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  • Garden Mosaics projects promote science education while connecting young and old people as they work together in local gardens.
  • Hope Meadows is a planned inter-generational community containing foster and adoptive parents, children, and senior citizens
  • In August 2002, the Los Angeles Unified School District (LAUSD) Board voted to ban soft drinks from all of the district’s schools

#875 -- How to Improve Health?, 05-Oct-2006

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Rachel's Democracy & Health News #875

"Environment, health, jobs and justice--Who gets to decide?"

Thursday, October 5, 2006...............Printer-friendly version
www.rachel.org -- To make a secure donation, click here.
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Featured stories in this issue...

How Can Health Be Improved in the U.S.?
  As we saw last week, the health of U.S. citizens is poor,
  compared to that of other wealthy, industrialized societies. In Part 2
  of this important essay, Dennis Raphael shows that U.S. public health
  policies largely ignore the primary determinants of health: early
  life, education, employment and working conditions, food security,
  housing, income and its distribution, social safety net, social
  exclusion, and unemployment and employment security.
Critics Say EPA Standards Leave Kids in Harm's Way
  The new EPA cancer guidelines are "not protective of children,"
  says Philip Landrigan, professor of pediatrics and community and
  preventive medicine at Mount Sinai School of Medicine in New York
  City. "It's an example of the administration failing the most
  vulnerable members of our society."
Op-Ed: House Democraps Helped Pass a Terrible Bill
  On Sept. 29 the House approved a bill that can only be described as
  a direct attack on local community land control. The bill was heavily
  promoted by the many corporate interests that make up the sprawl
  industry, particularly home builders, land speculators and sprawl
  developers.
A Platform of Bigotry
  Race is central to political power in the U.S. The Republicans'
  "southern strategy," developed decades ago, was fundamentally a
  racist strategy and it has served them well from 1964 to today.
  Anyone who wants to build political power -- for chemical policy
  reform or any other worthwhile reform -- probably can't succeed if
  they ignore race.
Better Health Through Fairer Wealth
  Research now tells us that lower socio-economic status may be more
  harmful to health than risky personal habits...

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From: Rachel's Democracy & Health News #875, Oct. 5, 2006
[Printer-friendly version]

HOW CAN HEALTH BE IMPROVED IN THE U.S.?

Is the Public Health Community Prepared to Become Involved?

By Dennis Raphael

[Editors' introduction: Dr. Dennis Raphael is a professor in the
School of Health Policy and Management, York University, Toronto. In
recent years he has edited two volumes on the social determinants of
health -- Staying Alive: Critical Perspectives on Health, Illness,
and Health Care (2006), and The Social Determinants of Health:
Canadian Perspectives (2004). He is the author of Inequality is Bad
for Our Hearts; Why Low Income and Social Exclusion are Major Sources
of Heart Disease in Canada (2001). If you have a high-speed internet
connection, you can see and hear Dr. Raphael delivering an
interesting lecture. If you are not familiar with the concept of
"social determinants of health," you might read this short article
in Wikipedia. In manuscript, this article was originally titled,
"Public Policies Drive the Deteriorating Population Health Profile in
the USA."]

The USA Public Health Scene

Numerous writers have considered how the USA population health and
public policy profiles are linked (9, 35, 36, 65, 75). Certainly, the
evidence urges the raising of these issues and seeking their policy
solutions through public health action. It is therefore, fascinating
to interrogate contemporary public health documents such as the
Institute of Medicine's The Future of the Public's Health (22),
Healthy People 2010 (23), and documents from the American Public
Health Association (APHA) (76, 77) for their attention to these
issues. The dominant model is organized around themes of:

a) racial and ethnic disparities with little concern for how broader
determinants of health cause these disparities;

b) access to health care rather than issues of income and other
resource distribution, and

c) a wide gap between knowledge concerning the broader determinants of
health and action to address these determinants in the policy sphere
(4).

National Policy Documents and Reports

Like other USA documents, Healthy People 2010 contains a chapter on
the broader determinants of health and its health model is consistent
with a broader health perspective. It has a prominent emphasis on
issues of access to health care which is not surprising given that 17%
or 45 million Americans are without health insurance coverage.

However, closer inspection of the document reveals that the role
played by broader determinants of health is undeveloped. The Leading
Health Indicators "[R]eflect the major health concerns in the United
States at the beginning of the 21st century." These objectives --
physical activity, overweight and obesity, tobacco use, substance
abuse, responsible sexual behavior, mental health, injury and
violence, environmental quality, immunization, and access to health
care -- are firmly planted in the biomedical and behavioural public
health model.

Explicit indicators of poverty or income levels, unemployment or job
security, or any other obvious indicator of broader determinants of
health are absent. Any and all examples of influencing policy are
limited to legislative changes designed to promoting healthy behaviors
or access to health care. There is little recognition of early life,
education, employment and working conditions, food security, housing,
income and its distribution, social safety net, social exclusion, and
unemployment and employment security as primary determinants of
health.

The Institute of Medicine's The Future of the Public's Health has
similar shortcomings (Institute of Medicine, 2002). It has a chapter
on developments in population health, yet these concepts do not
diffuse to the rest of the volume. Virtually all issues to be
addressed are health care-related or behaviorally-focused around diet,
tobacco use, or physical activity. Policy is conceived narrowly as
legislation related to risk behaviors and health protection.

