Want a long, healthy life? Don’t be poor.
August 25, 2018 9:44 AM Subscribe
“This is lifestyle drift in action. We know what really determines health - the deep and vicious inequalities that taint developed societies. But instead of trying to address these things, we imagine that if we impose the dietary choices of the privileged on those who are suffering, they will be transformed. And so every diet followed by a member of a privileged elite is touted as the solution, but none of them are. The only real solution is giving everyone a better life. “ Large nutrimental studies often come out in conflict with each other, so maybe we’re missing the point : It’s not diet, it’s inequality.
When I worked at a large, prestigious university, I used to love being on campus during Reunion because there were so many happy, vibrant older people. I'm talking eighties and nineties. It finally dawned on me that they weren't just feeling rejuvenated by being back at the old alma mater; they were rich (and mostly white) people who could afford the best healthy lifestyles, medical treatment, and cosmetic enhancements available. And they weren't ground down by having to worry about the things poorer people have to worry about, like survival.
posted by The Underpants Monster at 10:17 AM on August 25, 2018 [44 favorites]
posted by The Underpants Monster at 10:17 AM on August 25, 2018 [44 favorites]
I agree. The core argument that longevity and income are more strongly correlated than longevity and diet is a solid one that bears amplifying, but the related one that this drives the endless lifestyle dietary sales pitch cycle is less so. After all, a great deal of dietary woo is directed primarily at the wealthy who supposedly feel great in the first place. Longevity and health are not the same thing. And it can be simultaneously true that bad diet is contributing to the diabetes epidemic, and that income inequality is our greatest barrier to lifespan equality.
posted by q*ben at 10:22 AM on August 25, 2018 [4 favorites]
posted by q*ben at 10:22 AM on August 25, 2018 [4 favorites]
She’s not wrong of course. Social determinants of health is a very real and important thing that does not get enough attention. That said, her criticisms of methods aren’t anything that the public health community is not very aware of. Controlling for or adjusting for social determinants is great when it can be done, but epidemiological studies are difficult, often based on already gathered data, and it’s hard to capture many of these factors anyway. Often you hope that if your sample is big enough, you don’t need to block these other things.
posted by Lutoslawski at 10:28 AM on August 25, 2018 [4 favorites]
posted by Lutoslawski at 10:28 AM on August 25, 2018 [4 favorites]
I believe that diet impacts health based on the research I have read (and feel a huge difference based on what I eat.) So I'm not necessarily going to agree with some of the arguments made in the article. However;
I also believe that the effort required to cook and clean while working wage jobs that are physically demanding and stressful brings a type of physical exhaustion that is often far worse than the unpleasant feelings of eating a poor diet. And the lifestyle cult of shaming people for not doing enough "self care" brings an even further level of exhaustion to already depleted people who need to be allowed to just sit and rest in peace instead of feeling like they need to make themselves a fancy herbal bath, do yoga (WHICH IS EXPENSIVE ANYWAY), do meditation etc. Downtime is something wage workers frequently don't get, especially if you have kids and you have no income to pay for childcare at the gym, fresh prepared meals out of veggies and good ingredients that someone else makes for you and all the other luxuries people with money can do to get BOTH the rest they need and improve access to health improvement activities. (And I know, people with salary pay are exhausted as parents too, if you can imagine how hard and exhausting it is to go through parenting on 20,000 or more a year, consider that it's unspeakably difficult and health destroying to do so on an even lower wage as a single parent).
As a health nut who has dealt with being very low income, so much of the advice is for people who are in an income bracket that is at least lower middle class, or upper low income (like, more than 10 dollars per hour), while the people being blamed the most for "bad choices" are often in the lowest income brackets dealing with a kind of poverty that even lower middle class people can't relate to or WORSE relate to dealing with for 4-10 years in their 20's and 30's when they were at their healthiest and therefore underestimate what being stuck in these jobs into your 40's, 50's and beyond does to you especially while trying to raise kids.
