Behavior, income and health

Because I knew the March 24/31 issue of JAMA contained that dreaded article that we need 60 minutes a day of exercise to maintain a normal weight (I'm barely managing 40 min. 3-4x a week), I didn't look at it until today. I discovered in that issue another, far more interesting article on socioeconomic status, personal behavior and health outcomes done in Britain, which has a single payer, government health care system and far more government interference in personal lives than we experience here.

Let me back up. One of the most frustrating features in reading JAMA is the constant emphasis on "the gap" and not on improved health outcomes for all groups over time. There's usually a PhD, MSoc or MSPH among the authors, which means the article will dredge up the obligatory difference between Blacks and Whites, or Blacks and Latinos or 10 years of education vs. 14 years, or inner city hospitals vs. suburban rather than lives saved by advances in technology, surgery or new miracle drugs. In many articles, there is at least the suggestion that the top two quintiles are somehow to blame for the bottom two in health differences, and more government funding (taking from the top 2) would somehow equalize this.

I'm guessing publication of this one was held up, and certainly not promoted in 2 minute summaries on the evening news. "Association of Socioeconomic Position with Health Behaviors and Mortality," JAMA, Vol. 303, no. 12, pp 1159-1166 with editorial content on pp. 1199-1200. CONCLUSION: "In a civil service population in London, England [i.e., white collar but from different social classes], there was an association between socioeconomic position and mortality that was substantially accounted for by adjustment for health behaviors, particularly when the behaviors were assessed repeatedly."

Let me translate. Smoking, drinking, over eating and little physical activity are not good for you, whether one or all four, and you are more likely to do these things if you have lower/working class origins. Health insurance doesn't change you or the outcome of your bad behavior. You don't become poor and less educated because of the degree of access to health care, and it's terribly hard to change behavior whether rooted in the genes or the early life culture.