APHA policy statements and numerous "Fact Sheets" reveal an emphasis
on access to health care, the situating of health differences in terms
of racial and ethnic disparities, and attention to modifying
behavioral risk factors for disease and illness (76, 77). They
describe differences in health status among White, African-American,
Hispanics and Latinos, American Indian and Alaskan natives, and Asian
Americans and Pacific Islanders, but highlight findings of unequal
access to, and quality of, health care treatment.

Broadening the Scope

Some public health agencies address broader influence upon health. The
report America's Health: State Health Rankings provides data and
rankings for states on four sets of indicators of which two have a
broad scope (78). Community Environment (violent crime, lack of health
insurance, infectious disease, children in poverty, and occupational
fatalities), and Health Policies (percent of health dollars for public
health, per capita public health spending, and adequacy of prenatal
care) focus on broader health determinants.

A commentary accompanying the report points out that the infant
mortality rate in the USA showed the first increase in 40 years,
ranking the USA 28th internationally. Yet, like many other USA
analyses, the emphasis for action is primarily health care-related
with a consistent, though undeveloped call to address persistent
disparities, particularly among racial/ethnic groups.

A few innovative local public health initiatives address broader
determinants of health. Many of these are state-level initiatives
occurring under the auspices of a Robert Wood Johnson Foundation
program (25). The predominant activity of these is the creation of
data bases and community networks to meet basic public health
functions. Only Minnesota has highlighted broader determinants of
health and the role they play in health inequalities. A Call To
Action: Advancing Health for All Through Social and Economic Change
calls for public policy action to influence the broader determinants
of health (24). However, a new governor has modified the health
department mandate threatening this unique emphasis. A noteworthy
exercise taking place in New York City is the Agenda for a Healthy
New York where an alliance is educating the public with the goal
influencing a range of broader determinants of health (79).

In summary, public health activity in the USA is characterized by a) a
focus on providing access to health care access to its citizens; b)
ethnic and racial disparities in health rather than a range of health
determinants; c) a reluctance to consider the role structural aspects
of society such as the distribution of economic and social resources
play in influencing health; and d) a blind-spot as to the broad public
policy antecedents of these determinants.

The Role of Public Health in Linking Population Health and Public
Policy

Clearly, structural analyses of population health have had little
penetration into public health discourse. The increasingly
conservative public policy environment in the USA associated with
reduced assistance payments, reduction of entitlements to the poor,
and growing income and wealth inequalities combines with Americans'
generally negative attitudes towards the roles of governments to make
an activist public health agenda problematic (3, 9, 80).

The focus on racial and ethnic health differences represents a
carryover from the civil rights activities of the 1960s as well as the
intellectual and political barriers to addressing issues of income and
social class (81). The effects of this is remove increasing income and
wealth gap among Americans and issues important to the majority of
Americans such as wages, employment security and working conditions,
as public health issues. The focus on health care represents a
reasoned response to an egregious situation whereby over 45 million
citizens are not insured for health care costs. But again, the effect
of this focus is to divert attention from a variety of health
determinants whose quality is rooted in the public policy processes.

There are no shortage of suggestions on how public health researchers
and workers could begin to address the structural issues that shape
the presence of health inequalities and the USA population health
profile (37, 42, 82). It is not my intention to repeat these here.
What is obvious is that for the most part these suggestions have not
been taken up to any discernible degree by the public health community
in the USA. Why might this be the case?

In a series of interviews with prominent health researchers and policy
advocates across the USA, I investigated the reasons for public health
neglect of these broader issues. No surprises emerged from these
analyses. The rise of neo-liberal and neo-conservative forces --
reflecting both a breakdown of the post-war consensus among
government, business, and labor and the legacies of the Reagan
Revolution -- have served to actively suppress virtually all public
health activity related to addressing broader determinants of health.
This is especially the case for issues related to income and as noted
by Navarro,(56) social class as an object of inquiry and analyses has
always been the subject of derision by academic researchers,
policymakers, and elected officials.

Difficulties in addressing broader determinants of health and their
public policy antecedents is not a problem of evidence, it is a
problem of political will on the parts of public health researchers
and workers and their governmental masters. This analysis suggests
three key roles public health workers and researchers could play in
raising these issues: education, motivation, and activation in support
of the social determinants of health. These activities would help
build the political supports by which public policy in support of the
social determinants of health could be implemented. Each is considered
in turn.

Educate

In the USA the general public health community and the American public
-- remain woefully uninformed about, and stubbornly resistant to the
concept and implications of the social determinants of health. At a
minimum public health researchers and workers could carry out -- and
publicize the findings from -- critical analysis of the social
determinants of health and their role in influencing health. There is
no shortage of areas in which these activities could take place:
social determinants of health such as poverty, housing and food
insecurity, and social exclusion appear to be the primary antecedents
of just about every affliction known to humankind. My short list of
such afflictions includes coronary heart disease, type II diabetes,
arthritis, stroke, many forms of cancer, respiratory disease,
HIV/AIDS, Alzheimers, asthma, injuries, death from injuries, mental
illness, suicide, emergency room visits, school drop-out, delinquency
and crime, unemployment, alienation, distress, and depression.
Examples of such analyses and critiques of the dominant paradigms are
available (83, 84).

