00:05there's one view of us as biological
creatures that we are determined by our
00:10genes that what we see in our biology is somehow
innately us because of who we were born to be what
00:23that misses is that we grow up and develop
we grow up as children we grow up as adults
00:28and continue we interact constantly with the
world in which we are engaged that's the way
00:37in which our biology actually happens we carry our
history and our bodies how else could how could we
01:32Living in America should be a ticket to Good
Health we have the highest gross national
01:38product in the world very happy to finally have
some of my cars in one location some of them we
01:45spend 2 trillion dollar per year on medical
care that's nearly half of all the health
01:51dollars spent in the [Music] world but we've seen
our statistics we live shorter often sicker lives
02:02than almost every industrialized Nation we
rank 30th in life expectancy especially of
02:10economically developed countries we are at the
bottom of the list a higher percentage of our
02:17babies die in their first year of life than
in Malta Slovenia Cyprus how can this be is
02:28it just because 47 million of us have no Health
Care coverage Health Care can deal with the uh
02:36diseases and illnesses but lack of Health Care
is not the um cause of illness and disease it
02:42is like saying since um aspirin cures fever
that the lack of aspirin must be the cause of
02:48the fever so why are we getting sick in the first
place is it our American diet individual Behavior
03:01those behaviors themselves in part determined
by economic status and so our ability to avoid
03:08smoking and eat a healthy diet depends in turn on
our access to income education and what we call
03:16the Social determinance of Health written into
our bodies is a lifetime of experience shaped
03:24by social conditions often even more powerful
than our genes among twins who lived together
03:32until age 18 who basically grew up in the same
households so had at least a relatively similar
03:38exposure if they diverged later in life if one
became professional and the other was working
03:44class they ended up with different health status
as adults this is among identical twins there are
03:52ways in which our society is organized that are
bad for our health uh and there's no doubt that
03:58we could Recon configure ourselves in ways that
would benefit our health you're a doctor yes I'm
04:07a doctor now Dr OT Troutman knows this is true
in Louisville Kentucky I'm I'm the director of
04:13Health for Louisville I'm a physician I have
the primary responsibility of overseeing the
04:18public health of over 700,000 people in this
community think about a backup just in case you
04:24don't make DBA I do push personal responsibility
I do push self-determination in health but it
04:29has to be seen in the context of the broader
issues of social determinance which are the
04:34major forces that shape the health outcomes
of people in communities you did a fantastic
04:38job the details are in the data this map shows
infant mortality rates in the East very low for
04:46Louisville we we've generated data maps to get
a clear picture of what conditions uh correlate
04:53to illness and death across our city death rates
from lung cancer a little bit better outcome in
04:58the East so the lighter Shades mean lower rates
of death and illness and the darker Shades mean
05:03higher rates the highest rates of death from
diseases of the heart are in in the West End
05:09and that even does extend embedded in the data
is a somewhat morbid but revealing indicator
05:14of population Health excess death the notion
of excess death says that you should be able
05:21to predict in any one time frame how many
people in a population will die and if the
05:26number that actually die is higher than that that
differential excess death premature death death
05:31that should not have happened it's not as if we
won't die we all will die but the question is at
05:38what age with what degree of suffering with what
degree of preventable illness and then these are
05:43death rates from all types of cancer and you see
the same pattern in some areas people die three
05:51five even 10 years sooner than in others cancer
and heart disease are almost twice the rate in
05:57some areas as in others [Music] but Louisville has
many [Music] faces its population is spread over
06:1426 neighborhoods or council districts each with
its own social and economic environment and each
06:21with a distinct Health profile and the further
east you get the more affluent um the community
06:29become furthest East and North is Council district
16 home to Jim Taylor want to go upside down want
06:39to go on your feet Taylor is a father grandfather
and a CEO the rain passed at least so is this
06:48going to be like when your board chairman came and
the grill didn't work I like to think of myself
06:52as a pretty healthy person I'm only 12 months
away from the 60th year of my existence and and
07:00I feel pretty healthy I can't do the things I did
when I was 20 now that I'm almost 60 but I can do
07:07most of them in a little moderation is James
going to be here too I like James like many
