The Poor Status of American Health
Health Disparities: Physical Health
Socioeconomic status (SES) is an economic and social combined total measure of a person’s economic and social position in relation to others, based on income, education, and occupation; however, SES is more commonly used to depict an economic difference in society as a whole. Socioeconomic status is typically broken into three levels (high, middle, and low) to describe the three places a family or an individual may fall in relation to others. Recently, there has been increasing interest from researchers on the subject of economic inequality and its relation to the health of populations.
Not only do the poor have less money, but they also have much worse health, as the news story that began this chapter illustrated. There is growing recognition in the government and in medical and academic communities that social class makes a huge difference when it comes to health and illness (Centers for Disease Control and Prevention, 2011).Centers for Disease Control and Prevention. (2011). CDC health disparities and inequalities report—United States, 2011. Morbidity and Mortality Weekly Report, 60, 1–114.
Socioeconomic status is an important source of health inequity, as there is a very robust positive correlation between socioeconomic status and health. Socioeconomic status in the United States is related to health outcomes. Individuals higher in the social hierarchy, typically, enjoy better health than do those lower in the hierarchy. Low income and education levels have been shown to be strong predictors of a range of physical and mental health problems. These health problems may be due to environmental conditions in living and workspaces, increased levels of stress, lack of access to healthcare, food scarcity or poor nutrition. This correlation suggests that it is not only the poor who tend to be sick when everyone else is healthy, but that there is a continual gradient, from the top to the bottom of the socio-economic ladder, relating status to health.
Education in higher socioeconomic families is typically stressed as more important, both within the household, as well as the local community. In poorer areas, where food, shelter and safety are priority, education often takes a backseat – becomes less of a priority. American youth are particularly at risk for many health and social problems in the United States. Overall, lower socioeconomic status has been linked to chronic stress, heart disease, ulcers, type 2 diabetes, rheumatoid arthritis, certain types of cancer, and premature aging.
Social class in the United States is a controversial issue, having many competing definitions, models, and even disagreements over its very existence. Many Americans believe that in the country there are just three classes: the American rich; the American middle class; the American poor. Most definitions of the social classes in the United States entirely ignore the existence of parallel Black, Hispanic and minorities communities. SES differences in health have long been associated by many Americans as related to poor impulse control, unhealthy habits, and an overall lack of motivation (Braveman, et al, 2010). One difficulty with this oversimplification is that these attitudes reduce poverty (and related problems associated with lower SES) as a problem with the individual rather than a reflection of complex societal components that contribute to poor health and lower life expectancy. The assumption that individual choices and internal control are enough to overcome the impact of poverty further adds to the difficulty impoverished people have in overcoming economic hardships. Educational, economic, and health care inequity within lower SES groups have each been shown to correlate with poor health must be addressed in order to create meaningful change in the health of Americans (Braveman, et al, 2010). Given the ranking of the United States across global indicators, we might do well to address poor health of Americans as a social problem and not a personal problem.
Children and our Future
Examples of Social Class Differences
Other Factors Impacting Health
The history of United States Department of Agriculture (USDA) nutrition guides includes over 100 years of American nutrition advice. The guides have been updated over time to adopt new scientific findings and new public health marketing techniques. The current guidelines are the Dietary Guidelines for Americans 2015 – 2020. What the government promotes as a healthy diet has not only changed over the course of generations but is often heavily influenced be societal values at that time.
These guidelines have been criticized over time as not accurately representing scientific information about optimal nutrition, and as being overly influenced by profit, personal interest, and the agricultural industries the USDA promotes. The introduction of the USDA’s food guide pyramid in 1992 attempted to express the recommended servings of each food group into the American diet.
MyPlate is the current nutrition guide published by the United States Department of Agriculture, consisting of a diagram of a plate and glass divided into five food groups. It replaced the USDA’s MyPyramid diagram in 2011, ending 19 years of food pyramid iconography (USDA, 2019).
Diet is the sum of food consumed by an organism or group, and should not be confused with dieting, which refers to food restriction with the goal of weight control. Numerous studies have attempted to identify contributing factors for poor health habits in the United States that have contributed to rising rates of obesity and diseases related to obesity. These studies have resulted in numerous hypotheses as to what those key factors are. A common theme is that of too much food, too little exercise, and a sedentary schedule; however, these themes are increasingly viewed as overly simplistic and lacking in awareness to the complex approaches that are needed to improve healthy living for all Americans. For example, while dieting, people tend to consume more low-fat or fat-free products, even though those items can be just as damaging to the body as the items with fat. Currently, less than 20% of all Americans meet the recommended minimum dietary guidelines for optimal health (“Health Diet”, n.d).
Other factors not directly related to caloric intake and activity levels are also believed to contribute to lowered physical fitness and higher body-mass index (BMI) rates. These include careers that involve long hours of sitting, decreased ability to delay gratification, and heavy marketing to promote unhealthy foods. Genetics are also believed to be a factor that contributes to higher BMI. In a 2018 study, researchers stated that the presence of the human gene APOA2 could result in a higher BMI in individuals. Also, the probability of obesity can even start before birth due to things that the mother does such as smoking and gaining a lot of weight.