Motivate

Public health researchers and workers can shift public, professional,
and policymakers' focus on the dominant biomedical and lifestyle
health paradigms to a social determinants of health perspective by
collecting and presenting stories about the impact social determinants
of health have on people's lives. Ethnographic and qualitative
approaches to individual and community health produce vivid
illustrations of the importance of these issues for people's health
and well-being (85). There is some indication that policymakers -- and
certainly the media -- may be responsive to such forms of evidence
(86). In addition, community-based activities allow community members
to provide their own critical reflections on society, power and
inequality (87-89). These approaches allow the voices of those most
influenced by the social determinants of health to be heard and hold
out the possibility of their concern being translated into community
and political activity on their part and policy action on the part of
health and government officials.

Activate

The final role is the role that is the most important but potentially
the most difficult: supporting political action in support of health.
There is increasing evidence that the quality of any number of social
determinants of health within a jurisdiction is shaped by the
political ideology of governing parties (35). Nations with a larger
left-cabinet share from 1946 to the 1990s had the lowest child poverty
rates and highest social expenditures; nations with less left-share
had the highest poverty rates and lowest social expenditures (36).
Poverty rates and government action in support of health -- the extent
of government transfers -- is higher when popular vote is more
directly translated into political representation through proportional
representation (38).

The USA has never had members of a left political party in federal
government. The USA does not have a viable left party (90, 91) and
some argue the Democratic Party does not qualify as a center party
applying international baselines. Similarly, the strength of the labor
movement is a strong determinant of both public policy and population
health (92). The USA has the lowest union membership density (13%) and
lowest collective agreement coverage (14%) of any wealthy
industrialized nation (93). Strengthening workers' rights to organize
and improve wages, benefits, and employment security is clearly a
public health issue that requires action in the political sphere (94,
95). The implications are clear: population health will be improved by
support of political parties, governments, and policymakers that
propose public policies in favor of health. Public health in the USA
would be well-served by diverting at least a small portion of current
focus and activities towards these broader issues. Some beginnings
have been made in this direction in the USA (24, 79, 96-98) and
certainly numerous examples from outside the USA are available (28,
52, 99-101).

Conclusion

A political approach to addressing health inequalities and promoting
population health recognizes the public policy conditions necessary
for health. These conditions include equitable distribution of wealth
and progressive tax policies that create a large middle class, strong
programs that support children, families, and women, and economies
that support full employment. While the USA has become an outlier
among wealthy industrialized nations in its public policy approaches
in favor of health, American history shows that there have been
periods of progressive activity and legislative action in support of
its citizens (102). There is also increasing recognition that the USA
model of public policy is inappropriate for meeting the challenges of
a post-industrial economy (103). Political reversals are possible in
democracies. The United Kingdom emerged from two decades of neo-
liberal conservative rule to elect a labor government in 1997
committed to reducing health inequalities. New Zealand took a similar
neo-liberal course during the 1990s, but has now reversed direction.
Ideologies are malleable and national social policies can be changed.

The best means of promoting population health and reducing health
inequalities through a social determinants of health perspective
involves citizens being informed about the political and economic
forces that shape the health of a society. Once so empowered, they can
consider political and other means of influencing these forces. This
is not a role that public health researchers and workers have
considered their own. It appears rather a daunting task, but one that
hold the best hope of promoting the health of citizens in the USA. Is
this possible?

References

1. Engels F. The condition of the working class in England. New York:
Penguin Classics; 1845/1987.

2. Virchow R. Report on the Typhus Epidemic in Upper Silesia. In:
Rather LD, editor. Collected Essays on Public Health and
Epidemiology,. Canton MA: Science History Publications; 1848. p.
205-319.

3. Hofrichter R. The politics of health inequities: Contested terrain.
In: Health and Social Justice: A Reader on Ideology, and Inequity in
the Distribution of Disease. San Francisco: Jossey Bass; 2003.

4. Raphael D, Bryant T. The State's role in promoting population
health: Public health concerns in Canada, USA, UK, and Sweden. Health
Policy 2006;79:39-55.

5. Raphael D, Bryant T. The limitations of population health as a
model for a new public health. Health Promotion International
2002;17:189-199.

6. Raphael D, editor. Social Determinants of Health: Canadian
Perspectives. Toronto: Canadian Scholars Press; 2004.

7. Organization for Economic Cooperation and Development. Society at a
Glance: OECD Social Indicators 2005 Edition. Paris, France; 2005.

8. Smeeding T. Public Policy and Economic Inequality: The United
States in Comparative Perspective. Syracuse NY: Maxwell School of
Citizenship and Public Affairs, Syracuse University; 2004.

9. Raphael D. A society in decline: The social, economic, and
political determinants of health inequalities in the USA. In:
Hofrichter R, editor. Health and Social Justice: A Reader on Politics,
Ideology, and Inequity in the Distribution of Disease. San Francisco:
Jossey Bass; 2003.

