Documentary: Racism Harms Your Health
MICHEL MARTIN, host:
I'm Michel Martin, and this is Tell Me More from NPR News. Coming up, a veteran civil rights and political leader weighs in on the presidential race. Our Wisdom Watch conversation with former United Nations Ambassador Andrew Young is next. But first, we want to talk about health and equality. Our Declaration of Independence says all men are created equal, but what happens after that? Could our status in life affect our health? A provocative new documentary asks why, since American's spend more on health care than the citizens of any other Western industrialized nation, that our overall health is mediocre at best, and the health of lower income and minority Americans is often much worse. Larry Adelman, creator and executive producer, and Llew Smith, co-executive producer, are asking is inequality making us sick? Their documentary, "Unnatural Causes," is airing on PBS stations around the country this month, and they are with us now. Thank you both so much for speaking with us.
Mr. LLEW SMITH (Co-executive Producer, "Unnatural Causes"): Thank you. Thanks for having us.
Mr. LARRY ADELMAN(Executive Producer, "Unnatural Causes"): Thank you.
MARTIN: Mr. Adelman, what made you ask this question?
Mr. ADELMAN: In a certain sense it's kind of obvious, but nobody's talking about it. Our debates today really are about health care and access and treatment to health care. But health is much more than health care. Health care, really, as Robert - the economist Robert Evans once mentioned, is our repair shops. It's where we take our bodies where they break down, and God knows we need better repair shops. 47 billion Americans are not insured. But what's making us sick in the first place? And why are those patterns of health and illness so differentially distributed by race and by class? Those were the questions that really got our attention because the gap between not just the rich and the poor but the rich and the middle class seem to be large and growing.
MARTIN: I'm going to ask more about that in a minute, but I want to ask Llew Smith, what do you think this approach brings to our national conversation about health? Because I know Mr. Adelman thinks it's, sort of, obvious, but I'm not sure it is to a lot of people. I think a lot of people really believe that a lot of your health is in your own hands.
Mr. SMITH: That's a very good question. I don't think it is quite so obvious. I think it is true that it's certainly in front of our faces, and it's all around us. One of the things we're hoping that it brings to the conversation is this idea that, really, the way that we organize our society, which is entirely within our control, has a huge impact on the kind of health we'll have. It has an impact on how long we'll live and how healthy we'll be, and who will live longer and healthier and who will not.
MARTIN: Larry, what are some of the disparities that, perhaps, people are not aware of between - the major gaps - between whites and people of color and health outcomes and between people of greater means and lesser means?
Mr. ADELMAN: You know, most of us think of our, as I said, health as health care or we think of it in terms of just our behaviors. But the fact is, the way in which social conditions themselves now can get under the skin is making some profound effect on the life opportunities that we have. So, for example, the affluent tend to live at least six years longer than those who are poor. However, they also tend to live almost three years longer than folks who are in the middle class. Now, if you cut this by education you get the similar gradients. You get college graduates who live more than five years longer, on average, than high school dropouts. So, if you picture society as a pyramid, those with the most power, most affluence, sitting on the top, they're the ones who live, on average, the longest lives and the healthiest lives. Go halfway down, the managers, the middle managers, the supervisors, they're not doing as well. You go all the way down to the bottom to the folks who sweep the floor, they're doing worst of all.
Well, they're not - the ones who are doing worst of all are the folks that don't have any jobs at all. Now, however, that's class. What's interesting then, if you add now, on each level of that pyramid, if you bring in the conditions of, say, African-Americans, Native-Americans, Pacific Islanders, and some other peoples of color, at every level on that ladder, at that pyramid, they tend, on average, also to do worse. So, you have this situation that both race and class, or more precisely, racism and class, is having a profound affect on people's opportunity to live long and fulfilling lives.
MARTIN: This is something that I think we really need to talk about, is the question race or is it racism? And I want to raise one of the issues that the series looks at closely. Why African-American mothers are far more likely to have premature births and low birth-weight babies, even when you control for factors like education and socio-economic status? We're going to play this clip. This is Kim Anderson(ph). She's an educated African-American woman, a successful lawyer, happily married. She still gave birth to a baby prematurely. This is what she had to say.
SOUNDBITE OF DOCUMENTARY "uNNATURAL CAUSES"
Ms. KIM ANDERSON (African-American Lawyer): As a mother you're thinking, I did all the right things. They told me to take vitamins, I took vitamins. They told me to walk, they told me to eat vegetables, they told me not to drink. I didn't do all that. And why is my kid sitting here with these needles, and you know, you feel real helpless. You really feel helpless.
MARTIN: So, I'd like to ask, how do you know - is it that it's racism as opposed to race?