07:13residents here Taylor earns well into the six
figures his income places him in the top 1% of
07:21Americans the wealth of that 1% is greater than
that of the bottom 90% combined can share the
07:30we're fortunate that the choices we have may be
greater than people who have less means than we
07:35do I have a neighborhood where I can be outside
and know that I'm safe and that I can exercise
07:43and walk and I know that not every neighborhood
in this country or in this city um that's true
07:52excess death doesn't seem to be a health issue in
Council district 16 here life expect expectancy is
08:00nearly 80 years 2 years longer than the national
average most people can quite readily appreciate
08:08the fact that if you have more money you're going
to be healthier but it also turns out that that
08:14observation holds not just at the extremes so for
example let's say that there's a ladder it's not
08:20just that the rich differ in some way from the
poor in some kind of black white or yes no or
08:2501 kind of way there's a fine gradation all all
the way along this ladder both in wealth and in
08:32health researchers had wondered about this
for decades but in the 1970s the pioneering
08:41White Hall studies offered hard data Sir
Michael Marmet has been lead researcher I
08:48was interested in how social influences affect
disease and so we looked at people's grade in
08:55the hierarchy their employment grade over more
than 30 years Marmet and his team charted the
09:01health of 29,000 British civil servants when
we did this in the 1970s the conventional
09:09wisdom was that it was the business executive
who had a high rate of heart attacks and what
09:16we found in whiteall was the lower the grade of
employment the higher the risk of heart disease
09:22but not just heart disease every major cause
of death so if you were second from the top
09:28you have had worse Health than you if you were
at the Top If you were third from the top you
09:33had worse Health than if you were second from
the top all the way from top to [Music] bottom
09:41in Britain everyone has guaranteed Health
Care still Marmet found that death rates and
09:48illness correlated to status even after
he controlled for unhealthy behaviors a
09:55combination of smoking blood pressure cholesterol
overweight sedentary lifestyle explained no more
10:04than about a quarter of the social gradient in
mortality so heart disease among smokers if a
10:12poor person's smoking he or she has a higher
rate of disease than if a wealthy person is
10:17smoking when a classless country like the
United States said well we wouldn't find
10:27that here because we don't have social classes
like they do in Britain and of course once
10:32people started to look at the United States
they found social gradients in disease of the
10:38same order as those we found in [Music] Britain
in America the wealth Health gradient looks like
10:49this over 70% of affluent Americans report
very good to excellent Health almost twice
10:57as many as poor Americans no surprise but
in the middle levels good health decreases
11:04significantly this translates into a reverse
slope for chronic disease diabetes low-income
11:15Americans have twice the rate of disease as the
affluent and for those in the middle it's still
11:22almost twice the rate a similar pattern
holds for stroke heart disease eventually
11:30contributing to excess death especially for middle
and low-income Americans the conditions that show
11:40up in Stark form in the poor health of the poor
are showing up in somewhat less Stark form in
11:47people who we don't think of as poor the large
mass in the middle of society are also being
11:53affected we find these social gradients
in health everywhere [Applause] [Music]
12:04when I first came to Louisville I was
struck by how different the various
12:08communities looked and I began to
uh wonder and then understand that
12:12there's a direct connection between the
health of populations in Louisville and
12:16the social conditions that can be seen
as you go from one Council District to
12:20another South of Jim Taylor's
Home is Council District
12:3124 Tandra young lives here young is 37
a lab supervisor and she's just gotten
12:42engaged financially I'm comfortable um I
would like to be rich someday but uh right
12:50now I'm I'm I'm fine I'm doing a whole
lot better than my mom was just bought
12:56a new home and I I would describe
my family as a middle class family
13:02now to get ahead Tandra went back to college
while working full-time I am going to graduate
13:12in the spring I'm very excited about that uh
I've traveled a long ways to even get to that
13:19point research shows that college graduates live
on average 2 and 1/2 years longer than high school
13:28graduates education offers a way to move up the
wealth gradient it connects to the type of job
13:37it connects to optimism about the future but
getting it depends on whether or not you can
13:43afford it tandra's degree has left her $220,000
in debt on top of her mortgage leave leave the
13:51one alone I think I broke them in the Last 5
Years the cost of college has increased 35%
14:01only 15% of adults in tundra Council District
