Inequality Kills Us All, by Dr Stephen Bezruchka

Review by Dave Gamrath

One-liner:

In his new book Inequality Kills Us All: Covid-19's Health Lessons for the World, Seattle emergency room physician Stephen Bezruchka explains how America became the unhealthiest of all rich countries in the world.

Book Review:

The Covid-19 pandemic shined a bright spotlight on the poor state of health in America. The United States has had more Covid cases and deaths than any other country. How can this happen in the richest county in the world? In his new book Inequality Kills Us All: Covid-19's Health Lessons for the World, Dr Stephen Bezruchka explains how America became the unhealthiest of all rich countries in the world, resulting in not only over a million Covid deaths, but also terrible health outcomes across the board. After Bezruchka’s thirty years’ experience as an emergency physician, as well as a highly awarded Associate Teaching Professor at the University of Washington’s School of Public Health, Bezruchka concluded that “attention must be drawn to Americans being dead first.” In Inequality Kills Us All, Bezruchka explains how we got here, why we remain here, and what is needed to reverse America’s poor health status.

Back in the 1950s, America ranked among the best health of all nations. Today, America spends more on healthcare than any other country, yet ranks last amongst rich nations, as well as below many not-so-rich nations, in key health indicators. These include infant mortalities (ranked 50^th), women dying during childbirth (ranked 55^th), and life expectancy, where we ranked 46^th before Covid. Post-Covid, the Center for Disease Control reported that life expectancy from birth in the US dropped 1.8 years in 2020, and a further 0.9 year drop in 2021, even while other countries have bounced back from Covid. Why has this happened?

Bezruchka provides extensive data showing that inequality is the biggest driver of America’s poor health. “Economic inequality is the equivalent of a nuclear weapon. Its impact on the population is devastating and deadly.” How does inequality harm health? Inequality escalates stress and frustration leading to poor health. Increased stress leads to increased chronic illness and heart failure. Stress coping tactics, such as comfort foods and smoking, can be very unhealthy. “Inequality also leads to self-medicating with drugs.” Bezruchka states that “inequality kills many more people than gunshot wounds, car crashes, and drug overdoses,” and “is a form of structural violence or social murder.”

The sister to inequality, poverty, serves as a serious disability, limiting people’s ability to meet their basic needs. “Poorer people, in general, are more likely to suffer from various diseases and tend to respond less well to treatments.” Poorer people are more likely to live in unhealthy environments. They are less likely to get needed treatment for diseases. Their cancer rates and death rates are higher. Poverty “excludes and isolates people from the rest of the community.” Being poor in a wealthy society is extraordinarily difficult, and “being poor in early life is the worst tragedy that can befall us.”

Bezruchka writes that America’s lack of support for early life is the second key reason for America’s poor health. One’s early life situation affects one’s health for their entire lifetime. Studies have shown that “around half of adult health is determined in the first seven years” of life. For better health in America, “societal responsibility needs to begin at birth, conception or even earlier.” Birthweight is key factor for good health in adulthood. Stress and poverty impact birthweight, and low birthweight is a major factor in many adult diseases. “Diseases of the lung (including cancer), kidney, diabetes, high blood pressure, obesity, decreased immunity to infections” have their origins in early life. Bezruchka writes that “child abuse is the major hidden epidemic of our time,” and explains how trauma from child abuse lasts for a lifetime. Bezruchka also shares data that shows how “poverty in infancy is a type of toxic stress for which there is no cure later in life.” As impoverished infants age, brain development and their immune system are compromised. The adult immune system reflects the stress we experienced in early life. UNICEF ranked the United States “dead” last in child wellbeing amongst rich countries.

Poor health has become normalized in the US. Thus, we accept our poor health, and don’t question it. Many Americans reject the reality of America’s inequality because it conflicts with their belief in American exceptionalism, just as they reject science if scientific findings challenge their beliefs. Americans tend not to be interested in what happens in other countries, so will likely scoff at the extensive data that Bezruchka shares. American culture directs us to focus on individual rights, not our social responsibilities. Americans tend to believe that people are poor because they are lazy, and resist governmental efforts to improve public health or to support the impoverished.

So, how can we fix this? Bezruchka writes that “the primary determinants of disease are mainly economic and social,” thus “our health depends on political choices.” Yes, investment in healthcare is important, and Bezruchka supports universal healthcare, and is appalled that “unlike most rich nations, the US does not provide access to healthcare as a fundamental right.” But more investment in healthcare won’t address inequality, which is the key driver of our poor health. The US “medical industrial complex” has been structured as a growth industry, focused on making money, not to provide good health. All other rich nations have lower healthcare costs and longer lives.

If America is to reverse this trend, we need to successfully educate Americans about inequality’s impact on our health decline. We need to convince Americans to support policies addressing inequality and supporting early life. America can no longer be one of only two nations in the world that do not have a national policy of paid parental leave. Bezruchka hopes that Covid will be the trigger to affect the changes needed to make our society more equal, trusting, and cooperative. Bezruchka closes the book with many specific suggestions for us, as individuals, to get active and work politically for policies that will lead to better health in America. These include less incarceration, stronger civil rights, gun safety, as well as investment in education, housing, paid parental leave and childcare. Also, returning to the progressive tax rates of the 1950s to raise revenue for social spending will extend our lives. Many other countries have proven these policies work. We can spend far less on healthcare, and have far better health. Or, America can remain exceptional at living in poor health, and dying young.

Reviewer Opinion: Tons of data and compelling arguments packed into 200 pages.

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