What I will say most passionately is that research is made by people who profit from a classist system based on inequality and labor exploitation of the most vulnerable populations. It's no surprise that research focuses on solutions that blame the poor and ask the poor to do more labor. Doing a study that might find people's health improves if you redistribute wealth doesn't have a product that you can sell attached to it, indeed it comes only with a price tag. I read a lot of resiliency research in pubmed and am often astounded by how often it's used to focus on the person impacted by adversity as the problem rather than the adversity itself. So much of that research falls into oblivion when we have the blueprints of creating a human health friendly community and policies but use it mostly to hang over the heads of the poor how much they fail themselves for not doing better self care and self improvement.
posted by xarnop at 10:41 AM on August 25, 2018 [27 favorites]
I also believe that the effort required to cook and clean while working wage jobs that are physically demanding and stressful brings a type of physical exhaustion that is often far worse than the unpleasant feelings of eating a poor diet. And the lifestyle cult of shaming people for not doing enough "self care" brings an even further level of exhaustion to already depleted people who need to be allowed to just sit and rest in peace instead of feeling like they need to make themselves a fancy herbal bath, do yoga (WHICH IS EXPENSIVE ANYWAY), do meditation etc. Downtime is something wage workers frequently don't get, especially if you have kids and you have no income to pay for childcare at the gym, fresh prepared meals out of veggies and good ingredients that someone else makes for you and all the other luxuries people with money can do to get BOTH the rest they need and improve access to health improvement activities. (And I know, people with salary pay are exhausted as parents too, if you can imagine how hard and exhausting it is to go through parenting on 20,000 or more a year, consider that it's unspeakably difficult and health destroying to do so on an even lower wage as a single parent).
As a health nut who has dealt with being very low income, so much of the advice is for people who are in an income bracket that is at least lower middle class, or upper low income (like, more than 10 dollars per hour), while the people being blamed the most for "bad choices" are often in the lowest income brackets dealing with a kind of poverty that even lower middle class people can't relate to or WORSE relate to dealing with for 4-10 years in their 20's and 30's when they were at their healthiest and therefore underestimate what being stuck in these jobs into your 40's, 50's and beyond does to you especially while trying to raise kids.
What I will say most passionately is that research is made by people who profit from a classist system based on inequality and labor exploitation of the most vulnerable populations. It's no surprise that research focuses on solutions that blame the poor and ask the poor to do more labor. Doing a study that might find people's health improves if you redistribute wealth doesn't have a product that you can sell attached to it, indeed it comes only with a price tag. I read a lot of resiliency research in pubmed and am often astounded by how often it's used to focus on the person impacted by adversity as the problem rather than the adversity itself. So much of that research falls into oblivion when we have the blueprints of creating a human health friendly community and policies but use it mostly to hang over the heads of the poor how much they fail themselves for not doing better self care and self improvement.
posted by xarnop at 10:41 AM on August 25, 2018 [27 favorites]
The question is do we help more people by giving them better food or reducing inequality? Both are things we should strive for as a society but if I had to prioritize inequality seems the obvious winner.
posted by jeffamaphone at 10:59 AM on August 25, 2018 [1 favorite]
posted by jeffamaphone at 10:59 AM on August 25, 2018 [1 favorite]
Giving people better food is part and parcel of reducing inequality. It is not either-or.
posted by grumpybear69 at 11:01 AM on August 25, 2018 [30 favorites]
posted by grumpybear69 at 11:01 AM on August 25, 2018 [30 favorites]
These social determinants, they seem to be the same ones that predict academic achievement. Inequality seems to be one big-ass lever.
posted by klarck at 11:14 AM on August 25, 2018 [8 favorites]
posted by klarck at 11:14 AM on August 25, 2018 [8 favorites]
I feel like the ultimate robin hood setup would be to make a wellness company targetting the rich (a la, Goop) with product that are basically water in nice bottles. Add some fancy marketing etc...
Then, with the high margins, redistribute the profits to anyone on minimum wage. It's a capitalist version of wealth distribution - you just needed to target Rich people's insecurities in a way that makes them part with their money rather than to avoid taxes.
posted by Spritzu at 12:08 PM on August 25, 2018 [17 favorites]
Then, with the high margins, redistribute the profits to anyone on minimum wage. It's a capitalist version of wealth distribution - you just needed to target Rich people's insecurities in a way that makes them part with their money rather than to avoid taxes.