have a college education compared with over 63%
14:08in Jim Taylor's District life expectancy
here is 75 years 4 years less than in Jim
14:16Taylor's North West from Tandra Young's district
14:30is Council district 21 this is
where Cory Anderson lives with
14:35his wife angelik and their two teenagers
Cory's lived in this part of town all his
14:41life this is my mother this is the woman who
taught me how to iron my clothes putting my
14:51creases in get the wrinkles out I give her
all the praise and the glory for teaching
14:58me how to keep myself nice and neat When
Corey was young his mom worked full-time
15:05and her job was more than just a paycheck
she had just purchased the house everything
15:11is going great for me you know I'm doing
good you know I'm being blessed then all
15:16of a sudden you know the company moved it took
a major toe on her when she lost that job you
15:26know she she got ill you know her blood
pressure went up and she had to go to the
15:32doctor more often and you know it was just
it was just something that you know really
15:37you know took a toll on her you know mentally
and physically you know as well as me and my
15:43brother eventually Cory's mom did find work but
she had to leave her home for most Americans
15:53home ownership is a way to build Financial
Security I always wanted to have house with
15:58a big backyard and a fence my kids can run
around have their own room and a basement
16:06the husband have a basement with a pool table
in it I want to own the house I want both us
16:12to own the house so if anything happened
to me she ain't got to be put out in the
16:16streets Corey and Angelique both work full-time
their combined salaries place them right at the
16:25national median income about $48,000 half of
All American households live at this income
16:33level or below as far as like saving you
know we don't we don't earn enough to you
16:41know say I'm we we going to put up $250 and
don't touch it it's going to have to take
16:46to work two jobs to really make it well
you ain't working two jobs I didn't say
16:51me at 37 Cory has already been diagnosed with
16:59hypertension joining onethird of
the residents in Council district
17:0421 average life expectancy here is 2 years shorter
17:11than in tandra's Council district 6
years less than in Jim Taylor's say
17:18hey Troutman sees social conditions change even
more markedly as he drives through Louisville
17:32City Center across 9th Street there is um almost a
cultural demarcation in the city where on one side
17:40of this particular Street 9th Street uh there's a
tremendous amount of new development going on the
17:46condos rising up the downtown business environment
is uh very much alive and right across the street
17:54on Ninth Street is where the beginnings of the
the first set of projects are public housing
17:58projects very little business in
this area you know uh primarily the
18:06fast foods of small businesses barber
shops beauty salons porn Brokers nail
18:11parlors uh check cashing liquor
stores Payday Cash Cash when it
18:19counts and it seems like every place
has a Ninth Street uh whether it's
18:28um 110th Street in Harlem or souths
Side Chicago or you know sections of
18:34wat of course these differences are not
a natural thing you know it's not uh the
18:43design of nature that these environments are
going to be different they are they arise as a
18:46result of policies or the absence of policies
that create these enormous inequalities and
18:52resources is there adequate access to chain
supermarkets in this area the answer is
18:59no as a matter of fact why aren't there
zoning laws to regulate fast food Outlets
19:06here Enterprise zones to build businesses
better transportation why isn't there more
19:16mixed income [Music] housing you know
all these things and others are Health
19:22policy how social policies can Drive Health
becomes even more apparent in Council District
19:315 the home of Mary Turner this is where we
usually come down for shoes school shoes
19:40and school clothes up here Save A Lot this
is one a third of the residents here have
19:45never received a high school diploma almost
30% live at or below the poverty line like
19:52Mary life expectancy in Mary's Council District is
more than 3 years less than in Cory's District N9
20:02years less than in Jim Taylor's of course we're
dying young versus 80 in the Eastern section of
20:10the county you know because those people are more
fluent and they have things open to them Mary is
20:1949 with three children at home her husband is
disabled you have to eat what fits your budget
20:28so when you get these the family size and they're
$1.99 and you can feed four people with it you
20:34know versus maybe four with $4 I mean what's
your choices going to be you know especially
20:42when you're on a $200 a month budget for food
the food that we buy lasts about two weeks we
20:50spend cash first part of the month you know when
we get Social Security and SSI and then usually
20:56by the last two weeks of the month things are
getting really spare you know I've got like three
21:00teenagers so you know about the end of the month
I start reducing to 1 mil a day so that I can make