Among the complex factors impacting eating habits in American culture are two key enculturated trends:
- Consumer culture
- Mixed media messaging
Consumer culture focuses on the spending of the customer’s money on material goods to attain a lifestyle in a capitalist economy. Over the years, people of different age groups are employed by marketing companies to help understand the beliefs, attitudes, values, and past behaviors of the targeted consumers. As consumers grow increasingly removed from food production, the role of product creation, advertising, and publicity become the primary vehicles for information about food. With processed food as the dominant category, marketers have almost infinite possibilities in developing their products for mass appeal.
Today’s American citizens are inundated with marketed messages that food choices should be fast, bring us pleasure, and meet our emotional needs over physiological needs. Of the food advertised to children on television, 73% is fast or convenience foods (“Consumer Culture”, 2019). Additionally, Americans are often enculturated to pursue personal satisfaction while also adhering to unrealistic standards of fitness and attractiveness. Our consumer culture promotes these conflicting standards with mixed messaging in various media formats.
Mixed messaging can refer to any communication that is contradictory, inconsistent, or unclear, especially in its motive or intent. Media advertisements, athletic and entertainer role-models, and character storylines are often embedded (subtly, or at times, overtly) with the message that Americans “deserve” to feel good but must also look good in the process.
With 1 out of 3 adults and 1 out of 6 children in the United States categorized as excessively overweight by the Centers for Disease Control (CDC) it is imperative to examine the factors affecting this damaging trend (Obesity, 2019).
An additional factor influencing American health is sleep hygiene. This is the recommended behavioral and environmental practice that is intended to promote better quality sleep. Sleep hygiene recommendations include establishing a regular sleep schedule, using naps (with care), avoiding physical or mental exercise too close to bedtime, limiting worry, limiting exposure to light in the hours before sleep, getting out of bed if sleep does not come, not using bed for anything but sleep and sex, avoiding alcohol, nicotine, caffeine, and other stimulants in the hours before bedtime, and having a peaceful, comfortable and dark sleep environment.
One set of recommendations relates to the timing of sleep. For adults, getting less than 7–8 hours of sleep is associated with a number of physical and mental health deficits. A top sleep hygiene recommendation is allowing enough time for sleep. There is also focus on the importance of waking up each around the same time every morning and generally having a regular sleep schedule
Human sleep needs vary by age and among individuals. Sleep is considered to be adequate when there is no daytime sleepiness or dysfunction. Researchers have found that sleeping 7–8 hours each night correlates with longevity and cardiac health in humans, though many underlying factors may be involved in the causality behind this relationship.
Research also suggests that sleep patterns vary significantly across cultures (“Sleep”, 2019). Sleep deprivation, also known as insufficient sleep or sleeplessness, is the condition of not having enough sleep. According to the Centers for Disease Control and Prevention (CDC), 79% of Americans are currently getting less than the recommended 7-hour minimum of quality sleep per night. The United States experiences some of the highest rates of sleep deprivation and sleep disorder rates in the industrialized world; it is worth examining aspects of American culture that contribute to this trend.
Researchers examining health trends in the United States have highlighted our time-sensitive culture, emphasis on technology, and general attitudes toward sleep as contributing factors to our sleep hygiene. In 2000, the average American worked 1,978 hours per year, 500 hours more than the average German but 100 hours less than the average Czechoslovakian (“Sleep”, 2019). Overall the United States labor force is one of the most productive in the world, largely due to its workers working more than those in any other post-industrial country (excluding South Korea). Americans generally hold working and being productive in high regard. Being busy and working extensively is a source of pride for many and, as they say in America, “time is money.” Additionally, while there is little dispute that technology has enhanced our daily lives, studies show it is also negatively impacting our sleep habits. The increased stimulation of our devices can make it more difficult to unwind at the end of the night, while the unique light put off by these devices also block key sleep hormones. According to the National Sleep Foundation (2019), children (ages 6-17) who slept in the same room as an electronic device reduced the amount of quality sleep by one-hour each night.
Overall health is correlated with the quantity and quality of our sleep. Studies have shown that those who engaged in protective habits (e.g., getting 7–8 hours of sleep regularly, not smoking or drinking excessively, exercising) had fewer illnesses, felt better, and were less likely to die over a 9–12-year follow-up period (Belloc & Breslow 1972; Breslow & Enstrom 1980). For college students, health behaviors can even influence academic performance. Poor sleep quality and quantity are related to weaker learning capacity and academic performance (Curcio, Ferrara, & De Gennaro, 2006). Overall, people with sleep less are more likely to be obese, report higher levels of stress, and/or report symptoms of a mood disorder than those who obtain optimal levels of sleep each night (CDC, 2014).
Race and Ethnicity
|African American||Both sexes||73.6|
|Asian or Pacific Islander||4.5|
|Central and South American||4.5|
Health Disparities: Mental Health
Race and Ethnicity
FOR YOUR REVIEW
- 9.7: Socioeconomic Status (SES) by L. D. Worthy, Trisha Lavigne, & Fernando Romero is licensed CC BY-NC-SA 4.0. Original source: https://open.maricopa.edu/culturepsychology.
- 9.5: Diet by L. D. Worthy, Trisha Lavigne, & Fernando Romero is licensed CC BY-NC-SA 4.0. Original source: https://open.maricopa.edu/culturepsychology.
- 9.6: Sleep Hygiene by L. D. Worthy, Trisha Lavigne, & Fernando Romero is licensed CC BY-NC-SA 4.0. Original source: https://open.maricopa.edu/culturepsychology.