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March 24, 2008


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» Medical humanities and health disparities from HEALTH DISPARITIES BLOG
Thanks to a link from the current Health Wonk Review I noticed this post by Daniel Goldberg: ...work on health... [Read More]


Which is the cause, and which the effect? Poor health can lead quickly to poverty.

Also, who is poor? At times in my life I have been among the penniless uninsured. Now I am fairly well off. When I die, do the rich or poor times count? What if I die of a heart attack upon learning the Bill Gates has given me a billion dolloars? Would I be Very rich?

Hey Jim,

The issue of cause and effect in poverty and health is an extremely old issue -- though no less legitimate for its being old. The short answer is "both," but there is some outstanding and rigorous analysis in the SDOH and social epidemiology literature that makes it quite plain that while poor health causes poverty, poverty is much more likely to be productive of poor health.

The best source for this is the collection on SDOH edited by Marmot & Wilkinson.

As for who is poor, that's a methodological question that would depend on the particular study being evaluated. As far as I know, no one seriously questions our ability to specify the population by class and socioeconomic status at any given point in time.

I have seen (and heard of) people who live in real poverty all of their lives, but true poverty, in my experience cannot be measured in dollars. By using money or a lack thereof as a substitute for poverty, we get a real systemic error.

Look at the works of Thomas Sowell if he is not too heretical for your eyes.


Several points: first, when we are discussing the social determinants of health, we need to go way beyond a conception of absolute poverty, as Michael Marmot's work makes clear. African-American males in Harlem "enjoy" a GDP of just under $30,000 and have a life expectancy of 62. Costa Rican males have a GDP of approximately $6,000 and have a life expectancy of 71.

Work on the SDOH goes far beyond absolute poverty.

Second, your point that dollars is a limited way to conceptualize poverty has some merit. However, socioeconomic status factors in more than simply absolute wealth, although there is excellent evidence that income in and of itself is a crucial factor in SES.

Third, I should probably mention that I disagree with Thomas Sowell on almost everything, though what that has to do with heresy is beyond me.

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