Watch 'Unnatural Causes'

Mark your calendar! Starting on Thursday, March 27, your local PBS station will begin broadcasting an important new series called 'Unnatural Causes.' You won’t want to miss it. This film series, by the California Newsreel and Vital Pictures, looks at the social determinants of health and asks: Is inequality making us sick? The answer is ‘yes.’ This has implications for social justice organizers and public health advocates. 'Unnatural Causes 'addresses the broadest range of issues affecting health, and points the way toward pushing the debate about healthcare beyond individually-focused and consumer-oriented approaches, using a health equity frame.

'Unnatural Causes' uses multiple sources and numerous experts to document health disparities, and to link them to the underlying and multiple factors that can enhance or inhibit overall health and wellbeing. As the series makes clear, social factors like income and wealth inequality, conditions of employment and economic security, levels of autonomy and empowerment, conditions in neighborhoods, access to education, transportation, and the consequences of discrimination and racial disparities are far better predictors of an individual’s overall health than personal and family history, or genetic factors. The growing disparities in income and access to education, as well as the differential effects of race, gender and class, help explain why the United States continues to rank well below other advanced industrialized nations in terms of public health indicators. We rank 30th in life expectancy. Our infant mortality rates are higher than Cuba’s. Yet, we spend $2 trillion per year on medical care.

The timing of the broadcast coincides with a new government study that documents a growing life expectancy gap –– further evidence of the link between inequality and health. As reported in the New York Times on Sunday, March 23, a team of medical researchers has developed an index to measure social and economic conditions in several counties across the country, using census data on education, income, poverty, housing and other factors. They found “large and growing” disparities in life expectancy for richer and poorer Americans, paralleling the growth of income inequality in the last two decades. Specifically, “…life expectancy was higher for the most affluent in 1980 than for the most deprived group in 2000.”

The series makes a compelling case for looking at any and all health issues, including the problem of lack of insurance, within a broader framework that takes into account all of the above-mentioned social factors. This way of thinking about public health has many champions within the Centers for Disease Control (CDC). Researchers and practitioners like Bobby Milstein would like to expand its mission to “deal with all the conditions that create and sustain overall community health.”

The CDC is sponsoring research and networking across different facets of public health using a syndemics approach. Syndemics provides a set of tools and methodologies to deal with health equity, comparable in a sense to the tools that epidemiology provides to public health. Syndemics moves public health advocacy beyond its more familiar focus on acute health crises. By combining sociology, demography, health sciences, epidemiology and medical research, the CDC can offer much to our own efforts to promote health equity. Our vision of a good society, wed with good science and better public health advocacy, equals alternative policies and practices that we can test out and struggle over.

Speaking of struggle, health advocates and social movement organizers will have to engage in a worldview fight if we hope to shift the debate away from individualistic and crisis-focused approaches to health. 'Unnatural Causes' helps us wage this battle with solid evidence, but more importantly, with good stories that broaden the frame. The dominant frame for healthcare currently rests on a recurring theme: ‘personal responsibility.’ Consider the Heritage Foundation’s response to the government report on the growing life expectancy gap: The problem is not social policy, it is about a gap in ‘health literacy.’ Middle-class and upper-income people who are well-educated know more about taking care of themselves. They are more likely to understand the long-term consequences of certain behaviors, and they are more assertive in seeking out treatments and in adhering to treatment advice.

The theme of personal responsibility articulates well with anti-government themes to undermine a more systemic and societal approach to public health. When combined with arguments about the benefits of market competition, these themes define a narrow view of healthcare as a commodity. We are health consumers who purchase products and services in the healthcare marketplace. It is up to each of us to figure out how to get the best healthcare that money can buy. ‘Health as a commodity’ creates many distortions. If an outsider looked at healthcare priorities in terms of advertising dollars, the kinds of products people will pay for out-of-pocket, and the lucrative specialties that medical students are choosing, they might conclude that our greatest challenge is how to diminish fine lines and wrinkles.

A health equity framework can provide a comprehensive way of thinking not just about health, but about many if not most of the critical dimensions of people’s daily lives. It give us a way to link all these dimensions together, to demand that each of us deserves to live in conditions that promote health and wellbeing. 'Unnatural Causes' can help us get the conversation started.