10. Berkman LF, Lochner KA. Social determinants of health: Meeting at
the crossroads. Health Affairs 2002;21(2):291.

11. Huckabee M. A vision for a healthier America: What the states can
do. Health Affairs 2006;25(4):1005-1008.

12. Benjamin GC. Putting the public in public health: New approaches.
Health Affairs 2006;25(4):1040-1043.

13. McGinnis JM. Can public health And medicine partner In the public
interest? Health Affairs 2006;25(4):1044.

14. Gostin LO, Powers M. What does social justice require for the
public's health? Public health ethics and policy imperatives. Health
Affairs 2006;25(4):1053.

15. Fielding JE, Briss PA. Promoting evidence-based public health
policy: Can we have better evidence and more action? Health Affairs
2006;25(4):969-977.

16. Mechanic D. Disadvantage, Inequality and Social Policy. Health
Affairs 2002;21(2):48-59.

17. Mechanic D. Rediscovery Of the 'Public' In public health. Health
Affairs 2006;25(4):1178-1179.

18. Mechanic D. Policy challenges In addressing racial disparities and
improving population health. Health Affairs 2005;24(2):335-338.

19. Mechanic D. Disadvantage, inequality, and social policy. Health
Affairs 2002;21(2):48.

20. Marmot M, Wilkinson R. Social Determinants of Health. 2nd ed.
Oxford, UK: Oxford University Press; 2006.

21. World Health Organization. WHO to Establish Commission on Social
Determinants of Health. In. Geneva: WHO; 2004.

22. Institute of Medicine. The Future of the Public's Health in the
21st Century. Washington DC: National Academies Press; 2002.

23. U.S. Department of Health and Human Services. Healthy people 2010:
Understanding and improving health. Washington DC: U.S. Department of
Health and Human Services; 2000.

24. Minnesota Department of Health. A Call to Action: Advancing Health
for All Through Social and Economic Change. In. St. Paul, MN:
Minnesota Department of Health; 2001.

25. Turning Point. States of change: Stories of transofromation in
public health. Seattle, WA: Robert Woods Johnson Foundation; 2004.

26. Townsend P, Davidson N, Whitehead M, editors. Inequalities in
Health: the Black Report and the Health Divide. New York: Penguin;
1992.

27. Tarlov A. Social determinants of health: The sociobiological
translation. In: Blane D, Brunner E, Wilkinson R, editors. Health and
Social Organization: Towards a Health Policy for the 21st Century.
London UK: Routledge; 1996.

28. Mackenbach J, Bakker M. Tackling socioeconomic inequalities in
health: Analysis of European experiences. Lancet 2003;362:1409-1414.

29. Scarth T, editor. Hell and High Water: An Assessment of Paul
Martin's Record and Implications for the Future. Ottawa: Canadian
Centre for Policy Alternatives; 2004.

30. Madanipour A, Cars G, Allen J. Social Exclusion in European
Cities. London: Jessica Kingsley; 1998.

31. Lurie N. What the Federal Government can do About the Nonmedical
Determinants of Health. Health Affairs 2002;21(2):94-106.

32. McGinnis JM, Williams-Russo P, Knickman JR. The Case for More
Active Policy Attention to Health Promotion. Health Affairs
2002;21(2):78.

33. Nettleton S. Surveillance, health promotion and the formation of a
risk identity. In: Sidell M, Jones L, Katz J, Peberdy A, editors.
Debates and Dilemmas in Promoting Health. London, UK: Open University
Press; 1997. p. 314-324.

34. Rainwater L, Smeeding T. Doing Poorly: The Real Income of American
Children in a Comparative Perspective. In: Luxembourg Income Study;
1995.

35. Rainwater L, Smeeding TM. Poor Kids in a Rich Country: America's
Children in Comparative Perspective. New York: Russell Sage
Foundation; 2003.

36. Smeeding T. Poor People in Rich Nations:The United States in
Comparative Perspective. Syracuse: Luxembourg Income Study Working
Paper #419. Syracuse University, Syracuse, New York; 2005.

37. Hofrichter R, editor. Health and Social Justice: A Reader on
Politics, Ideology, and Inequity in the Distribution of Disease. San
Francisco: Jossey Bass; 2003.

38. Alesina A, Glaeser EL. Fighting poverty in the US and Europe: A
world of difference. Toronto: Oxford University Press; 2004.

39. Rank MR. One Nation, Underprivileged: Why American Poverty Affects
Us All. New York: Oxford University Press; 2004.

40. Kawachi I, Kennedy B. The Health of Nations: Why Inequality Is
Harmful to Your Health. New York: New Press; 2002.

41. Brooks-Gunn J, Duncan GJ, Britto PR. Are SES Gradients for
Children Similar to Those for Adults? Achievement and Health of
Children in the United States. In: Keating DP, Hertzman C, editors.
Developmental Health and the Wealth of Nations: Social, Biological and
Educational Dynamics. New York: Guilford Press; 1998.

42. Auerbach JA, Krimgold B, editors. Income, Socioeconomic Status,
and Health: Exploring the Relationships. Washington, DC: National
Policy Association; 2001.

