Suddenly, and for no apparent reason . . .
This New York Times article on class and heart attacks contains the following assertion by a public health professor:
It's like diffusion of innovation: whenever innovation comes along, the well-to-do are much quicker at adopting it. On the lower end, various disadvantages have piled onto the poor. Diet has gotten worse. There's a lot more work stress. People have less time, if they're poor, to devote to health maintenance behaviors when they are juggling two jobs. Mortality rates even among the poor are coming down, but the rate is not anywhere near as fast as for the well-to-do. So the gap has increased.
.
There's a lot wrong with this. some of this isn't true--in America, the rich work longer hours than the poor, and a postal worker is less likely to have a stressful job than an investment banker. And note the use of the passive voice: "Diet has gotten worse". It's like how in Spanish, no one ever breaks everything; everyone says "se rompio. Diets have gotten worse because poor people are eating crappy food, not because the diet fairy left them with the pork rinds rich people didn't want.
[Doesn't the poor quality of inner-city markets make good food hard to get?-ed. I shop at a market in a housing project, and while it's not exactly Wegmans, I manage to put together a balanced diet on a budget so tight the nickels squeak. Plus, as the man says, "diets have gotten worse", but supermarkets, even in poor areas are only getting better. People are eating fattier, more sugary diets because as food has gotten cheaper, they have chosen to consume more of the things that aren't good for us.]
This is nitpicking, but that quote is absolutely typical of the way obesity among the poor is presented in the media: low-income people are framed as hapless victims rather than agents. This is bad for two reasons. First, it distorts people's beliefs about what sorts of policy interventions are likely to succeed--if you believe the average news article, it would be easy to decide that the best way to lick obesity would be to air-lifting rhubarb and radishes into East New York, and pay doctors to harangue people. Whereas if you spend some time with actual people in, say, assisted housing, you'll find that they, like everyone else know
a) what makes you fat
b) that being fat is unhealthy
c) that you can easily buy fresh fruit if you cut out the slurpees
They're not stupid, and they're not particularly ignorant, though they're probably not as up on the ins-and-outs of saturated fats and Omega-3's as your average food-obsessed young professional. They are choosing to eat the way they do. Which is the second problem with this sort of thing. By treating the poor as if they are not choosing their diets in any meaningful sense, people license themselves to start making choices for the poor. John doesn't realise that his hamburger is killing him, so I'll just take it away and give him a nice sliced turkey sandwich and an apple and if Johnny is very, very good Mommy will take him to the zoo later. I've never understood how the belief that a large swathe of our society is in need of a nanny is reconciled, ideologically speaking, with the belief that we should do everything we can to encourage those people to vote. But that's another rant.
Update Then there are things like this:
For years he was a high-voltage cable splicer, a job he loved because it meant working outdoors with plenty of freedom and overtime pay. But on a snowy night in the early 1980's, a car skidded into a stanchion, which hit him in the back. A doctor suggested that Mr. Wilson learn to live with the pain instead of having disc surgery, as Mr. Miele [the rich guy also profiled in the piece] had done.
Now, Mr Wilson works for Con Ed. And if there's anything that unionised electrical workers have, it's gold-plated health insurance; it's certainly a lot better than what I have. If the doctor suggested Mr Wilson not have surgery, it's because the doctor thought that he shouldn't have surgery (and coming from a family rife with back problems--being tall and all--everyone tells me that surgery should be absolutely the last resort).
Overall, other than the initial luck of location--the man in midtown has his choice of Manhattan's hospitals, while the other two have to take the slimmer pickings of the boroughs--it's not clear that the bad outcomes which accrue to the middle-class and poor people in the story have much to do with class. The maid they profile has trouble communicating with her doctors because she can't speak English, a problem in any health care system. The middle class man likes fried shrimp. The maid refuses to follow doctor's orders, eats fatty foods and smokes, and doesn't even look for a cardiac rehab programme. But again, the article treats these things as if they just happened, with no suggestion that any of these people have any choices in the matter...
janegalt.net |
