[NYTr] 30 Years: The Difference in Life Expectancy Between Rich and Poor

[All the News That Doesn't Fit]

The Independent via CubaNow - Sep 10, 2007
http://www.cubanow.net/global/loader.php?&secc=10&item=3303&c=2

Thirty Years: Difference in Life Expectancy 
Between the World's Rich and Poor Peoples

By Jeremy Laurance

Cubanow.- Life expectancy in the richest countries of the world now
exceeds the poorest by more than 30 years, figures show. The gap is
widening across the world, with Western countries and the growing
economies of Latin America and the Far East advancing more rapidly than
Africa and the countries of the former Soviet Union.

Average life expectancy in Britain and similar countries of the OECD
was 78.8 in 2000-05, an increase of more than seven years since 1970-75
and almost 30 years over the past century. In sub-Saharan Africa, life
expectancy has increased by just four months since 1970, to 46.1 years.

Narrowing this "health gap" will involve going beyond the immediate
causes of disease - poverty, poor sanitation and infection - to tackle
the "causes of the causes" - the social hierarchies in which people
live, the Global Commission on the Social Determinants of Health says
in a report.

Professor Sir Michael Marmot, chairman of the commission established by
the World Health Organisation in 2005, who first coined the term
"status syndrome", said social status was the key to tackling health
inequalities worldwide.

In the 1980s, in a series of ground-breaking studies among Whitehall
civil servants, Professor Marmot showed that the risk of death among
those on the lower rungs of the career ladder was four times higher
than those at the top, and that the difference was linked with the
degree of control the individuals had over their lives.

He said yesterday that the same rule applied in poorer countries. If
people increased their status and gained more control over their lives
they improved their health because they were less vulnerable to the
economic and environmental threats.

"When people think about those in poor countries they tend to think
about poverty, lack of housing, sanitation and exposure to infectious
disease. But there is another issue, the social gradient in health
which I called status syndrome. It is not just those at the bottom of
the hierarchy who have worse health; it is all the way along the scale.
Those second from the bottom have worse health than those above them
but better health than those below."

The interim report of the commission, in the online edition of The
Lancet, says the effects of status syndrome extend from the bottom to
the top of the hierarchy, with Swedish adults holding a PhD having a
lower death rate than those with a master's degree. The study says:
"The gradient is a worldwide occurrence, seen in low-income,
middle-income and high-income countries. It means we are all
implicated."

The result is that even within rich countries such as Britain there are
striking inequalities in life expectancy. The poorest men in Glasgow
have a life expectancy of 54, lower than the average in India. The
answer, the report says, is empowerment, of individuals, communities
and whole countries. "Technical and medical solutions such as medical
care are without doubt necessary. But they are insufficient."

Professor Marmot said: "We talk about three kinds of empowerment. If
people don't have the material necessities - food to eat, clothes for
their children - they cannot be empowered. The second kind is
psycho-social empowerment: more control over their lives. The third is
political empowerment: having a voice."

The commission's final report, to be published next May, will identify
the ill effects of low status and make recommendations for how they can
be tackled.

In Britain a century ago, infant mortality among the rich was about 100
per 1,000 live births compared with 250 per 1,000 among the poor, a
rate similar to that in Sierra Leone

Infant mortality is still twice as high among the poor in Britain, but
the rates have come down dramatically to 7 per 1,000 among the poor and
3.5 among the rich. Professor Marmot said: "We have made dramatic
progress, but this is not about abolishing the rankings - there will
always be hierarchies - but by identifying the ill effects of
hierarchies we can make huge improvements."

A ray of hope from the street vendors of Ahmedabad

The women street vendors of Ahmedabad, India, have peddled their wares
for generations, rising at dawn to buy flowers, fruit and vegetables
from wholesalers in the markets before fanning out across the city.
They frequently needed to borrow money, faced punitive rates of
interest and were routinely harassed and evicted from their vending
sites by local authorities.

They were a typical example of disempowered women, prey to the evils of
debt, loss of livelihood and ill health, until they campaigned to
improve their status.

With help from the Self-Employed Women's Association of India (Sewa),
the vegetable sellers and growers set up their own wholesale vegetable
shop, cutting out the middlemen who had exploited them. They also
organised childcare, set up a bank for credit and petitioned for slum
upgrading.

To overcome possible health crises, when poor women frequently had to
sell their possessions to raise money for treatment, Sewa set up a
health insurance scheme for them.

Emboldened by their links with Sewa, the vegetable sellers campaigned
for the local authority to recognise them formally and strengthen their
status by issuing street vending licences and identity cards, giving
them security of employment. The campaign started in Gujarat and went
all the way to the Supreme Court, attracting international attention.