Health Deteriorates in the Two-class Society
Published on Monday, December 22, 2003 by the San Francisco Chronicle
Health Deteriorates in the Two-class Society
by Harley Sorensen

Shortly after Lyndon Johnson became president in 1963, he declared a "war on poverty."

In the wealthiest nation on Earth, Johnson argued, there was no reason anyone should be poor.

Nor was there any reason some Americans should be second-class citizens, he maintained, and with that in mind he hammered the Civil Rights Act of 1964 through a reluctant Congress.

And, for a while, it looked like poverty might be overcome. Federal money was put into the hands of poor people, who used it to become self-sufficient. It was an exciting time. An entire underclass of American citizens suddenly had a voice in our society and the opportunity to make good.

Many did make good. A good share of the emerging black middle class in America can be credited to programs started by Lyndon Johnson, a Democrat from Texas.

Unfortunately, the new influence of black people was considered a threat by many in the white majority, so it was an easy task for Richard Nixon to capitalize on that fear and be elected president in 1968. Nixon ran on a "law and order" theme, which was code for "put the blacks and hippies back in their place."

So the war on poverty ended.

If there was any doubt that rich conservative America wants its boot on the neck of poor people, Ronald Reagan, a Republican from California, put that to rest when he became president. Reagan's policies extolled the rich and helped make them richer. He blamed the poor for being poor, and he helped them stay that way.

One remarkable result of this class warfare against the poor is that Americans, rich and poor, have poorer health and die sooner. That's the argument of a physician in the state of Washington, who was brought to my attention by my good e-mail buddy, Phil Dunn, of that state.

The doctor's name is Stephen Bezruchka. He's a career emergency-room doctor, one of a very rare breed. Few doctors can tolerate the strain of ER work for long; they soon go on to less stressful and more financially rewarding jobs.

In an e-mail Friday, Bezruchka described himself as "an ER doc who teaches in the University of Washington's public-health school's international-health program. I also work in Nepal with Nepali doctors trying to improve surgical services in remote district hospitals."

In addition, he's written on such topics as how to prevent and treat altitude sickness, and trekking in Nepal. His best-known book, perhaps, is "The Pocket Doctor," which The Vancouver Columbian called "the ultimate preventative approach to health care for travelers." He has produced tapes in Nepali. He definitely qualifies as a Renaissance man.

In a lecture in Seattle on Dec. 6, Bezruchka pointed out that "studies overwhelmingly show that for every health condition, for every disease, for every cause of death, those who have lower incomes have it much worse than those who have fatter paychecks."

Then he went on to show how, in comparison with other countries, health in the United States has deteriorated over the years. Using life expectancy as a measure, Bezruchka said, "55 years ago, we were one of the healthiest countries in the world .... Today, there are some 25 countries that are healthier than we are."

"Think of it," he added. "All the other rich countries are healthier than we are, and a number of poor ones as well."

Health barometers other than life expectancy show the same results, Bezruchka said.

"For example [among developed nations], we have the highest infant-mortality rate, the highest child-poverty rate, the highest teen-pregnancy rate, the highest child-abuse death rate and so on. There are no indicators in which we excel, except in spending money on health care, for we spend half of the world's health-care bill."

This wasn't always so. What has caused the change? "Fifty years ago," Bezruchka said, "it was the poorest families that saw the biggest gains in income. Now, as you all know, it is only the rich and super rich that are seeing gains in income."

Bezruchka's studies show that residents of nations with a strong middle class and small income disparities, such as Sweden or Japan, have the best overall health. Countries like Nigeria and the United States, with huge gaps in income, have the worst.

"An African-American male in Harlem lives less long than a man in Bangladesh, one of the world's poorest countries," he said. "A black man in Washington, D.C., lives less long than a man in Ghana."

In reconstructing Japan after World War II, U.S. Army Gen. Douglas MacArthur changed the rules. He redistributed the wealth and the land in a way to make everyone more nearly equal (or at least less unequal).

He installed what was known as a 3D program (demilitarization, democratization and decentralization). As we all know, it worked marvelously. And it brought Japan to the world's No. 1 spot in health. The Japanese now live longer than anyone.

While Japan was improving, we in the United States were going the other way. We've become tremendously militaristic, our democracy is waning and our institutions are becoming more and more centralized. (Think Wal-Mart.)

So, what's the solution to our national health problems? Bezruchka suggests that the poor learn to flex their political muscle. Only when the politicians start serving the masses, rather than their rich contributors, will things change.

"If the poor organized, if the working class got together, it would be a piece of cake to change things," he said. "After all, the poor and the working class are the majority in this country."

I certainly agree with Bezruchka on this, except for one problem: the Republicans have convinced the working class to vote against their own best interests.

Candidates can hold 99 positions that benefit working-class people, but if they hint that they might favor some sort of gun control, like keeping assault weapons out of the hands of gangsters, many of the working class will vote against them.

Or, if those same candidates say they favor a woman's right to choose, many, many working-class people will vote against them on that one issue alone.

So the rich keep spewing out the poisonous lies that the liberals will take all our guns away -- they won't, they can't: the Constitution forbids it -- and that abortion is liberal-sponsored murder. Those two issues keep the working class in line, and, in the process, jeopardize the health of us all.

Bezruchka's Dec. 6 lecture prints out to 11 single-spaced pages. I just scraped the surface of it here and didn't begin to do it justice.

If you can spare the time, if you're really interested in learning how to help your country, I recommend you read it.

2003 SF Gate