"Bad Habits" Do Not Explain Higher Death Rates in the Poor

"Contrary to popular opinion, behavioral risk accounts for only a small proportion of differences in mortality across age, sex, and race groups when taking income into account. Controlling for other demographic factors, persons with incomes of less than $10,000 were 3.22 times more likely to die of any cause than those with incomes over $30,000. When factors such as smoking, drinking, obesity, or physical inactivity were considered, the risk of dying of any cause for the lowest income group was still 2.77 times as great." (Inequality and Health: Patterns and Dynamics. David R. Williams, University of Michigan Institute for Social Research, Ann Arbor; and: Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. PM Lantz, JS House, JM Lepkowski, DR Williams, RP Mero, J Chen. JAMA 1998 Jun 3;279(21):1703-1708).

"The researchers concluded that although reducing the prevalence of health risk behaviors in low-income populations is an important public health goal, socioeconomic differences in mortality are due to a wider array of factors and therefore would persist even with improved health behaviors among the disadvantaged." Why is this "an important public health goal" if it fails to materially improve public health? Perhaps because it provides an excuse for emplying public health busybodies, and, even more importantly, it is a lie for the health fascists to use to increase so-called "sin taxes" to exploit smokers and perhaps politically incorrect eaters, for the benefit of the politically correct.

The study's authors believe that "Because income is so important a determinant of health disparities among people of different races, policies to reduce income differentials - especially to raise incomes in the lowest tier - would provide the most help to deal with these differences." But this would not be sufficient. Poverty does not actually cause cancer, and you can't literally buy health if you don't already have it even if you're rich - thanks to the stifling of research on infection in chronic diseases by the health fascist ideologues. The interpretation of the study by this school of thought is that infection is the actual cause, with spurious supposed risks for "lifestyle" factors being generated through confounding by infection.

This study was funded by the Robert Wood Johnson Foundation, presumably by accident due to their dogmatic certainty that so-called bad habits are to blame for most of poor peoples' illnesses and earlier deaths. Needless to say, the study has had no effect whatsoever on the juggernaut of health fascism, which continues to rumble on like a runaway freight train in need of someone to hop aboard and stop its menace to society.

Nutrition. The soft science of dietary fat. Gary Taubes. Science 2001 Mar 30;291(5513):2536-2545.

Neighborhood of residence and incidence of coronary heart disease. AV Diez Roux, SS Merkin, D Arnett, L Chambless, M Massing, FJ Nieto, P Sorlie, M Szklo, HA Tyroler, RL Watson. NEJM 2001 Jul 12;345(2):99-106. "Residents of disadvantaged neighborhoods (those with low summary scores) had a higher risk of disease than residents of advantaged neighborhoods, even after we controlled for personal income, education, and occupation. Hazard ratios for coronary heart disease among low-income persons living in the most disadvantaged neighborhoods, as compared with high income persons in the most advantaged neighborhoods, were 3.1 among whites (95 percent confidence interval, 2.1 to 4.8) and 2.5 among blacks (95 percent confidence interval, 1.4 to 4.5). These associations remained unchanged after adjustment for established risk factors [sic] for coronary heart disease."

Reports like this have surfaced again and again over the years. But rather than question their dogmas about "established risk factors," the health establishment merely emits rhetoric about 'addressing health inequalities' and throws more money into worthless lifestyle interventions.

Association of body mass index and obesity measured in early childhood with risk of coronary heart disease and stroke in middle age: findings from the aberdeen children of the 1950s prospective cohort study. Findings From the Aberdeen Children of the 1950s Prospective Cohort Study. DA Lawlor, DA Leon. Circulation 2005 Apr 19;111(15):1891-1896. "There was no association between childhood body mass index and CHD risk. There was no linear association between childhood body mass index and stroke risk,..."

Education, socioeconomic and lifestyle factors, and risk of coronary heart disease: the PRIME Study. J Yarnell, S Yu, E McCrum, D Arveiler, B Hass, J Dallongeville, M Montaye, P Amouyel, J Ferrieres, JB Ruidavets, A Evans, A Bingham, P Ducimetiere; PRIME study group. Int J Epidemiol 2005 Apr;34(2):268-275. "In all, 842 men (8%) showed some evidence of CHD at screening examination and these men were more likely to be living in poorer material circumstances, be unemployed, or have had less full-time education than men without CHD at screening in both France and Northern Ireland. These relationships persisted following adjustment for all known risk factors for CHD.... Among men free of CHD at baseline, although there is strong evidence of socio-economic differentials in cardiovascular risk factors these do not contribute independently to risk of CHD at 5 years of follow-up in this large cohort of men from France and Northern Ireland."

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cast 11-18-06