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Sunday, November 12, 2006

Feeling poor may make you sick

Feeling poor may make you sick

The results of a recent survey on poverty and hunger by the Social Weather Station (SWS) provoked a rancorous debate in the media.

SWS has been doing this survey every quarter since 1998. Respondents are asked to locate themselves on a socioeconomic ladder. They are also asked in the vernacular whether they have experienced moderate or severe hunger in the past three months.

This survey was done between September 24 and October 4, the period when the economy was on the mend. SWS reported that fewer respondents—51 percent—rated themselves mahirap compared to 59 percent in the previous quarter.

But, as usual, columnists and politicians found fault with the self-rating method. They forget that this should not be used as the only measure, but in conjunction with quantitative data to give a fuller picture of the national condition.

I do not intend to join the debate on methods and intentions except to say that I’m convinced that SWS’s method are scientific and its intentions beyond suspicion.Instead I’ll try to point out the effect of prolonged experience of poverty on a person’s health.

The poor, at least statistically, are less healthy than the more fortunate. For obvious reasons. Their food is inadequate, their surroundings are insalubrious and polluted and they do not have enough money for health care.

But feeling poor, or being made to feel poor, is a more insidious threat to a person’s well-being even if he or she has some means to pay for health care.

Let me explain. The human body is superbly adapted to deal with sudden stress. Those who have been in a fight or flight situation experience a surge of energy. In physiologic terms, this is due to the release of glucose from the body’s reserves, an increase in the heart rate to deliver the glucose to the muscles. If the stress persists, functions like digestion, tissue repair, reproduction all shut down. The immune system is put on alert to stop pathogens that might enter the blood stream. All the senses, including memories in the limbic area of the brain, become sharper. But the toll on the body is very high. Exhaustion follows.

There are scientists who think that poverty, especially long-term poverty, is a stressor. The feeling of hopelessness affects the homeostatic balance of the body. This kind of psychosocial stress could bring on respiratory and heart ailment, depression and gastro-intestinal disease, among others.

The best-known study of poverty as a stressor was done at the University of Nottingham in the UK by Richard Wilkinson. His 15-year study showed that income inequality predicted a number of health issues.

The correlation between income disparity and poor health was particularly marked in the US where income inequality is highest in the developed world.

Wilkinson’s hypothesis found some experimental support in the work of David H. Abbott at the Wisconsin National Primate Research Center. By putting monkeys in a subordinate position in a hierarchical environment and at the same time withdrawing rewards from them, Abbott was able to approximate roughly the human phenomenon of income inequality. He found that the deprived primates had a higher resting level of a stress hormone, an indicator of deteriorating health.

Wilkinson’s definition of poverty is much broader than just lack of money. Among the working poor, he discovered that being bossed around, made to do repetitive work, travel long hours brought on illnesses that otherwise would have been less frequent.

The other line of investigation into the connection between inequality and health is being carried out in Harvard University by Ichiro Kawachi and Bruce Kennedy.

Their study is built around the concept of social capital. This includes a number of factors but the most important are the levels of trust and support in a community.

Using a complex statistical method called path analysis, Kawachi demonstrated quite persuasively that the route from income inequality to poor health runs through chronic suspicion of other people’s motives, absence of family support and the indifference of neighbors. These predicted self-reported statistically significant bad health.

Studies on psychosocial factors as an explanation of poor health are potentially valuable for national policies.The SWS has amassed considerable information on self-rated poverty. Perhaps one of our universities could begin looking at the nexus between feeling poor and poor health.Instead of giving the SWS results only a political interpretation, economists and public health specialists could collaborate on an investigation of a psychosocial stressor.


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