posted by Spritzu at 12:08 PM on August 25, 2018 [17 favorites]
This echoes Ben' Goldacre's rant against Media Nutritionists more than a decade ago, still pertinent today:
But most offensive to me, as a hard working NHS doctor, is the way that media nutritionists assume the moral high ground, as if they were somehow the source of all that is right and good in the management of lifestyle risk factors for cardiovascular disease and cancer. Nutritionists trade on a peculiarly obsessive, overcomplicated, narcissistic, and - dare I say it - right wing, individualist take on the management of risk factors. But in reality the most important lifestyle risk factors for ill health are difficult and unglamorous ones, such as social inequality.posted by talos at 1:14 PM on August 25, 2018 [26 favorites]
Public health interventions to address these real problems are far less lucrative and far less of a spectacle than anything a food crank or a television producer would be willing to delve into. What prime time series looks at food deserts created by drive-in supermarkets, companies with which media nutritionists so often have lucrative commercial contracts? Which television shows deal with social inequality as a driver of health inequality? Where’s the human interest in prohibiting the promotion of bad foods, using taxation to make nutrient rich foods more accessible, or maintaining a clear labelling system? Where is the spectacle in “enabling environments” that naturally promote exercise or in urban planning that prioritises cyclists, pedestrians, and public transport over the car?
Basic, uncomplicated dietary advice is effective and promotes health. Overly complicated, confusing, tinkering nutritionism is poorly evidenced, because it’s a branch of the entertainment industry - it’s there to make money, to create a new market for a new profession, to soup up a recipe show, to titillate, to distract us from social inequality and the real lifestyle causes of ill health, and to pander to our collective modern obsession with food. It tarnishes and undermines the meaningful research work of genuine academics studying nutrition.
Poverty is violent. Allowing poverty to exist is perpetuating violence. Creating systems that rely on part of the world being impoverished is intentionally violent. Hoarding wealth is violent. Capitalism is violent. Trust funds, legacies, corporations, and monopolies are all violent.
posted by FirstMateKate at 1:32 PM on August 25, 2018 [17 favorites]
posted by FirstMateKate at 1:32 PM on August 25, 2018 [17 favorites]
A major factor here is access to higher level medical care. Poor do not have it.
(says the fellow denied a life-saving cancer operation due to inadequate/non coverage medicare insurance...)
Wealth would have moved on after Dx, my poverty at the time blocked surgery/hospital care.
I am alive today and cancer free due to a surgeon who later volunteered the operation to save my life.
posted by CrowGoat at 1:43 PM on August 25, 2018 [23 favorites]
(says the fellow denied a life-saving cancer operation due to inadequate/non coverage medicare insurance...)
Wealth would have moved on after Dx, my poverty at the time blocked surgery/hospital care.
I am alive today and cancer free due to a surgeon who later volunteered the operation to save my life.
posted by CrowGoat at 1:43 PM on August 25, 2018 [23 favorites]
Through an accident of being semi-related to a couple of people both wealthy and kind, I was able to spend the past 7 days in a luxury sports retreat in one of the most breathtaking, overwhelming places in the world, in almost complete wilderness (except for the spa infrastructure and maximally competent staff looking out for us). After being catered to every wish, including flawless meals, a spa massage, the quiet observation of nature, and after all but ignoring the rest of the world*, I feel better than I have after any vacation ever.
But the thing is: the other guests seemed to have perfect relaxation already, like a permanent state of being maybe?, right at the start. So apart from the obvious lack of common life experiences --which, I have to say, we all did kind of get over after the first few days of awkward conversations, so that by the end we had figured out what to say or not say in order to enjoy each other's company--, it was really hard to enter that kind of vacation wavelength, emotionally. I might as well have had a literal black cloud above my head, it was so noticeable, though I had arrived there feeling just fine.
By the end (and this was delightful to see) it got even better, all were visibly glowing with happiness and, you could tell, they too had had the most amazing time. Most probably went from 70% to an average of maybe about 90% (depending on age and other factors) in a subjective sense of well-being scale, whereas, I probably went from a 67% (the masseuse found super tense muscles I wasn't even aware of...) to a 94%. Supremely happy people in happy environments can be pleasant and funny and calm and polite in ways I had not dreamed of: all kinds of negative thoughts seem totally out of place.