21:05sure those the kids got everything they need 12%
of the residents here are unemployed more than
21:13double the national average as is Mary for now
so she volunteers at the neighborhood Museum she
21:21loves I do feel like that then sometimes things
are out of your control because as soon as you
21:27try to better yourself I mean if I even can get a
job you know then I might lose my medical coverage
21:34and my medical coverage is necessary you know
because I had to have my medications in order to
21:39work now I had a heart attack several years
ago I was mild but it was still heart attack
21:49thyroid problems you know and arthritis
you know a little bit of everything so
21:58[Music] we can predict on aggregate based on where
somebody lives High School graduation rates and
22:10their income how long they'll live and when they
will die now obviously there'll be exceptions to
22:18that but for the most part we'll be right and
we should not be able to do that your life
22:25expectancy how long you will live should not be
dependent on essentially the resources you have
22:32accessible to you we know that social class is
the most important determinant of Health above
22:39any other risk factor but what does social class
mean is it housing Medical Care education or is
22:49it power confidence a sense of security which one
of those is most important hopeless they're all
22:57inex stably intertwined can't take them apart so
it's really a challenge but how do we carry social
23:06class in our bodies how does it get under our skin
as you go through the alternative explanations the
23:15one that seemed most impressive to me was this
idea of control of Destiny I don't like that word
23:22what I mean by it is the ability to influence
the events that impinge on your life even even
23:28if it means not doing anything but one way or the
other managing those pressures there are all sorts
23:35of ways we've devised um for depriving people
of a sense of control over their lives living
23:41in a community uh where it's not safe to go out
middle class families having to work two jobs
23:48middle class families not being able to spend time
with their kids being relatively poor having job
23:55insecurity all of those things will decrease
control over people's lives and all of those
24:02things are likely to increase risk of illness
and there are good biological reasons why that
24:07might be the case when we feel threatened or
don't have control in our lives one critical
24:14biological reaction kicks in the stress response
when the brain perceives a threat it signals the
24:22adrenal glands to release potent stress hormones
among them cortisol they flood your bloodstream
24:29with glucose increase your heart rate raise
blood pressure they put your body on alert
24:38cortisol improves memory it enhance enhances
immune function uh it it helps you reestablish
24:46energy supplies Mother Nature put all of this
stuff in there to help us survive stress helps
24:54to motivate us in our society today everybody
experiences stress in fact the person who has
25:01no stress is the person who's dead a normal
stress response spikes up when needed then turns
25:08off but what happens when pressures
are Relentless and you lack the power
25:15and resources to control them when the stress
response stays turned on for months or years
25:24these systems begin to work over time we produce
too much cortisol chronically cortisol can impair
25:32immune function it can actually inhibit
memory and even cause areas of the brain
25:37to shrink when you get prolonged activation
of these stress Pathways they in turn affect
25:46heart rate variability the ability to handle
insulin and glucose and those in turn we think
25:53increase risk of diabetes and heart disease
because of the stresses that wear and tear
26:00on the body systems is reflected ultimately
in higher rates of disease and accelerated
26:06aging University Hospital
Louisville's major teaching
26:20Hospital you'd expect to see the wear
and tear of stress in the bodies of
26:26patients yeah but as a large hierarchical
workplace much like any other university
26:32hospital reveals more stress is everywhere
there are days that the pager that I carry
26:40goes off Non-Stop and gives me a horrible
headache and I just think that the next
26:45time I hear a page or a beep I'm
going to throw it up against the
26:47wall Corey Anderson floor technician
is stressed so is Tandra young super
26:57supervisor of a clinical lab and
Jim Taylor CEO of the hospital is
27:02stressed but neither chronic stress nor its
health effects are equally distributed on a
27:11hierarchy all right that's a Chase and a flea
so that one's dominant over the one that ran
27:20away consider this hierarchy of maak monkeys
primatologist shivley has been studying Max
27:29for almost 30 years same thing happened he can
play that game all day long with her cuz he's
27:36dominant it's a very mild sort of harassment
a dominant animal has complete control over
27:44his life he can go where he wants in the
pen do what he wants that animal has all
27:49the control that it needs to create an optimal
environment for himself in contrast subordinate
27:57animal animal have almost no control over what
