Laura Pemberton was in labor and ready to give birth at her home in Florida when a sheriff arrived at her door, took her into custody, strapped her legs together, and forced her to go to Tallahassee Memorial Regional Medical Center, where doctors had instigated urgent court proceedings.
They claimed that Pemberton was risking the life of her unborn child by attempting to have a vaginal birth after having had a previous cesarean surgery. The judge ordered the woman to undergo the operation, which she did against her will later that day in 1996.
Regina McKnight, 21 years old and pregnant, suffered a stillbirth that led to her arrest and conviction on homicide charges in South Carolina in 2001. Although the stillbirth later proved to be the result of an infection, prosecutors argued that McKnight caused the stillbirth because she used cocaine. A jury found her guilty after 15 minutes of deliberation and she was sentenced to 12 years in prison.
Pregnant with her second child in 2005, 20-year-old Rachael Lowe went with her husband to a hospital to get help for her addiction to Oxycontin. An emergency room doctor reported her to Wisconsin state officials and Lowe wound up confined against her will in a psychiatric ward, where she received no prenatal care. She remained incarcerated for more than 25 days before a doctor testified that Lowe’s addiction posed no significant risk to the health of the fetus and a judge ordered her release.
The U.S. and other wealthy nations have practically eliminated all of the infectious diseases that seemed to account for the unequal burden of death in poor households and neighborhoods in earlier times. And yet inequalities in mortality have continued at more or less the same level since at least the early 1800s. What has changed are the major causes of death, which are cancers and chronic disease of the heart and vascular system.
Social scientists Jo Phelan and Bruce Link were among the first to make the case that inequalities in health are unlikely to change unless policy makers address inequalities in income, education and social status. Link and Phelan developed an influential theory that describes how social forces are the fundamental causes of health disparities.
A new key concept in AHCJ’s core topic area on the social determinants of health gives a quick overview of fundamental causes theory, the supporting evidence, and the implications for health policy. The theory predicts that interventions that aim solely to change individual risk factors will tend to worsen social inequalities in health, and there is some evidence that this really happens. Read more…
People whose socioeconomic status is low are more likely to act in ways that harm their health compared with those higher on the ladder of income and social stature. On average, they smoke more, exercise less, have poorer diets, and more often ignore health advice and fail to comply with treatment. As a group, they are even less likely to use seatbelts.
Researchers have proposed many theories to explain why this is so, and these involve more than the inability to pay for goods and services that promote health.
Investing less in health behavior may be a positive adaptation to socioeconomic deprivation, according to a theory inspired by evolutionary biology. In other words, it’s like deciding to spend little on car maintenance when you live in a neighborhood of rampant car theft. Living under threat of high mortality from outside causes may set a limit on how much energy it is worth to put into lowering mortality from internal causes.
So far, there is no grand unified theory that accounts for all social, psychological and political forces that press on people on the lower rungs of the socioeconomic ladder. In an informative review, Fred C. Pampel, Patrick M. Krueger, and Justin T. Denney break down the evidence for and against nine major pathways by which socioeconomic status shapes health behavior. Learn about those pathways.
The Bronx has ranked as the least-healthy county in New York State for several years running. The news team at WNYC wanted to find out if the Affordable Care Act or other recent policies were having any impact.
Heart disease, diabetes and asthma are unusually prevalent in the borough, where people also struggle with high unemployment and poor housing.
“People in the Bronx have excellent access to health care. So why are so many of them so sick?” one of the resulting news reports asked. Others explored the links between education, employment and health; whether housing should be considered health care; and how neighborhood conditions shape food choices.
WNYC reporter Amanda Aronczyk was new to health reporting when she got the assignment. We asked her to share how she juggled all the moving parts to sustain the deeply reported series that aired in June.
“The assignment was to report a series on health and health care in the Bronx between January and May, with an airdate at the beginning of June,” Aronczyk says. “I had about month to propose a package of stories.” Read more…
Megan Sandel, M.D., M.P.H., an expert on the impact of housing on child health, says journalists would do well to broaden the conversation about health care to include questions about social support – especially support for safe, affordable and stable housing.
Sandel has contributed a tip sheet that includes key stories to pursue and critical insights on the housing-as-health-care trend.
Find out why housing has an enormous impact on educational attainment and economic stability, how unequal enforcement of health and safety codes creates disparities and what the three essential elements of healthy housing are. See the tip sheet now.
The statistics are hard to believe.
- The most dangerous counties in the United States have rates of violent death that are more than 10 times higher than the safest counties.
- In Los Angeles County, homicide subtracts nearly five years from the expected life span of African American men in some neighborhoods.
- Across the U.S., death by homicide is more than eight times more common among blacks, and three times more common among Native Americans, compared with white Americans.
What could account for such staggering inequalities? A new key concept in AHCJ’s core topic area on the social determinants of health sizes up the problem, what’s known about root causes, and how people are trying to reduce the unequal burden of violent injury and death.
Note how the risk of violent injury rose with each step of decreasing neighborhood socioeconomic status in this 10-year study of hospitalizations in Memphis, Tenn, and surrounding Shelby County.