Now, my life is relatively carefree too. My partner and I are both still (again: luck) childless students with institutional and family support, though at this age, with no savings or a real prospect for a middle-class income job for myself yet, that can be pretty stressful. But I have had an amazing year, and, after a few seasons of ennui and other ailments, my current excitement/stress about a new study program/career prospect in a dream domain still feels like a huuuuuuge improvement. Dealing with the negatives feels good, talking about politics can be so fun, even these days. And while all this does truly feel like happiness, I think we may have an entirely different scale.
*I did intermittently read the US-politics megathread this week but that just added to my well-being
posted by ipsative at 3:08 PM on August 25, 2018 [13 favorites]
But the thing is: the other guests seemed to have perfect relaxation already, like a permanent state of being maybe?, right at the start. So apart from the obvious lack of common life experiences --which, I have to say, we all did kind of get over after the first few days of awkward conversations, so that by the end we had figured out what to say or not say in order to enjoy each other's company--, it was really hard to enter that kind of vacation wavelength, emotionally. I might as well have had a literal black cloud above my head, it was so noticeable, though I had arrived there feeling just fine.
By the end (and this was delightful to see) it got even better, all were visibly glowing with happiness and, you could tell, they too had had the most amazing time. Most probably went from 70% to an average of maybe about 90% (depending on age and other factors) in a subjective sense of well-being scale, whereas, I probably went from a 67% (the masseuse found super tense muscles I wasn't even aware of...) to a 94%. Supremely happy people in happy environments can be pleasant and funny and calm and polite in ways I had not dreamed of: all kinds of negative thoughts seem totally out of place.
Now, my life is relatively carefree too. My partner and I are both still (again: luck) childless students with institutional and family support, though at this age, with no savings or a real prospect for a middle-class income job for myself yet, that can be pretty stressful. But I have had an amazing year, and, after a few seasons of ennui and other ailments, my current excitement/stress about a new study program/career prospect in a dream domain still feels like a huuuuuuge improvement. Dealing with the negatives feels good, talking about politics can be so fun, even these days. And while all this does truly feel like happiness, I think we may have an entirely different scale.
*I did intermittently read the US-politics megathread this week but that just added to my well-being
posted by ipsative at 3:08 PM on August 25, 2018 [13 favorites]
Honestly, I aspire to the income level at which my poor lifestyle decisions can be attributed to being a carefree bon vivant and not an irresponsible fatso. Or does that ever work for women?
posted by thivaia at 3:34 PM on August 25, 2018 [23 favorites]
posted by thivaia at 3:34 PM on August 25, 2018 [23 favorites]
Nationalize the spa resorts as a way of controlling medical costs and let every American spend four weeks of thier choosing getting massages and eating fruit and spending time in nature.
posted by The Whelk at 3:48 PM on August 25, 2018 [12 favorites]
posted by The Whelk at 3:48 PM on August 25, 2018 [12 favorites]
Honestly, I aspire to the income level at which my poor lifestyle decisions can be attributed to being a carefree bon vivant and not an irresponsible fatso. Or does that ever work for women?
That's an interesting point. Because it seems to me that, in England at least, there's an answer. I think that "upper middle class" women (the rough rule of thumb I use for gauging "upper middle class" is "families who traditionally and habitually send their children to fee-paying schools) are allowed to have agency as larger people. The archetypal case is the Two Fat Ladies cooking show (which shows up on the cooking channels all the time). The stereotype is of a woman who is, although not sexualised, deeply carnal. As well as being an eater, she is jolly hockey-sticks; hunting, shooting and fishing; dog loving; and takes no nonsense. I suppose, in this case, she might be allowed to have appetites because her class permits her to take on certain traits that are coded as male, and appetite is one.
I don't think that there are any similar female stereotypes "further down" the English class structure, with regards weight. There are some stereotypes of larger working class women with power and agency (e.g. an East End "ma" figure may well derive some of her fearsome potency from her weight), but even there I don't think that the agency is manifested in respect of the issue of weight itself. It feels to me like those caricatures still exhibit "fatness as failure", whereas don't think that's the case for women in the Two Fat Ladies category. Jesus Christ our class system is a fucking abomination; it's fascinating, like the most intricately and fiendishly designed torture device imaginable.
I have personal experience of this, I think. In my 20s, when I had a BMI of 34 and drank like a drowning man, people very much engaged with me as a jocular middle-class bon vivant, or at the worst as a slightly louche bon viveur. It's quite possible that their private opinions of me were more judgemental, but functionally, I had a decent enough status. I think people perceive me as more serious and harder working, now that I'm thinner, but it's possible that's also a function of age.