happens to them they have to be watching all
28:03the time and in fact with that high level
of vigilance comes increases in heart rate
28:09maacs with less power and control are in a
state of chronic stress the evidence is in
28:15their stress hormone levels they have higher
levels of cortisol circulating in their blood
28:22it's the same chemical that is released in
human beings in response to stress and when
28:29it is sustained at high level starts having
negative effects on cellular function and
28:34tissues Shively can actually look into
the hearts of maax to see the damage
28:41from chronic stress this is a cross-section
of the artery of a dominant monkey the hole
28:50in the center is large and that means
that there's lots of room for blood to
28:55flow through now this this is the artery of a
subordinate animal so what's happened here is
29:02that a subordinate monkey has developed a
much larger atherosclerotic plaque than a
29:08dominant animal who lived for the same amount
of time ate the same amount of diet and so on
29:14and so forth and that is simply due to the
stress of social subordination now if this
29:22monkey keeps developing atherosclerosis at
this increased rate relative to this monkey
29:29this one is going to end up with an artery that
is completely compromised and have a myocardial
29:36inunction in other words a heart
29:41attack monkeys are one thing humans are another do
we see a similar pattern that's what psychologist
29:55Sheldon Cohen wanted to know he used the same
stress measure shivy used levels of cortisol
30:03who's next we have people uh chew on uh little
cotton swabs till they get wet can take it and
30:11analyze it for cortisol he compared their levels
with their socioeconomic status and to tell you
30:19the truth I'm I'm always somewhat surprised
when I see the these data it turns out the
30:27more education you have the less cortisol you
release during the day the more income you have
30:32the less cortisol you release during the day then
Cohen wanted to test the effect of stress on our
30:39bodies his focus our immune system basically
we brought healthy people in we exposed them
30:48to a virus we actually do this by putting a
drop in their nostrils that has cold virus in
30:55it Cohen's finding next those with less chronic
stress caught fewer colds than those with more
31:04stress thank you while a CO virus may seem minor
it could signal more serious health problems the
31:13cold study is a paradigm we can use that allows
us to see how effectively the immune system is
31:21operating which has implications for not only
colds and other infectious diseases AO immune
31:27diseases and some kinds of cancer so higher
status less stress less stress better immune
31:37function still still like this place compared to
where you were being CEO is a high demand job but
31:45Taylor usually has the power resources and control
to manage that pressure Tandra young has a high
31:53demand job but less power and control sometimes
I get a little stressful because you know like
31:59I have 50 something employees running around on
three different shifts three different buildings
32:04sometimes it can be tough for me because you know
everybody's not going to like the decisions that
32:09I I've made for the department but I'm making the
best decision for the department and for patient
32:13care it's coming along okay it's looking good in
32:20here the control that I have
on doing my job is limited
32:30Cory Anderson's job requires him to respond to a
lot of Demands from above yes mission is complete
32:38up on the first floor Mission want to know what's
my next project in one scenario Cory is first told
32:45to clean patient rooms but I got pulled to help
out with trash so I started on the trash and when
32:54I pull the trash I got a p page to tell me to go
back to the runes I was bounced around you want
33:02this uh scrubed ey like Cory one in every five
American men Works in a high demand low Control
33:10[Music] job they're more likely to experience high
blood pressure at work and their blood pressure
33:26doesn't fall as much as men with more control
even when they sleep it's not only about work it's
33:34about where you are in the hierarchy and how that
relates to the circumstances in which you live
33:40grow up as well as work so this is basically what
I call my neighborhood I don't Venture no farther
33:50you know because I just I'm not comfortable with
you know venturing back there or back over that
33:56way a lot of things you know do occur back in the
back and my wife uh she knew a cab driver who was
34:05uh who was murdered back there in the back two
c drivers one got shot in the head other one got
34:11shot and they dropped him off in his yard remember
Cory right over here on Kingston I thought he got
34:17strangled well yeah they strangled him and then
they shot um shot another another young [Music]
34:24boy the accumulation of stress or the accumulation
of resources to manage them so much is determined
34:33by class you're welcome I am well paid for what
I do I'm fortunate enough to be able to have the
34:41choice of where we lived and more than half the
mornings when I come to work I have to stop for
