On Monday, I came across the Union Tribune's article that stated San Diego County Health Officials now claim that the number one cause of mortality in the county is cancer. Historically, cardiovascular disease was the number one killer in the county. That is consistent with the national trend where cardiovascular disease is the country's top killer -- cancer and stroke follow as the second and third leading causes of death in the nation respectively.
But for a number of reasons, in many areas cancer has supplanted cardiovascular disease's spot as the nation's largest health threat. San Diego County joins the ranks of other areas in the U.S. that are faced with similar statistics. States such as Minnesota, Washington, North Carolina and Colorado all list cancer as the number one cause of death among its residents.
After reading the article I was able to peruse through some of the other reader's comments, and I came across this opinion: "...disease effects the rich and the poor. It has no preference." Well, honestly it does seem to be that way doesn't it? I can't imagine rogue cancer cells, infectious bacteria or menacing viruses deny applications based on a person's gross income the year before. However, there are many well-designed studies that have demonstrated that the poor and less-opulent bear a disproportionate amount of the world's health woes.
Last December, Medical News Today reported on a study out of Colorado called "Cancer and Poverty in Colorado: 1995 - 2006". The study analyzed the rates and incidence of multiple cancer types across the state of Colorado. Overall, the report noted that poorer residents of the state had a greater disadvantage in battling cancer. The authors of the report note that, "for most cancers, Coloradans who lived in poorer neighborhoods were more likely to die within the first five years following cancer diagnosis".
They went on further to state, "the inequities of the health care system put poor people at a tremendous disadvantage in the fight against cancer. Poor people are less likely to get properly screened for cancer, although early detection is a crucial component in fighting its development. Poor people also are likely to have poorer health insurance coverage or no coverage, and coverage plays a crucial role in an individual's [health]."
For instance, lets look at Medicare coverage. Patients on Medicare coverage often have less aggressive treatment and are not given the same amount of care than those with private insurance are provided. This has been shown to be especially true for patients with kidney disease. Even though under Medicare a patient is covered for kidney treatment. Shockingly, medicare patients are consistently referred less often than those with private insurance to undergo kidney transplantation.
Moreover, as Donald Barr MD says in his book Health Disparities in the U.S., "the relationship between social class and health is a continuous relationship that spans all levels of the social hierarchy from the very lowest to the very highest". Health tends to get better proportionally as one's socioeconomic status increases.
This has been demonstrated in the Whitehall study. This study tracked the health, morbidity and mortality of workers in the British Civil Service for more than twenty years. Within the U.K. all citizens are all guaranteed the same health coverage and access to care. Thus one might assume that health of their workers would be less stratified. Surprisingly enough, the study demonstrated that, starting from the lowest, less-prestigious job positions chances of mortality steadily declined as you traveled to the ranks of CEO's.
However, why relationships between being poor, having lower socioeconomic status and health exist have not fully been made aware yet. Similarly to what Jillian Jacobellis said in Medical News Today, I am not arguing that being poor is the ultimate cause of acquiring a disease. It is clear that there are many factors that guide the health of any one individual or any one society: health behaviors, lifestyle, income, place of residence.
Although it is clear that being poor significantly compounds ones chances of acquiring disease and succumbing to its pernicious effects. It is unfortunate that where one lives might make them more susceptible to, say, cancer, or that how much money one makes might make them more susceptible to high-blood pressure. But it does. Sadly, it seems as though disease has an inherent propensity. A propensity for the poor(er).
- m.tsang
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