Beloved Community Medicine

March 28, 2011

By Jeff Ritterman

A prior edition of HealthyCal.org documented a worrisome trend of rising income inequality within our state, a trend which runs in tandem with the statistics for the country as a whole. The latest research findings show just how worrisome this trend is.

University of California economics professor Emmanuel Saez has analyzed tax returns dating back to World War I. What he found was amazing and startling. We are more unequal now that at any time in the last one hundred years and significantly so. The last time we were this unequal, the stock market crashed and ushered in The Great Depression.

Would a more equal California be a healthier California? The answer appears to be a resounding yes.

There are now hundreds of papers and an excellent book, “The Spirit Level: Why More Equal Societies Almost Always Do Better” by Richard Wilkinson and Kate Pickett (*), which document the health and social costs of rising income inequality. These researchers from the U.K. compare health and social measures for all of the rich countries. The data show that the U. S. is the most unequal of all of the rich countries with the exception of Singapore.

Wilkinson and Pickett document a long list of health concerns and social ills that correlate with increases in income inequality. We don’t live as long as our peers in more equal countries, nor do our infants. We’re fatter, more of our teens get pregnant, we incarcerate more of our citizens, our children score worse on math and science tests, we kill one another more often, and we trust one another less. We even recycle less often.

Correlation, however, does not prove causality. Wilkinson and Pickett address this question at some length. They analyze the data on civic trust and conclude that the overwhelming balance of the evidence supports causality. It appears to be the case that the increasing income disparity causes us to trust one another less. The breakdown in trust causes the social fabric to unravel and we begin to experience life as a Hobbesian struggle of all against all. This results in disease in the individual and dysfunction in our society.

A generation ago, Sir Michael Marmot and colleagues (**) showed convincingly that social class was a far more important determinant of health outcome than cholesterol level, blood pressure, diet, and smoking behavior combined. The message was clear. The social environment is the major determinant of health outcome.

To create a healthier California, clearly we will need to move toward a much more equitable distribution of the income and a significant redistribution of wealth. Doing so will require a major change in our collective consciousness. We each need to work toward that end.

While we work, we need to build resilient caring, loving communities. Rising inequality causes disease and social dysfunction due to the unravelling of the social fabric once we stop trusting one another. The antidote is in our creating The Beloved Community which Dr. King envisioned;

a society based on justice, equal opportunity, and love of one’s fellow human beings.

As explained by The King Center, the memorial institution founded by Coretta Scott King to further the goals of Martin Luther King:

“Dr King’s Beloved Community is a global vision in which all people can share in the wealth of the earth. In the Beloved Community, poverty, hunger and homelessness will not be tolerated because international standards of human decency will not allow it. Racism and all forms of discrimination, bigotry and prejudice will be replaced by an all-inclusive spirit of sisterhood and brotherhood.”(***)

The best medicine for creating healthy communities is Beloved Community Medicine. It is in the building and strengthening of caring and kind social relationships that we can heal our social fabric. Medical research shows that volunteering for community and religious organizations improves the health outcome of the volunteer. We are wired to do good deeds.

As we work toward a more equitable and healthier California, let’s build loving and caring community. The Beloved Community is the Healthy Community.

Jeff Ritterman, MD is a Richmond city councilman. He recently retired from Kaiser Richmond after 30 years as a cardiologist.

*Wilkinson, R, Pickett, K “The Spirit Level: Why Greater Equality Makes Societies Stronger”, Bloomsbury Press, New York 2009.

**Rose, G, Marmot, M, Social class and coronary heart disease. Br Heart J 45(1):13-9. 1981

***The King Center. The Beloved Community of martin Luther King Junior. Available from:http://www.thekingcenter.org/GetInvolved/Default.aspx(accessed March 26, 2011).

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