43. Collins C, Hartman C, Sklar H. Divided Decade: Economic Disparity
at the Century's Turn. Boston: United for a Fair Economy; 1999.

44. Association of Community Organizations for Reform. ACORN'S Living
Wage Web Site. In; 2003.

45. Bernstein J, Brocht C, Spade-Aguilar M. How much is enough: Basic
family budgets for working families. Washington DC: Economic Policy
Institute; 2000.

46. Mishel L, Bernstein J, Boushey B. The State of Working America
2002/2003. Ithaca: Cornell University Press; 2003.

47. Heymann J. The Work, Family, and Equity Index: Where does the
United States Stand Globally? Boston: The Project on Global Working
Families; 2004.

48. Brink S, Zeeman A. Measuring Social Well-Being: An Index of Social
Health for Canada: Human Resources Development Canada, Applied
Research Branch,; 1997. Report No.: Report R-97-9E.

49. Deaton A, Paxson C. Mortality, Income, and Income Inequality Over
Time in Britain and the United States: National Bureau of Economic
Research; 2001 October. Report No.: NBER Working Paper No.w8534.

50. World Health Organization. Ottawa Charter for Health Promotion.
In. Geneva, Switzerland: World Health Organization European Office;
1986.

51. Raphael D, Macdonald J, Labonte R, Colman R, Hayward K, Torgerson
R. Researching income and income distribution as a determinant of
health in Canada: Gaps between theoretical knowledge, research
practice, and policy implementation. Health Policy 2004;72:217-232.

52. Mackenbach J, Bakker M, editors. Reducing Inequalities in Health:
A European Perspective. London UK: Routledge; 2002.

53. Diderichsen F, Evans T, Whitehead M. The Social Basis of
Disparities in Health. In: Evans T, Whitehead M, Diderichsen F, Bhuiya
A, Wirth M, editors. Challenging Inequalities in Health: From Ethics
to Action. New York: Oxford University Press; 2001.

54. Muntaner C, Borrell C, Kunst A, Chung H, Benach J, Ibrahim S.
Social class inequalities in health: Does welfare state regime matter?
In: Raphael D, Bryant T, Rioux M, editors. Staying Alive: Critical
perspectives on Health, Illness, and Care. Toronto: Canadian Scholars
Press; 2006.

55. Muntaner C. Commentary: Social Capital, Social Class, and the Slow
Progress of Psychosocial Epidemiology. International Journal of
Epidemiology 2004;33(4):1-7.

56. Navarro V. The politics of health inequlities research in the
United States. International Journal of Health Services
2004;34(1):87-99.

57. Oliver MN, Muntaner C. Researching health inequities among African
Americans: The imperative to understand social class. International
Journal of Health Services 2005;35(3):485-498.

58. Innocenti Research Centre. A league table of child deaths by
injury in rich nations. 2001.

59. Innocenti Research Centre. A League Table of Child Maltreatment
Deaths in Rich Nations. Florence: Innocenti Research Centre; 2003.

60. Esping-Andersen G. A child-centred social investment strategy. In:
Esping-Andersen G, editor. Why we need a new welfare state. Oxford UK:
Oxford University Press; 2002. p. 26-67.

61. Esping-Andersen G. Towards the good society, once again? In:
Esping-Andersen G, editor. Why we need a new welfare state. Oxford UK:
Oxford University Press; 2002. p. 1-25.

62. Percy-Smith J, editor. Policy Responses to Social Exclusion:
Towards Inclusion? Buckingham UK: Open University Press; 2000.

63. Galabuzi GE. Social exclusion. In: Raphael D, editor. Social
determinants of health: Canadian perspectives. Toronto: Canadian
Scholars Press.; 2004.

64. Innocenti Research Centre. A league table of child poverty in rich
nations. Florence Italy: Innocenti Research Centre; 2000.

65. Navarro V, Borrell C, Benach J, Muntaner C, Quiroga A, Rodrigues-
Sanz M, et al. The importance of the political and the social in
explaining mortality differentials among the countries of the OECD,
1950-1998. In: Navarro V, editor. The Political and Social Contexts of
Health. Amityville NY: Baywood Press; 2004.

66. Coburn D. Beyond the income inequality hypothesis: Globalization,
neo-liberalism, and health inequalities. Social Science & Medicine
2004;58:41-56.

67. Coburn D. Health and Health Care: A Political Economy Perspective.
In: Raphael D, Bryant T, Rioux M, editors. Staying Alive: Critical
Perspectives on Health, Illness, and Health Care. Toronto: Canadian
Scholars Press; 2006. p. 59-84.

68. Navarro V, editor. The Political Economy of Social Inequalities:
Consequences for Health and Quality of Life. Amityville, NY: Baywood
Press; 2002.

69. Navarro V, Muntaner C, editors. Political and Economic
Determinants of Population Health and Well-being: Controversies and
Developments. Amityville NY: Baywood Press; 2004.

70. Bambra C. The worlds of welfare: illusory and gender blind? Social
Policy and Society 2004;3(3):201-211.

71. Bambra C, Fox D, Scott-Samuel A. Towards a politics of health.
Health Promot. Int. 2005;20(2):187-193.

72. Saint-Arnaud S, Bernard P. Convergence or resilience? A
hierarchial cluster analysis of the welfare regimes in advanced
countries. Current Sociology 2003;51(5):499-527.

