Arnold School of Public Health

PUBH 102: INTRODUCTION TO PUBLIC HEALTH

UNNATURAL CAUSES: “In Sickness and In Wealth”

What to Look for….

Focus of this episode: How does the distribution of power, wealth and resources shape
opportunities for health?

1) What did the Whitehall study reveal about the connection between health and wealth?
The Whitehall study revealed that the wealthier a person is, the healthier they
would be when compared to someone less wealthy. A wealthier person also had a lower
risk of every major cause of death than the less wealthy person.
a) What is the wealth-health gradient?
The wealth-health gradient is described as the wealthier a person is, the better
health they are likely to have and the less risk they are at for excess death. (71%
of wealthy Americans report good-excellent health, decreasing down to 37%
excellent health for poor Americans)

2) Dr. David Williams says: “Stress helps motivate us. In our society today everybody
experiences stress. The person who has no stress is a person who is dead.”
a) Describe the body’s stress (fight-or-flight) response.
When the body receives a threat, it signals the adrenal glands to release stress
hormones (cortisol) that release glucose into the bloodstream, increase heart
rate, raise blood pressure and put the body on high alert.
Cortisol improves memory and enhances immune function.
b) How is chronic stress different?
Chronic stress occurs when pressures are relentless, you lack power/resources
to control them, and your stress response stay on for long periods of time. The
body produces too much cortisol, which inhibits immune function and memory,
can affect heart rate and the body’s ability to handle insulin and glucose.
c) How might chronic stress increase the risk of illness and disease?
Chronic stress can increase the risk of illness and disease because the heart rate
is affected, and the body cannot handle insulin or glucose as well, so there is an
increased risk of heart disease and diabetes. There is also a higher toll on the
body and therefore leads to increased disease risk and accelerated aging.

3) How do the lives of Jim Taylor, Tondra Young, Corey Anderson and Mary Turner exemplify
concepts like the wealth-health gradient and the importance of power and control?
The lives of the people prove that the wealth-health gradient does exist, that the
job you hold directly relates to your health because it is how much power and
control you have over your life.
a) What does comparing data maps of disease rates in the different Louisville council
districts reveal?
In comparing data maps of disease rates reveals that the more affluent councils
had a noticeable difference in the death rate and life expectancy (very low death
rate, high life expectancy) than in the poorest councils.
b) What might explain observed differences?
 Somethings that might explain the observed differences include education about
healthy behaviors, quality of food, safety, ability to exercise, and working
conditions.

4) Professor Leonard Syme defines control of destiny as the “ability to influence the events that
impinge on your life.” Why is this ability an important factor for health?
This is an important factor for health because the things you cannot control are
likely to increase your risk for illness.

5) What stories from Corey Anderson’s life exemplify a high demand / low control job and
stressful home situation?
His mother bought a house, then lost her job, suffered from high blood pressure
as a result, and had to spend more time at the doctor. His combined income with
his wife puts them directly at the median income. He has hypertension.

6) What stories from Jim Taylor’s life illustrate how wealth, power and status translate into
better health?
He had a good education and good job, so he was able to live in an area that was better
off. This resulted in him having the safety to exercise in his neighborhood, good food
sources nearby, and the financial capabilities to see doctors or other professionals about
his health.

7) What did the Macaque monkey research teach primatologist Carol Shively about the
connections between power, subordination and health?
The dominant monkey held power, was able to do whatever he wanted and he
controlled the subordinate monkeys. The subordinate monkeys were in constant stress
because they had no control over their lives. Their constant stress led to heart defects.
a) What parallels can we draw to human society?
Education and income were the highest factors that led to less chronic stress.
They also tested infecting people with a cold virus to see the effects on health.
The people with less chronic stress were less likely to get sick, while the people
with more stress were very likely to get sick.

8) Describe examples from the film that illustrate how racism imposes an additional health
burden on people of color.
Being constantly on guard/wary makes people vulnerable to getting sick. Racial
discrimination can lead to high blood pressure, increased infant mortality and
coronary artery disease.
a) Give examples of both “everyday” racism (being treated unfairly) and “structural” racism
(access to resources, power, status and wealth) and describe how these might affect
health in different ways.
“Everyday” racism- being followed/scanned in stores, people holding onto
valuables
“Structural” racism- exclusion from post-war benefits, health disparities

9) What social changes were most responsible for the 30-year increase in American life
expectancy over the 20th century?
Improvements in medicine, improved living conditions, universal education, better
sanitation, regulated workday, antipoverty programs.
a) What policies does the film point to that might account for our low rank in recent years
compared to other countries?
 Cutting social programs, reduced taxes on the wealthy, and deregulated industry
(following recession).
b) What characterizes the policies and priorities of countries that have better health
outcomes than we do?
Universal healthcare coverage, paid vacation (4 weeks), higher minimum wage,
free college education, increase access to recreation, lower infant mortality, paid
family leave.