34:45the deer to go by and that kind of thing is just
what happens in his neighborhood this is the this
34:52is the second biggest that you get this we have
the time to exercise because because the lives
34:57we live don't require us to try to find a bus
that we have to ride for 2 hours to get to our
35:03job and on the other end and we don't have um you
know huge demands on us when we're not working oh
35:10you want to try a little mango oh sweetie it's all
Jackie and I talked a lot about healthy choices of
35:15eating well um that doesn't come for free we have
the ability to get to places where one can make
35:22those choices we have the time to prepare the
meal that we had the money to buy do you want
35:29to try a piece of kiwi so a certain of economic
status brings you control over other parts of
35:35your life kinds of places you can live the kinds
of vacations you can take or if you can take a
35:42vacation we went by bus all the way from here
to Miami we got on this party bus once we got
35:54on that boat brother it was over for throw
your hands up that's how she was I was like
36:01Hallelujah no kids no kids it was just a a
break a piece of something that we needed cuz
36:08we we never get to go nowhere you know we always
here with the kids or babysitting somebody else's
36:13kids vacation to me is going to the park sitting
on the river and watching the river flow by you
36:26know that's my vacation uh little short things
you know it's not there's no family vacations
36:34it doesn't happen my children I think they're
living with a whole lot of stress a whole lot
36:41you know and they really you know are kind of
at a loss to do anything about it you know I
36:47mean they're young I mean what can they do
they don't like being by their yourself on
36:53the streets you know they don't like to walk
by theel they want somebody with them that's
36:57the reason why you see them going two and
three you know and it happens a lot around
37:01here contrary to some stereotypes most of the
poor in America are white Mary grew up poor her
37:13children join the 21% of All American children
who live in poverty the unremitting stress of
37:21childhood poverty can have lifelong Health
consequences just the the burden of day after
37:26day not knowing whether there's going to be food
on the table and not knowing whether you're going
37:30to have a roof over your head is actually toxic to
the brain and the reason for that is because when
37:35these stress hormone levels go up and if it stays
up for days and weeks on end those hormone levels
37:41literally interfere with the development of brain
circuitry they interfere with the development of
37:46the connections in the brain so we begin to see
in children who experience toxic stress long-term
37:54impacts of what's basically been chemically
Dam damaging to their brains the concept here
37:59is is the pile up of of risk the cumulative
burden of having things that are increasing
38:06your chances of having problems as opposed to
the cumulative protection of having things in
38:12your life that increase the likelihood that
you're going to have better outcomes Economic
38:17Security may offer some of those cumulative health
benefits in another coold virus study Cohen used
38:24a familiar proxy for that security home ownership
we ask people if their parents own their own home
38:34does we their parents on their home when they
were a kid predict whether you get a cold when
38:39you're an adult we now take them as an adult we
expose them to a virus it turns out it's a great
38:46predictor and it's a graded predictor that is the
more years their parents own their home the less
38:53likely they are to get a cold when we expose
them to a virus all of it really comes down
38:59to whether you're building a strong or a weak
foundation in early childhood when you pile up
39:04risk factors it ends up being translated into a
weaker Foundation a brain that's been subjected
39:11to more disruption an immune system that's been
more threatened and poor or not if you're not
39:19white the prognosis can be worse you live around
here no what do you live I live in Jefferson Town
39:27in Jefferson you you travel a long way to get
here I'm clear that um on the social gradient
39:33that line that we talked about earlier that
I'm on the top of that line Kenneth how old
39:38are you kenth 11 11 I'm highly educated I have
a medical degree I have several other degrees
39:44I make good money I live in a good neighborhood
uh and but I know that according to the research
39:51if you're an African-American no matter what
your social status your socioeconomic status
39:56your health outcomes are going to be worse than
your white counterpart African-Americans die
40:03earlier and have higher rates than whites of many
chronic diseases across the social gradient why
40:12should there be an elevated risk of disease
in African-Americans of higher social class
40:19bad genetics not true when you look at other
countries where the Discrimination is not as
40:23prevalent you don't find those kinds of rates so
some something's happening as a physician I've
40:29been followed around the store when I go in to buy