73. Brady D. The politics of poverty: Left political institutions, the
welfare state, and poverty. Social Forces 2003;82:557-588.

74. Organization for Economic Cooperation and Development. Society at
a Glance: OECD Social Indicators 2002 Edition. Paris, France; 2003.

75. Navarro V, Schmitt J. Economic efficiency versus social equality?
The U.S. liberal model versus the European social model.
2005;35(4):613-630.

76. American Public Health Association. Leave no one behind:
Elimimating racial and ethnic disparities in health and life
expectancy. Washington DC: American Public Health Association; 2004.

77. American Public Health Association. Disparities in Health Fact
Sheets. Washington, DC: American Public Health Association; 2004.

78. United Health Foundation. America's Health: State Health Rankings.
Minnetonka, MN: United Health Foundation; 2004.

79. Public Health Association of New York City. Agenda for a Healthy
New York. 2005.

80. Bryant T. Politics, public policy and population health. In:
Raphael D, Bryant T, Rioux M, editors. Staying Alive: Critical
Perspectives on Health, Illness, and Health Care. Toronto: Canadian
Scholars Press; 2006. p. 193-216.

81. Navarro V. The Politics of Health Policy: The US Reforms
1980-1994. Cambridge MA: Blackwell Publishers; 1994.

82. Auerbach JA, Krimgold B, Lefkowitz B. Improving Health: It Doesn't
Take a Revolution. Washington, DC: National Policy Association; 2000.
Report No.: NPA report # 298.

83. Raphael D. Social justice is good for our hearts: why societal
factors -- not lifestyles -- are major causes of heart disease in
Canada and elsewhere. Toronto, Canada: Centre for Social Justice
Foundation for Research and Education (CSJ); 2002.

84. Raphael D, Anstice S, Raine K. The social determinants of the
incidence and management of Type 2 Diabetes Mellitus: Are we prepared
to rethink our questions and redirect our research activities?
Leadership in Health Services 2003;16:10-20.

85. Popay J, Williams GH, editors. Researching the People's Health,
Routledge. London UK: Routledge; 1994.

86. Bryant T. Role of knowledge in public health and health promotion
policy change. Health Promotion International 2002;17(1):89-98.

87. Park P. What is participatory research? A theoretical and
methodological perspective. In: Park P, Brydon-Miller M, Hall B,
Jackson T, editors. Voices of change: Participatory research in the
United States and Canada. Toronto: Ontario Institute for Studies in
Education Press; 1993. p. 1-19.

88. Minkler M, Wallerstein N, Hall B. Community Based Participatory
Research for Health. San Francisco: Jossey Bass; 2002.

89. Minkler M. Community-Based Research Partnerships: Challenges and
Opportunities. Journal of Urban Health 2005;82(Supplement 2):ii3-
ii12.

90. Lipset M. Continental Divide: The Values and Institutions of the
United States and Canada. New York: Routledge; 1990.

91. Lipset M, Marks G. It Didn't Happen Here: Why Socialism Failed in
the United States. New York: W. W. Norton; 2000.

92. Navarro V, Shi L. The Political Context of Social Inequalities and
Health. In: Navarro V, editor. The Political Economy of Social
Inequalities: Consequences for Health and Quality of Life. Amityville,
NY: Baywood; 2002.

93. Organisation for Economic Co-operation and Development. OECD
Employment Outlook 2004. Paris: Organisation for Economic Co-operation
and Development; 2004.

94. Zweig M. The working class majority: America's best kept secret.
Ithaca: Cornell University Press; 2000.

95. Zweig M, editor. What's Class Got to Do with It?: American Society
in the Twenty-First Century. Ithaca NY: Cornell University Press;
2004.

96. National Association of County and City Health Officials. Tackling
health inequities through public health practice: A handbook for
action. Washington DC: National Association of County and City Health
Officials; 2006.

97. Minnesota Department of Health. Healthy Minnesotans: Public Health
Improvement Goals 2004. Minneapolis: Minnesota Department of Health,;
1998.

98. Office of Minority Health M. Populations of Color in Minnesota:
Health Status Report. Minneapolis: Minnesota Department of Health;
1997.

99. Hayward K, Colman R. The Tides of Change: Addressing Inequity and
Chronic Disease in Atlantic Canada. Halifax NS: Atlantic Regional
Office, Health Canada; 2003.

100. Public Health Agency of Canada. Turning the Tide: Why Acting on
Inequity Can Help Reduce Chronic Disease. 2005. Halifax, NS: Public
Health Agency of Canada; 2006.

101. European Committee for Health Promotion Development. Reducing
Inequalities in Health: Proposals for Health Promotion Policy and
Action. In: World Health Organization; 2000.

102. Phillips K. Wealth and Democracy. New York: Broadway Books; 2002.

103. Rifkin J. The European Dream: How Europe's Vision of the Future
is Quietly Eclipsing the American Dream. New York: Tarcher; 2004.