To say something with some vague relationship to the point of the linked piece, I anecdotally note that I show remarkably few (if any) physical consequences of the levels of drinking that I sustained for a long time, most notably in comparison to those of my clients (who are overwhelming people who have lived in relative or absolute poverty for the majority of their lives) with backgrounds of heavy drinking. It does feel like the affluence of my background cushioned me, somehow, even during the long period of time when I was very poor.
Anyway I'm going to go and try and find some papers on the interactions of class and weight in English literature. There must be loads of stuff that's actually properly thought out, unlike my stream of consciousness above...
posted by howfar at 5:40 PM on August 25, 2018 [12 favorites]
That's an interesting point. Because it seems to me that, in England at least, there's an answer. I think that "upper middle class" women (the rough rule of thumb I use for gauging "upper middle class" is "families who traditionally and habitually send their children to fee-paying schools) are allowed to have agency as larger people. The archetypal case is the Two Fat Ladies cooking show (which shows up on the cooking channels all the time). The stereotype is of a woman who is, although not sexualised, deeply carnal. As well as being an eater, she is jolly hockey-sticks; hunting, shooting and fishing; dog loving; and takes no nonsense. I suppose, in this case, she might be allowed to have appetites because her class permits her to take on certain traits that are coded as male, and appetite is one.
I don't think that there are any similar female stereotypes "further down" the English class structure, with regards weight. There are some stereotypes of larger working class women with power and agency (e.g. an East End "ma" figure may well derive some of her fearsome potency from her weight), but even there I don't think that the agency is manifested in respect of the issue of weight itself. It feels to me like those caricatures still exhibit "fatness as failure", whereas don't think that's the case for women in the Two Fat Ladies category. Jesus Christ our class system is a fucking abomination; it's fascinating, like the most intricately and fiendishly designed torture device imaginable.
I have personal experience of this, I think. In my 20s, when I had a BMI of 34 and drank like a drowning man, people very much engaged with me as a jocular middle-class bon vivant, or at the worst as a slightly louche bon viveur. It's quite possible that their private opinions of me were more judgemental, but functionally, I had a decent enough status. I think people perceive me as more serious and harder working, now that I'm thinner, but it's possible that's also a function of age.
To say something with some vague relationship to the point of the linked piece, I anecdotally note that I show remarkably few (if any) physical consequences of the levels of drinking that I sustained for a long time, most notably in comparison to those of my clients (who are overwhelming people who have lived in relative or absolute poverty for the majority of their lives) with backgrounds of heavy drinking. It does feel like the affluence of my background cushioned me, somehow, even during the long period of time when I was very poor.
Anyway I'm going to go and try and find some papers on the interactions of class and weight in English literature. There must be loads of stuff that's actually properly thought out, unlike my stream of consciousness above...
posted by howfar at 5:40 PM on August 25, 2018 [12 favorites]
Poverty is violent. Allowing poverty to exist is perpetuating violence. Creating systems that rely on part of the world being impoverished is intentionally violent. Hoarding wealth is violent. Capitalism is violent. Trust funds, legacies, corporations, and monopolies are all violent.
Paul Farmer's linkage of structural violence and health (quoted on Wikipedia) has always seemed apt to me:
Paul Farmer's linkage of structural violence and health (quoted on Wikipedia) has always seemed apt to me:
Their sickness is a result of structural violence: neither culture nor pure individual will is at fault; rather, historically given (and often economically driven) processes and forces conspire to constrain individual agency. Structural violence is visited upon all those whose social status denies them access to the fruits of scientific and social progress.posted by Dip Flash at 5:43 PM on August 25, 2018 [4 favorites]
class and poverty are indeed violent and deeply immoral. we know this fact because civilization today is in the odd position of judging itself (mainly) by enlightenment standards where individual human lives matter, and yet most human political behavior is still governed (and this attitude is increasingly resurgent) by ancient notions that individuals dont matter at all, only traditions and ethnic or nationalist heroic narratives are important. i hope the conflict can be resolved in the next few hundred years.
posted by wibari at 9:05 PM on August 25, 2018 [5 favorites]
posted by wibari at 9:05 PM on August 25, 2018 [5 favorites]
I know some people for going Paleo has been a game changer. The difference in their health, outlook and energy and their medical test metrics has been enormous.
