Tonight I began the UCSF mini-med school series on healthcare reform, attending an engaging lecture by Dr. Laura Schmidt about how economic inequality is the root of healthcare disparities. She argued that achieving universal health care coverage, although it's a laudable goal, would not do much on its own to close gaps between different populations.
The more serious solution for improved health outcomes--as she argued with a bevy of studies, although some of them were quite dated--is to redistribute the wealth within a society. (This is not the same thing as socialism, as Dr. Schmidt strenuously argued toward the end of her talk.) The idea isn't to make the pie bigger, but to change the allocations of wealth that already exists. So progressive taxation is in, and flat taxes are out. Dr. Schmidt feels that the tax policies supported by President Obama are a major step in the right direction.
So it was a standard left-wing health policy talk, in good measure. What did stand out among the usual fare was the discussion of anomie, Emile Durkheim, and social hierarchies.
1. Anomie and Durkheim: Emile Durkheim is the father of modern sociology, and developed the concept of anomie--a state of normlessness that could ultimately tear societies apart. People who experience anomie, Dr. Schmidt argued, are less integrated into their larger society and ultimately more susceptible to health ailments and early deaths. For those who argue that correlation is not causation, Dr. Schmidt responds that this connection between social status and health outcomes is a "robust finding" that has been validated repeatedly.
A great deal of epidemiological research seeks to isolate various factors that lead to health disparities among different populations--poor nutrition, little exercise, etc. Obviously these factors have some effect, but the root cause remains the difference in social status between various groups in a society.
2. This leads to the reality of hierarchies. All societies have them, and it is hard to imagine a world with no pecking order. However, it is possible to minimize or magnify the reality of hierarchy. More redistributionist societies soften the edges, more individualistic societies magnify them. And thus Dr. Schmidt made the inevitably unflattering comparison between the US and more egalitarian countries like Sweden.
I always grow weary at this juncture in the health care debate, because there is never any allowance for the fact that the individualistic US model also has benefits--to some extent the rest of the world's health care systems depend on the R & D funded here. It's a yin yang relationship between the individualistic and collective impulses, not a zero-sum game.
But I digress. One aspect of hierarchies was completely new to me, and I'm glad Dr. Schmidt shared it. I learned that a person's level of autonomy over their work has a significant impact on their health--two people can have an identical income, but the person with greater control over their activities and schedule on the job will tend to be healthier. This was a key finding of Sir Michael Marmott, who led the landmark World Health Organization Social Determinants of Health study.
Just today I pondered how fortunate I am to have a great deal of autonomy at work. Obviously I have to coordinate my activities with others. But I can take a long lunch one day and grab a quick bite the next day, all at times of my choosing. And in most cases I can shuffle my schedule around if new opportunities or needs arise.
Normally I don't think twice about this. Perhaps this came to mind because I'm going back to Ohio for a few days on Saturday, and am hoping to meet a childhood friend for lunch Monday. For planning purposes, I needed to know if his lunch hour was fixed or flexible. (Flexible, it turns out.) As I typed the email, I realized how long it had been since I'd asked such a question--anyone I lunch with at work has equal or greater autonomy than me.
So on the whole I'm very fortunate, despite this difficult year. I've now made a vow not to take my level of control at work for granted--not only do I have a good job, but I'm healthier than I might otherwise be.