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From: Dallas (Tex.) Morning News, Jul. 22, 2006
[Printer-friendly version]

CRITICS SAY EPA STANDARDS LEAVE KIDS IN HARM'S WAY

Rules on cancer-causing chemicals add margin of safety, agency says

By Sue Goetinck Ambrose

For years, scientists have warned that government safety standards
leave children too exposed to cancer-causing chemicals.

Last year, the Bush administration took action. But many experts say
the new guidelines may offer only one-tenth the protection that
children need from the chemicals most dangerous to them.

The U.S. Environmental Protection Agency, which issued the guidelines,
says they add an extra margin of safety to already stringent
standards. But some public health specialists note that while some
chemicals are 100 times more toxic to children than adults, the EPA's
new guidelines assume the worst chemical is only 10 times as bad.

The new guidelines are "not protective of children," said Philip
Landrigan, professor of pediatrics and community and preventive
medicine at Mount Sinai School of Medicine in New York City. "It's an
example of the administration failing the most vulnerable members of
our society."

The need for special protection for children was widely recognized
more than a decade ago, after a 1993 report from the National Academy
of Sciences concluded that pesticides probably posed greater risks to
children than adults. But it wasn't until March 2005 that the EPA
issued the guidelines, officially known as the Supplemental Guidance
for Assessing Susceptibility From Early-Life Exposure to Carcinogens.

The guidelines are used primarily by the EPA to set standards for
acceptable chemical exposure levels in various settings, such as in
air or drinking water or at waste cleanup sites.

Until the early 1990s, many scientists say, the idea that children may
have an extra sensitivity to some chemicals was not widely
appreciated, Dr. Landrigan said.

"I don't think there was deliberate inaction," he said. "The
consciousness of children's susceptibility just wasn't there."

Children are not miniature adults when it comes to chemical exposures.
They have their own behaviors -- playing close to the ground, putting
dirty hands to their mouths -- that distinguish them from adults.
Children also eat, breathe and drink more per pound of body weight
than adults and differ in how they metabolize foreign chemicals that
enter the body.

And in recent years, scientists have become aware of a deeper
difference between children and grown-ups: The rapid development of
children both before and after birth can make them more susceptible to
harm from chemicals.

Scientists suspect that a child's swift growth can leave less time to
repair chemical damage to cells or genes, creating populations of
cells with dormant, tumor-causing alterations that can erupt into a
cancer later in life. Indeed, studies in lab animals have shown that
exposure to certain chemicals before birth or early in life can cause
cancer in adulthood.

Each year, about 700 new chemicals enter the market, according to a
2005 government report. Not all of those will be directly tested for
their potential health effects. And when a chemical is tested for its
ability to cause cancer, the research generally is conducted on adult
lab animals, not juveniles.

"Virtually all the data that are now used for cancer risk projection
are based on these studies that exclude the period of greatest
vulnerability," said Dale Hattis, a geneticist and toxicologist at
Clark University in Worcester, Mass.

To create the new guidelines, the EPA examined the few published
studies that do exist -- some dating to the 1960s -- on cancer-causing
chemicals given to juvenile animals. Of 50 chemicals identified by the
EPA as causing cancer after early-life exposure, adequate comparisons
between juvenile and adult exposure existed for only 18. And of those,
the EPA focused its efforts on 12 chemicals that appear to cause
cancer by creating mutations in genes.

The EPA calculated how potent each of the 12 chemicals was in its
ability to create tumors in juveniles vs. adults. Some chemicals were
almost 10 times more potent in adults. But the EPA found that others
were more than 100 times more potent in juveniles.

Studies limited

Few of the known cancer-causing chemicals -- the government lists more
than 230 known or probable cancer-causing substances -- have been
compared in studies on younger and older animals. So the EPA took, in
essence, a one-size-fits-all approach to devise its new policy for all
untested chemicals. To account for the wide range of potencies, the
agency chose to use a value known as the geometric mean, which is
similar to an average.

For the potencies of the 12 chemicals, the geometric mean was 10 --
and the EPA used that number in its guidelines. For children under age
2, for example, the EPA said acceptable carcinogen levels for any
untested chemicals should be set 10 times lower than they would have
been before the guidelines were issued. For children between 2 and 16,
the acceptable levels should be three times lower.

"What it's telling you is that, on average, children are more
susceptible and that tenfold is the average," said Dr. Lynn Goldman,
professor at the Johns Hopkins Bloomberg School of Public Health in
Baltimore and a former assistant administrator at the EPA under the
Clinton administration. "But by applying this factor, they may not be
sufficiently protective."

It's likely, she said, that many carcinogens -- if they were
specifically tested -- would be more than 10 times as potent in
juveniles, just like the chemicals in the EPA analysis found to be
more than 100 times as potent in young animals.

"You don't want to stop here and say 10 is right," she said. "That
should be the starting point to make sure we aren't underprotecting
kids from a whole series of chemicals."

The chemical industry has its own perspective on the EPA guidelines -
at least one industry group said it thinks the EPA's guidelines are
based on faulty science.

"There are fundamental problems with the dataset," said Rick Becker, a
toxicologist with the American Chemistry Council. "There's very
limited data across the board to show that there's increased
susceptibility" in children.