Mr. SMITH: It's a good question. One of the things that that particular show, "When the Bough Breaks," it's one of the films in the series. One of the things that that show explores is this very question because in terms of this question of infant mortality among African-American community, but also among other kinds of health issues, there's this assumption that it must be about race, it must be something about the genetic disposition of African-Americans. It must be something within their type that really encourages this to happen. And in this case, what the researchers did was look at some various assumptions that you have, for example, if infant mortality among African-American mothers is something that's based in race, then it's a reasonable assumption if you went to Africa, you went to West Africa, and you looked at African mothers you'd see infant mortality because black people came from Africa.
You'd see a greater concentration of this so-called genetic pool that would allow this disposition. What they found is, that's not the case. In fact, African women who have children tend to have babies who are healthy at the same rate, comparable to white women in the United States. So, what this research and other research begins to point to is it's not something that's innate to being black. But it is innate to the conditions of race that African-Americans live with. And there's other research that's coming out around other kinds of diseases, heart disease, and especially cancer that begins to suggest that there's something about living with the stress or living in the conditions of being an African-American in the United States that tends to have - it's detrimental to your health and that's measurable.
MARTIN: Why would that be? Is it - you mentioned stress. You think it's the stress of living with racism? Could it be that you are treated differently by medical professionals when you present yourself looking for care? Why would that be?
Mr. SMITH: What do you think Larry?
Mr. ADELMAN: Well, I think the experience, the everyday experience of racism, of just, basically, in essence, puts ones body on alert, which means it triggers the stress response. Your heart beats faster, your blood pressure rises, blood sugar rises. Also, that you can fight harder or run faster, the classic fight or flight response. But what scientists are finding is if that response, that stress response, is turned on, even at a low level, not for five minutes, but for five months or five years or through the lifetime, it takes a toll. It weathers the body and puts you at risk for all the chronic diseases. Now, we all experience stress. Obviously, we have this myth of high-pressure executives dropping dead of heart attacks. That's not true because there's a difference between pressure and stress.
Stress is whether or not you have the resources to manage the stressers, those pressures on your life. Chief executives normally do, but as you go down the ladder, things get more and more difficult, as you're living from paycheck to paycheck and bills and problems etcetera that you need worrying about your schools, all of which take a toll on the body. You add to that the extra burden of racism through the lifetime, it's just micro insults that we're now being able to measure and that they seem to take an effect on the body that, among other things, creates a predisposition, so this life-course hypothesis suggests, towards pre-term delivery, low birth-weight babies, and putting babies at risk.
MARTIN: If you're just joining us, you're listening to Tell Me More from NPR News, and we're talking about the PBS series "Unnatural Causes: Is Inequality Making Us Sick?" And we're speaking with producers Llew Smith and Larry Adelman. Larry, the series doesn't just concentrate on disparities between African-Americans and whites. It also talks about other groups, including Hispanics. What was the most surprising thing you discovered about the health of Latinos in America?
Mr. ADELMAN: Well, that's pretty amazing because it goes against many of the stereotypes we have. Most Latinos, who come over the border to the United States to live here, tend to be, on average, poorer than the average American. And because there is this wealth-health gradient, that the poorer you are the worse on average your health, you'd expect them, of course, to have worse health. Well, all the research indicates is that new Latino immigrants, despite being poor, are in fact healthier than the average American. In several counties, they tend to be the healthiest group in the entire county. So that's the first surprising thing. But the second part of this is that the longer they're here, the more their health advantage erodes, that is, the sicker they become.
MARTIN: Larry, is there something that you learned about the way Latinos live in family or in community that could be applied to other minority groups and that has positive health affects?
Mr. ADELMAN: There is the way in which immigrants who come together and work in communities and families, which provide mutual support and help and aid, both physical material aid as well as emotional sustenance, which tends to buffer people from the health threats that they find from the problems that their job and their community. However, over time, what happens, it seems, is if people have to work long hours, at poor jobs, maybe two jobs, and what happens is that because of the pressures on their working lives, those integuments that tie people together tend to erode. And as time goes on, we become more and more isolated, or excluded, and hence those structures, those traditional family structures, aren't able to play the role because they are eroded. Because you don't have time to eat together, or shop, or do the things together that you did have, because you are working two jobs.
MARTIN: The series talks not just about, you know, race per se, or sort of ethnicity or something like that, but it also talks about the effect of - I guess what I would call economic trauma on health. Here's a clip I want to play. You talk about the health of a Michigan community and what happened when a local plant shut down. Here's a conversation between some of the people who were laid off.
Unidentified Woman: When you've got to go to unemployment. I don't know if that's anxiety or - but I didn't really think about it until how today, Marcella (ph) said, like my jaw's been hurting. Like I'm clenching my teeth or something while I'm sleeping.
Unidentified Man: I get nauseated all...
Unidentified Woman: I do too.
Unidentified Man: My stomach will be nerved.
Unidentified Woman: I've been, yeah.
Unidentified Man: Just nauseated. Some nights I'll just wake up and I'll be up at one o'clock in the morning. I got up. I'm sitting in the chair and I was watching TV until four o'clock. Went and laid down and tossed and turned till six o'clock and got up. I don't think I got two hours of sleep all night.