something I've been looked at as scans I've I've
40:35seen uh a woman grab her purse when I come into
the elevator and for goodness sakes you know I
40:41am Dr Troutman you know why this shouldn't happen
to me but it does the whole idea of of vigilance
40:48and the and the burden that it takes to be
constantly on guard over time really does change
40:55biological markers and make people vulnerable
to getting sick racial discrimination can be an
41:02added stressor linked with high blood pressure
increased rates of infant death coronary artery
41:10disease Troutman knows what this can
lead to he authored a Cornerstone
41:18study with former Surgeon General
David satcher on excess death among
41:22African-Americans the was a national study and
we found over 83,000 excess deaths per year in
41:32the African-American Community alone 83,000
excess deaths each year that's the equivalent
41:40of a major airliner filled with black passengers
falling out of the sky every single day every
41:48year if these inequalities in health
this gradient in health was a fixed
41:57property of society and never changed then
you'd say we're stuck but that's not the
42:03case I mean the magnitude of the inequalities
in health changes over [Applause] time it can
42:16get rapidly worse and if it can get
rapidly worse it ought to be possible
42:21to make it rapidly better I'm hanging
around reducing Health inequality is not
42:26impossible as a society we've done it
42:31before a century ago the average American lived
only about 48 years as living conditions and
42:41Medical Care improved we began living
longer those improvements reached more
42:47Americans through social reforms like Universal
education better sanitation the 8-h hour work
42:54day even a cont controversial tax on personal
income this social security measure the 1930s
43:05an array of new social programs prevented
an economic crisis from becoming an even
43:10worse Health crisis increased services for the
protection of children and the prevention of ill
43:17health returning World War II veterans got the GI
bill it offered homes and education and eventually
43:27the kind of wealth that sets Health on an upward
trajectory still most African Americans were
43:35excluded the 1950s the middle class was growing
income inequality was declining prosperity and
43:45medical advances extended Our Lives even longer
but the vast majority of improvements in health
43:52in our society over the last century uh have
had very little to do with medical Innovation
43:59what really counts it's other kinds of things
we can do and those other kinds of things tend
44:04to be non-medical things like thinking about
the distribution of wealth in our society or
44:09providing Public Health infrastructure or better
education for people better housing all of those
44:15things which aren't medical phenomena it is
all of those that are really material for
44:20public health black and white together in the
1960s civil rights laws anti-poverty programs
44:31Medicare and Medicaid all brought the benefits
of prosperity to those who hadn't yet shared in
44:37it during the 1960s to early '70s the black white
Gap in income narrowed and the black white gap on
44:46multiple indicators of Health also narrowed what
this says very eloquently is that economic policy
44:56is Health policy and when we improve economic
circumstances and narrow the economic Gap we
45:05improve the health so we can potentially intervene
or potentially see a world in which while we do
45:15not eliminate hierarchy we constrain the way in
which hierarchy affects human beings so it's not
45:23just that the people at the top can afford those
things and get the and those at the bottom that
45:26do not if we provide them to all we still have
some hierarchy but now we've kind of reduced the
45:31disparities but since the 1980s
we've gone in the opposite
45:37direction look at me I used to work for these
people now I got to stand in line and get a
45:44box of cheese waiting for the Ragan trickle
down and it's not trickling in the midst of
45:49a recession government slashed social programs
deregulated industry reduced taxes for the the
45:56wealthy with consequences that remain with
us today where the people just like dead
46:02in a country that Prides itself on equality
of opportunity it is becoming anything but
46:07that as the gap between the super rich and the
middle class widens in dramatic fashion Warren
46:14Buffett the world's richest man here are a
few figures on the Forbes 400 other people
46:20save their Playboy magazines I saved the Forbes
400 magazine um uh 20 years ago the total wealth
46:27of the list was then 220 billion now it's 1.54
trillion exactly a s for one increase tax law
46:38changes have benefited this group including
me in a huge way wealth inequality reached a
46:47record low in 1976 since then it has soared
today we are Far and Away the most unequal
46:55of of the world's Rich democracies during that
same period the average American went exactly
47:02nowhere on the economic front he's been on a
treadmill while the super rich have been on a
47:07spaceship the poor are getting poorer and
the middle class is getting squeezed with
47:16what we know in terms of health that suggest
