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Volume 4: No. 4, October 2007

EDITORIAL
Unnatural Causes: Is Inequality Making Us Sick?

Transcript

NARRATOR:  

Living in America should be a ticket to good health. We have the highest gross national product in the world.

GORDON STAUFFER:  

It’s good to have some of my cars in one place. . . .

SIR MICHAEL MARMOT:  

If you look at the U.S. as a whole, the U.S. is the second richest country in the world after Luxembourg.

NARRATOR:  

We have the most sophisticated medical technology. The most Nobel laureates in medicine. We spend 1.7 trillion dollars per year on medical care. That’s nearly half of all the health dollars spent in the world.

Slowly scroll down first five countries on UNDP list of life expectancy and infant mortality statistics.

NARRATOR:

Shouldn’t we rank at the top of international health indicators?

Scroll down the next five.

NARRATOR:

Or at least in the top five? The top ten?

Pick up pace through the next 20 countries until we come to the United States.

NARRATOR:

We barely make it among the top 30. We’re 30th in life expectancy. Costa Ricans live longer.

DAVID WILLIAMS:  

Especially of the similar economically developed countries, we are at the bottom of the list.

NARRATOR:  

A higher percentage of our babies die in their first year of life than in Cuba, Slovakia, or Estonia. 

NARRATOR:  

And this is not because of our so-called “melting pot.”

DR. RICHARD DAVID:  

White Americans, if they were a separate country, would still rank 23rd in the world.

NARRATOR:

How can this be?

SIR MICHAEL MARMOT:

There are huge inequalities in the society. All this wealth is maldistributed.

NARRATOR:  

Inequality in America is higher today than at any time since before the Great Depression. And it’s greater than in any other industrialized nation.

SIR MICHAEL MARMOT:  

And I think that’s in part why the U.S. as a whole has relatively poor health amongst the rich countries. And we think that that is not inevitable.

Fade to black.

NARRATOR:  

This is a story about health in one American city. It’s not about health insurance or better drugs. But it is about how social conditions and policies can dictate who will be sicker, who will live longer. To see how that happens, you only have to stop and look, wherever you are. Even here.

WOMAN #1:

Welcome to Louisville.

WOMAN #2:

Welcome to Louisville.

MAN #1:  

Welcome to Louisville.

MAN #2:

Louisville.

MAN #3:

Louisville.

MAN #4:

Louisville.

MAN #5:

I’m not from around here.

MAN #5:

Welcome to Louisville.

NARRATOR:

Sixteenth largest city in the United States. Population 750,000.

DR. ADEWALE TROUTMAN:

Diabetes, cardiovascular disease, low birth weight, infant mortality.

DR. ADEWALE TROUTMAN:  

Certainly, the health is bad. So there are major health problems in Louisville.

NARRATOR:  

Overall, we are healthier than we were 50 years ago. But those gains are not shared equally. Dr. Adewale Troutman should know. As the director of public health, he can tell you that in some Louisville neighborhoods people die on average 13 years sooner than others. And he wants to know why.

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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.


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