Unidentified Woman: And I started thinking more about needing a drink. Which I don't need, and I've stayed away from that, so then I go and eat. But I've never weighed this much in my life.
MARTIN: Now some people would say, well gee, this is a short-term effect. It's inevitable that you have sort of a stressful period in your life. You'd go through some things. But is it true of you, Larry that this can have long term effects on people's well being?
Mr. ADELMAN: When people are laid off, and in this case, we had a shutdown at the largest refrigerator factory in North America, in Greenville, Michigan. 2,700 jobs disappeared. What happens is the - first of all your self esteem falls. Because so much of our self esteem is measured by the jobs we have.
Mr. SMITH: Absolutely.
Mr. ADELMAN: Second of all, your ability to provide for yourself falls because, you know, you are on unemployment just for several months and when those benefits run out, you are on your own. You are just smack on your own in this country. And over time, again, you have this similar situation of this buildup of anxiety and chronic stress which takes a toll on the body and makes one less resistant to those chronic diseases that are killing us here in America. We aren't dropping dead of Cholera here. We are dropping dead of heart disease, hypertension, stroke, asthma, diabetes, and so forth. Studies have shown that these lay offs will in the next 10 years result in an additional 138 deaths in Macomb County as a result of the shut down and people being just left on their own.
MARTIN: I'd like to ask each of you, what would you like people to get from this film? And obviously, we are in the middle of an election year, and the reason people make films is that they want to have some impact on the national conversation, you know, one would assume. So, what do you think you'd like to introduce into our national conversation about health?
Mr. SMITH: One of the things that I'd like to see is people who watch the series or think about health or are interested in thinking about how do these social factors get under our skin. Really ask the question, are the people in my community, who live five or six or seven years, or 10 years, longer than I do? Or do I live six or seven years or 10 years longer than people who live six or seven miles away from me? And why is that?
Mr. ADELMAN: Well, two or three things, I suppose, Michel. One, in picking up with what Llew said, I think that it's important that we realize and come to understand is that society matters. That the jobs that we do, the money we make, the neighborhoods we reside in, the schools we attend, the power we have to control the things that affect our lives are really as much health issues as diet, smoking, and exercise. And I think we really need to expand that debate. Two, is that social policy is, in fact, health policy. Housing policy is health policy. Living-wage jobs, those are health policies. That's going to improve the health of people in the United States.
And then, the third thing is that as the economic inequality has widened since 1980, so indeed has life-expectancy gaps. So it shouldn't be a surprise that today we, living in the society with the greatest inequality of all the rich countries, have, in fact, among the worst health outcomes, but it doesn't have to be that way. These are ultimately political questions. If we hold our government officials accountable and can make those changes, like we made early in the century where we imposed the eight-hour day, we got rid of child labor. We had social security, we had the civil rights movement, we could extend those benefits to extend to greater amounts of the population. All of those social policies actually paid off in better health.
MARTIN: Just very briefly, Larry, there are those who will listen to this conversation and say that the work is inspired by a political point of view? So for those who would argue that the reason - you seem to have...
Mr. SMITH: But can I ask you a question about your question? What's the alternative view? I'm not sure it's political, but maybe - if you're saying that the alternative is that essentially we make our own health. We make our own choices. The choices are even and fair for everyone. So if someone is sick, or the community is sick then they've basically made the wrong choices, and they could have done better. If that's the political view you're talking about, to me, that view just doesn't make sense on its face at all. It's clear that if you look at any city, I mean any city, you are going to see that there are communities that are wealthy, and there are some communities that are poor. I mean, for example, just take the simple idea of, we should eat healthier meals.
OK, I have a family. I should have a healthy meal for my family. If I live in a community where I can't get to a decent supermarket, I have to take two buses to get to a supermarket. OK. Poorer people pay more for poorer food. That's a great interview with the woman in the film who's impoverished in Louisville and she happens to be white, incidentally, and she talks about the fact that essentially it becomes clear. I know what I should buy for my family. I know what they should eat to be healthy, but I have this much money, 250 dollars a month, for five people. So I'm going to spend the money so that I can feed them so that they are fed, not healthily, but fed. And the question is, can we equalize the playing field so that more of us have the choices that we all want to have for good health?
MARTIN: Larry Adelman is the creator and the executive producer of the documentary series, "Unnatural Causes: Is Inequality Making Us Sick?" He joined us from member station KQED in San Francisco. We were also joined by Llew Smith. He is co-executive producer of the series, and he joined us from CSPS studios in Boston. Thanks to you both.
Mr. SMITH: Thank you.
Mr. ADELMAN: Thank you.
MARTIN: "Unnatural Causes" is airing on Thursday nights on PBS. Please check your local listings. You can also go to our website at npr.org/tellmemore for a link to the "Unnatural Causes" homepage.
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