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Health - The American Dream or just a Dream?

By Dr. Teeb Al-Samarrai

“If Americans want to live the American dream, they should go to Denmark.” Richard Wilkinson

As a physician and epidemiologist, I am perpetually thinking about how to improve the lives of my patients.  In medicine we have faith in the randomized control trial to show the potential impact of a new medication for example.  How do we do that? For certain medications, a small percentage difference in effect from placebo can lead to significant and real differences in health outcomes.  But we can’t do randomized control trials for social or institutional or government policies… Or can we? And if we were to do so, do we know how to measure what matters?

Richard Wilkinson and Kate Pickett, two epidemiologists from the UK recently wrote a fascinating book called “The Spirit Level: Why Greater Equality Makes Societies Stronger.”  This remarkable book quantifies the intuition of many, inequality breeds unhealthy societies.  Wilkinson and Pickett measure and quantify a number of things but one of the seemingly simplest and most captivating charts they convey is one in which they have created an index of health and social problems which includes life expectancy, infant mortality, homicides, imprisonment, teenage births, obesity, mental illness (including drug and alcohol addiction), social mobility, math and literacy, and trust and graph this against income inequality (not Gross Domestic Product or GDP) in the 20 wealthiest nations of the world. The greater the income inequality, the worse those countries do on the health and social problems index.

Can you guess which country did the worst?

Sadly, our very own.

If you don’t have time to read the book, I encourage you to take a look at Richard Wilkinson’s recent TED talk which provides a glimpse of the remarkable evidence.

As physicians we have dedicated our lives to improving the health of our patients using evidence-based medicine to make decisions about medications and treatments for patients…  Can we also use this evidence to write a prescription to make our society more equal and therefore healthier for all of us? 

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