that we will have even more health problems
47:22in our society in the future that's because
here Health depends largely on our individual
47:29assets and resources in America it's the
strongest relationship you'll find anywhere
47:36that wealth pretty much equals health
and that's true for me as it is true for
47:42you know the poorest person in in the quote
unquote inner city and people living in the
47:47suburbs the wealth Health gradient is not as steep
47:55in most other industrialized nations
many use their resources to ensure
48:01that more of their citizens have the
freedom to lead flourishing healthy
48:05lives all guarantee Universal Health Care
coverage mandate at least 4 weeks of paid
48:14vacation France's minimum wage has been twice
as much as ours Ireland provides free college
48:23education Sweden's family policies reduce
child poverty to a mere 4.2% compared to
48:30our 21% it's it's tragic actually that that
we are the richest country in the world and
48:38that we are far behind many other countries
in terms of how we use our resources to make
48:44life better for families with young children and
and and thereby invest in in our [Music] future
48:54those countries have found way to break the
tight linkage between income and wealth and
49:02health and they they invest in better education
systems housing support child care um access to
49:14Recreation they subsidize through tax policy
mechanisms that break that strong relationship
49:21those countries where wealth is more equitably
distributed are [Music] healthier here in the US
49:31many communities are taking Health matters into
their own hands I'm glad you're here I'm really
49:38I I'm excited that you're here because this
is the the the Mosaic of people Partnerships
49:44organizations agencies that we need to come
together to make this a reality one 2 3 in
49:52Louisville the city's new Health Equity Center
trains citizens to take political action and
49:58design policies that address the health needs
of their Community it's not enough to talk
50:03about individual behavior and feel that if we
could just get people to exercise more and eat
50:09more fruits and vegetables everything would
be all right that is not the case the bigger
50:13issue are the social conditions that drive
the ultimate health status of populations we
50:20sold nine of them on Saturday oh did you abely
oh I knew you in Seattle Washington activists
50:26Target unhealthy housing and the asthma
that keeps many from leading productive
50:31lives be filtered out so the air inside
the home is actually healthier than the air
50:35outside part of good public health is empowering
communities and I don't think we should shy away
50:43from that and empowering communities means
creating those conditions where people
50:47become empowered and make the changes they need to
control their lives power is a public health issue
50:53and here's my grandpa he died of diabetes diabetes
and the complications of diabetes in Arizona
51:02Native Americans are farming again with better
food and New Economic resources they're beginning
51:09to take control of their Destinies and diabetes
of course the proof is in the pudding the proof
51:16is in next steps what we can organize what we
can Implement uh and how we're able to move this
51:21community ahead it's about human rights it's about
addressing ing the social determinance of Health
51:27in order to make a difference it's about fairness
it's about Health Equity and social justice we've
51:34got to create a movement where people understand
we're talking about leading more flourishing
51:39lives we need to do certain things CU they're the
51:45right things to do but it's
also an issue of individual
51:52self-interest if I live in a just Society
I'll benefit yeah but look right here I got
52:01a to right here is trying to come up right here
an economist would tell you it's inefficient to
52:07have people who could otherwise be contributing
during their productive years to the overall
52:13benefit of society caught up in hospitals that
create a net dependence on society so they're
52:20drawing resources down from society rather than
producing resources that benefit F the society
52:25as a whole and the cost of that lost productivity
to business due to chronic illness is staggering
52:33it's now estimated at over $1 trillion a
year worse one study predicts that today's
52:41generation of Young Americans may be the first
in a century to live shorter lives than their
52:47parents and I would hope that we would all be
able to to gravitate towards an egalitarian
52:58society where health is seen as a basic human
right told me somebody told me this table had
53:03the fastest kids in all of Louisville is that
true yes but even if you're not willing to go
53:08that far you better be involved in this
because the self-interest would dictate
53:12that you're at risk too we can wait for
things to happen and try to repair them
53:19in this mode of damage control or we can
invest early try to set good trajectories
53:27for families and children and communities we
can do those things or we can engage in damage
53:35control all right see you bye-bye we have a choice
