public health and sociology at the Johns Hopkins School of Public Health, said that not only do poor people often have less access to care, their diets often are inadequate in both quality and amount.
In addition, many poor people live in overcrowded housing where disease spreads more readily and where insecurity, tension and violence are more prevalent.
Navarro said poor neighborhoods have higher rates of disease, drugs and alcoholism, and stress can lead directly to health problems such as cardiovascular disorders.
Leroy Schwartz, pediatrician and president of Health Policy International, said earlier studies suggest that low-income and poorly educated people may use health care, especially preventive care, less, even when it is available to them.
Social and behavioral problems, not just medical concerns, may bring on many instances of bad health, experts have concluded from such findings.
In a related article in the Journal, physician James C. Hurowitz argued that many conditions treated medically are the result of "excess" or "unmanageable stress" caused by social conditions.
Thus, instead of depending on reforming the health-care system alone, Hurowitz wrote, "resources should be reallocated from the medical-care system to systems that support the prevention of illness - for example through the creation of meaningful jobs, and a resulting higher standard of living, or through a cleaner environment."
Differences in death rates between the classes increased from 1960 to 1986, a time when Medicaid programs were set up to improve access to care for the poor, researchers found.
The Pappas study found that while overall U.S. age-adjusted death rates have declined since 1960, they remain highest among the less-educated and poor.
In 1986, white men age 25 to 64 with annual incomes of less than $9,000 had an age-adjusted rate of 16 deaths per 1,000 persons; those with $25,000 in income or more had a rate of 2.4 per 1,000. Similarly, white men with less than 12 years of school had a rate of 7.6 deaths per 1,000 - almost twice the rate for those with 12 years or more. Similar differences were found for women and blacks.
A Journal article by Jack M. Guralnik of the National Institute of Aging and others found that "at the age of 65, those with 12 or more years of education had an active life expectancy that was 2.4 to 3.9 years longer than the values of those with less education."
"Among older blacks and whites, the level of education, a measure of socioeconomic status, has a greater effect than race on total life expectancy and active life expectancy," the article said.
According to an editorial in the Journal, "Despite the importance of socioeconomic status to health, no one knows quite how it operates," wrote Dr. Marcia Angell, the journal's executive editor. "It is perhaps the most mysterious of the determinants of health."
by CNB