or finding a ride to work, taking a trip to the gym or to the
doctor for a check-up can seem like a luxury, says Linda
Gallo, PhD, a psychologist at the Institute for Behavioral and
Community Health at San Diego State University.
“With life’s competing crises, those demands take precedence
over health behaviors,” she says.
When considering the American health disadvantage, the
picture changes dramatically depending on whom you look at,
says Hector González, PhD, a behavioral health psychologist at
Wayne State University. In 2012, homicide was the leading cause
of death for young African-Americans and the second-leading
cause for young Latinos, the CDC reports. “Violent deaths seem
to be something that is part of the black experience, and part of
the Latino experience, too,” he says.
If we’re concerned about America’s position in the global
health rankings, González says, these are the groups we need
to help most. “If we could do something about these terrible
disadvantages, our life expectancy would go up,” he says.
The power of stress
People living at the low end of the socioeconomic spectrum
may be most affected by health inequalities, but poorer health
doesn’t exist only among the poor. “Just having money in your
pockets doesn’t make you healthier,” says Adler.
The National Academies report noted that even Americans
who are insured, college-educated, with higher incomes and
healthy behaviors are worse off than similar groups in other
What accounts for this difference? Richard Wilkinson, PhD,
a social epidemiologist at the University of Nottingham Medical
School, says it’s the inequality itself. In decades of research,
Wilkinson has shown that societies with greater inequality suffer
more health and social problems. People in more egalitarian
societies live longer, experience less violence, have lower rates of
obesity and teen pregnancy, are less likely to use illicit drugs and
enjoy better mental health than their counterparts in countries
with a wide divide between rich and poor, he and his colleagues
have found. And children in more equal societies score higher on
the UNICEF Index of Child Wellbeing, which includes factors
such as immunization rates, deaths from accidents, alcohol and
tobacco use and educational success.
In America, the gap between the haves and have-nots is wide
and getting wider. Since the 1970s, inequality has risen sharply.
The richest 1 percent of Americans made 9 percent of the total
pre-tax income in 1970, compared with 19. 8 percent in 2011.
“The U.S. is one of the most unequal of the rich, developed
countries, and it suffers so many of the consequences,”
Inequality seems to do its dirty work through the biology
of chronic stress, says Wilkinson. Acute stress evolved for good
reason — a racing heart and heightened alertness came in
handy when our savannah ancestors wanted to avoid being
eaten by a lion. But when the fight-or-flight feeling persists for
hours or days, the immune system is down-regulated, tissue
repair and growth slow down, and reproductive functions are
put on hold. “All those things don’t matter in an emergency,
but you pay the cost if you go on feeling stressed for weeks and
months and years,” he says.
In unequal societies, he says, competition is fierce and
“While some [Americans] might be aware that our
we worry about our place in the pecking order. Often that
translates to a constant, low-level anxiety. “We all become more
twitchy about how we are seen and judged,” he says, and social
contact becomes increasingly trying. “People trust each other
less and community life weakens. Inequality affects the whole
Unfortunately, Americans are plenty familiar with stress,
as APA’s annual Stress in America survey shows. Last year, 20
percent of those surveyed reported experiencing extreme stress,
health-care system has some issues, they probably
think their health is still very good. Our findings are
the exact opposite.”
STEVEN H. WOOLF
Virginia Commonwealth University