However, what happened is that one day they said, "This is insupportable. I gotta start looking after myself and doing something for my health!" Paleo sounded attractive, so Paleo it was. They adjusted their budget to buy more of the type of food they liked and spent more time prepping it. They joined a community of like minded people. They also usually started getting out more and being more active. And so Paleo has made an enormous difference. The found a structure for looking after themselves and taking control.
There is an old truism about it doesn't matter what type of mental health treatment you get. If you are ready anything - CBT, Freudian analysis, anti-depressants, a workbook on bad childhoods from the library, journaling, going off booze with the help of your doctor, nature-therapy and exercise - it's going to make a difference. And if you are not ready nothing will make a difference. Court mandated mental health treatment has a really low success rate. But when you hit a wall and say to yourself, I am miserable, I am damn well going to figure out how to stop being miserable and follow through, it is amazing how many mental health problems start to improve.
I think that is what happened with my friends who took up Paleo and biking to work, or whatever they took up.
posted by Jane the Brown at 7:45 AM on August 26, 2018 [6 favorites]
However, what happened is that one day they said, "This is insupportable. I gotta start looking after myself and doing something for my health!" Paleo sounded attractive, so Paleo it was. They adjusted their budget to buy more of the type of food they liked and spent more time prepping it. They joined a community of like minded people. They also usually started getting out more and being more active. And so Paleo has made an enormous difference. The found a structure for looking after themselves and taking control.
There is an old truism about it doesn't matter what type of mental health treatment you get. If you are ready anything - CBT, Freudian analysis, anti-depressants, a workbook on bad childhoods from the library, journaling, going off booze with the help of your doctor, nature-therapy and exercise - it's going to make a difference. And if you are not ready nothing will make a difference. Court mandated mental health treatment has a really low success rate. But when you hit a wall and say to yourself, I am miserable, I am damn well going to figure out how to stop being miserable and follow through, it is amazing how many mental health problems start to improve.
I think that is what happened with my friends who took up Paleo and biking to work, or whatever they took up.
posted by Jane the Brown at 7:45 AM on August 26, 2018 [6 favorites]
Health effects from air pollution from living near to busy roads are huge and tend to be undermentioned. It can be as bad as smoking multiple packs of cigarettes per day. And of course living near a busy road tends to correlate with poverty.
posted by Jacqueline at 4:33 PM on August 26, 2018
posted by Jacqueline at 4:33 PM on August 26, 2018
Health effects from air pollution from living near to busy roads are huge and tend to be undermentioned. It can be as bad as smoking multiple packs of cigarettes per day. And of course living near a busy road tends to correlate with poverty.
This is where the concept of Health Justice can come into play, if it’s easier (and cheaper) to stop medical problems before they happen, they assign reducing emissions and increasing public transportation as a healthcare issue. Fewer cars on the road, fewer cases of asthma and the Like.
posted by The Whelk at 8:31 AM on August 27, 2018
This is where the concept of Health Justice can come into play, if it’s easier (and cheaper) to stop medical problems before they happen, they assign reducing emissions and increasing public transportation as a healthcare issue. Fewer cars on the road, fewer cases of asthma and the Like.
posted by The Whelk at 8:31 AM on August 27, 2018
Things like this just make me glad I have already lived longer than I wanted to and do not care in the least bit for my own health.
posted by GoblinHoney at 12:54 PM on August 27, 2018 [1 favorite]
posted by GoblinHoney at 12:54 PM on August 27, 2018 [1 favorite]
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The “you feel great on your diet because you’re rich” thing doesn’t make sense to me. Ostensibly, they were rich and didn’t feel great, changed something in their diet, and now do. The thing that changed wasn’t the money. (Presumably, in some small numbers, people who were poor felt badly, got rich, ate better and felt better, but we can all agree that the poor aren’t becoming rich in numbers to affect the data much.)
Now don’t get me wrong, I think it’s very possible that some other psychological thing is happening where people “take control” of their diet and there’s a physical response that accompanies it, like a placebo effect. But he’s not really saying that. He’s saying “rich= feel good, poor=feel bad.” And that seems over-simplified.
posted by greermahoney at 10:13 AM on August 25, 2018 [7 favorites]