Since I’m on a Bezruchka kick lately, I figured I’d post my thoughts on Womb to Tomb. I read much faster than most people speak, so I was happy to find a transcript of this talk so I could simply read it. Additionally, most of the time I am listening to talks I am also driving or otherwise preoccupied (which is why it takes me so long to getting around to posting my thoughts).
This talk took place after — almost two years after — Bezruchka’s Damaged Care talk, although I don’t find Damaged Care to be any less eloquent or well developed in its reasoning. The central thrust of this talk, like the aforementioned, is that health and lack of disease are not the same thing. This isn’t necessarily an intuitive concept — just as structural violence isn’t intuitive, because often we think of violence as obvious and having a culprit — and it took me some contemplation about ‘health’ in my first Global Health class to really come to understand that disease and health are only fractionally related. That is to say, someone with cancer could be considered healthy based on the current WHO definition of health (the prior definition addressed health as the “absence of disease,” and we now know health is about much more than just disease).
Health is not produced by how well we look after ourselves. It is not what we do to make ourselves as individuals healthy, namely the usual do’s and don’ts that I preach to my patients all the time: eat right, exercise, don’t smoke, wear a condom, buckle your seat belt. There is nothing wrong with following that individual advice, it isn’t wrong. But that advice is not that important when it comes to our health. Why do I say that? Take the healthiest country in the world by any measure, Japan. Twice as many men smoke in Japan as in the USA. Japan smokes the most of all rich countries, yet it is the healthiest. I’m not saying that is the reason Japan is the healthiest country namely the men all smoke. If I made that statement, you would be wise to discount everything else I say. But what that observation tells me is that although smoking is bad for you, compared to other things, it isn’t that bad. There are worse things we do for our health than smoke cigarettes. What are those? Not caring for and sharing with each other.
The quote above I think best makes this point, and also furthers Dr. Bezruchka’s previous analogy (in Damaged Care) that developing health doesn’t come from responding to trauma but instead preventing it, it doesn’t come from invasive reactions but from nuanced proaction. This talk is even more thoroughly insinuated with an analogy, this time of children sliding down the bank of a river, and again I find Bezruchka to be spot on in his analogical prowess.
The entire talk is a little less stat- and study-heavy than Damaged Care, but still contains plenty of factual information and useful references:
[T]he New York Times reported in the front business page that a boss in the US makes 531 times what an average worker makes. The boss makes in half a day what you and I make in a whole year. If you have looked at almost any newspaper in the last decade, you’ve seen many reports about how the income gap has sky rocketed in this country over the last few decades. Business Week reported that the gap was only 42 to one in 1980. In the same issue of the New York Times, they mentioned that in Japan, the world’s healthiest country, the boss only makes 10 times what an average worker makes. As a measure of caring and sharing, during Japan’s economic crisis in the late 1990s, bosses and managers took pay cuts, rather than laying off workers. You can’t imagine that happening here. It won’t take place unless we the people made it happen.
This is, for me, maybe the most useful section of his work, as far as pure numbers go. He further expands “Back in 1940, US corporations paid 40% of our federal tax bill. By 1960, it was 26%, by 1990, 13% and in 2000 only 7%. From 1996 to 2000 during a period of strong economic growth in the US, 60% of US corporations paid no tax according to the general accounting office. In 2003, Time-Warner, for example, made 4 billion, 224 million dollars in profits and paid no income tax.” In my own Googling, according to treasury.gov, “Over the 22 year period from 1964 to 1986 the top individual tax rate was reduced from 91 to 28 percent.”
Bezruchka doesn’t go as far as possible in developing the listener’s understanding of the nature of economic inequality in US, but he does a decent enough job. Sadly, of recent I am seeing a concerted effort on the part of ‘fiscally conservative’ politicians to portray our current national debt and economic mess as the result of ‘overspending,’ when it’s at least as reasonable to characterize it as ‘undertaxing.’ Bush (II) came into office with a budget surplus, and readily cut taxes for the wealthiest of Americans (here’s a CBS article published in 2001 that explains his reasoning: a projected $5.6 trillion surplus over the next 10 years). That CBS article is short but full of a lot of exasperating quotes, I highly recommend glancing at it. Before Bush, Reagan cut the top marginal tax rate from 70% to 28%, having entered office with the US as the world’s largest creditor, and later left with it as the largest debtor. So the trend over the last fifty or more years is for massive tax cuts for the wealthy, for their corporate entities, and for unprecedented increases in public debt.
What Bezruchka is getting at is that health correlates directly with fairness and socialism. The more we look after each other, the more healthy we are, even the highest margins of society. And therein lies the problem. Good health in the United States, as I understand Bezruchka to be positing, is not going to come due to some medical revelation, not from lower smoking rates or increasing the popularity of jogging, but with the realization that pursuit of wealth as main priority has its costs. I say ‘therein lies the problem’ because pursuit of wealth is — or at least has become — the American dream, and many Americans vote against their own current economic and social interests in hopes that one day they can join the elite and take advantage of the regressive social structuring of our society.
Anthropology is of great interest to me, and I’m fascinated by cultural attitudes toward different phenomena, most of all poverty and health. Unfortunately the United States is not terribly progressive with its views on either. Bezruchka’s talk examines maternity leave in Scandinavian countries, as well as the United States. He makes the excellent point that Swedes take a mandatory year of 100%-paid maternity leave (and an optional second year at 80%), that their daycares require workers to have masters degrees, and that although this may seem extravagant by US standards, they enjoy better adult mortality as a result of these social and economic determinants. So it won’t be (in my estimation) until the US can see the benefit of preventative social spending that we can begin to improve in health. As Bezruchka has pointed out previously, we spend more government money already per capita on health care than any other rich country, so simply by restructuring healthcare we could theoretically provide care equivalent to any other socialized system in the world. In that same vein, daycare with masters degrees may seem expensive, but compare that to the cost of prison (it costs $30,000 per year to house an inmate), and it doesn’t seem so extravagant.