He argues that the EPA should be responsible for testing whether
chemicals actually are worse for juveniles.

"You shouldn't base decisions on science that isn't supported by the
data," he said.

Dr. Landrigan dismissed Dr. Becker's reasoning.

"They're ignoring the vast body of literature that children are more
susceptible than adults," he said.

The EPA says it will incorporate new information on chemicals' effects
on juveniles, should it become available.

"We didn't choose the chemicals that were tested," said Martha Sandy,
a toxicologist at California's state EPA. "We're depending on what's
out there in the literature. We don't know about other chemicals that
we're exposed to that haven't been tested."

As a result, Dr. Sandy said, the guidelines essentially are an
educated guess for any chemicals that haven't been tested. If some of
the studies analyzed by the EPA simply hadn't been done, Dr. Sandy
said, the default factor could have come out lower or higher.

Another shortcoming is that the studies weren't originally designed to
measure the relative potencies for juveniles vs. adults, scientists
said. So even choosing the best calculation to capture the broad range
of potencies is a matter of scientific debate.

Environmental officials from California and Connecticut, for example,
have said that for their states' own guidelines, they are likely to
use calculations that end up offering more protection than the EPA's
federal guidelines.

In theory, the EPA could have proposed a higher adjustment factor for
children, one that would account for the higher potencies seen in the
animal studies. This would cover more chemicals that are the worst for
juveniles but overprotect for chemicals that don't seem to pose any
increased risk.

Bill Farland, a top official in the EPA's office of research and
development, predicted that there would not be many chemicals that
would need more stringent regulation to protect children.

Further, he said of the new guidelines, "We're adjusting something
that was already... protective."

Prenatal exposure

But other scientists said it's unfortunate that the EPA guidelines
don't address prenatal exposure to potentially harmful chemicals.
Studies have shown that exposure to chemicals in utero can influence
adult health. For example, women whose mothers took the anti-
miscarriage drug DES were more likely to develop vaginal cancer in
their 30s.

"The policy that the EPA put in place does not address prenatal
exposure but clearly... that's an important time and needs to be
thought about," said Tracey Woodruff, an EPA scientist who
participated in the study that led to the new guidelines. She made her
comments in a lecture at the National Academy of Sciences this year.

And the EPA's guidelines only cover chemicals thought to cause cancer
via genetic mutations.

"We don't quite have enough information to look at any [other] group
of chemicals as a whole," Dr. Woodruff said.

Others disagree. Dr. Henry Anderson, a medical officer at the
Wisconsin Division of Public Health, led the advisory committee
assigned to evaluate the guidelines while they were still in draft
form. He said the EPA could have addressed chemicals that trigger
cancer in ways other than via mutations.

"The EPA said... for the other carcinogens that don't work through
that [mutation] mechanism, we aren't going to change anything," Dr.
Anderson said in an interview. "We came at it the other way."

In fact, scientists are beginning to understand that while genetic
mutations definitely contribute to cancerous growth, other kinds of
changes to the genetic blueprint can be just as harmful.

One type of such change reprograms genes without actually causing a
mutation. Just like mutations, these so-called epigenetic changes can
encourage the rampant growth that's the hallmark of cancer cells. One
new theory even holds that epigenetic changes -- not mutations -- are
the first missteps on the long road from healthy tissue to cancer.

The debate over the guidelines raises another, broader issue, said
Clark University's Dr. Hattis -- a cost-benefit analysis of what risks
are acceptable, given the conveniences that chemicals offer and the
costs associated with avoiding any potential harm from them.

"You might want to impose more burden on the responsible parties to
achieve confidence that you should be more protective," he said. "But
all that is a discussion... that has not been really engaged in by
risk managers or the public."

E-mail sgoetinck@dallasnews.com

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From: OpEdNews.com, Oct. 2, 2006
[Printer-friendly version]

OP-ED: HOUSE DEMOCRAPS HELPED PASS A TERRIBLE BILL

By Joel S. Hirschhorn

An amazing 37 House Democraps voted in favor of HR 4772 Private
Property Rights Implementation Act of 2006 that passed on September
29. Considering the many other toxic political events, this little gem
of our MISrepresentatives serving corporate interests received little
attention. In a nutshell, the legislation serves corporate interests
with significant financial resources who are unhappy with unfavorable
local zoning decisions. The bill allows them to strong-arm local
governments that cannot afford to litigate every zoning decision in
federal courts.

By the way, 27 Republicrooks voted against the bill. And the bill
would have passed anyway without the support of the Democraps. There
simply is no logical explanation for voting for the bill other than to
please corporate interests.

Jerry Howard, executive vice president and chief executive officer of
the National Association of Home Builders said: "We commend House
Majority Leader John Boehner (R-Ohio) for bringing this bill to a vote
and Chairman Jim Sensenbrenner (R-Wis.) for bringing it out of the
House Judiciary Committee. I want to thank Representatives Steve
Chabot (R-Ohio) and Bart Gordon (D-Tenn.) for introducing the measure
and helping to bring strong bipartisan support."

The bill is a direct attack on local community land control. It was
desired by many corporate interests that make up the sprawl industry,
particularly home builders, land speculators and sprawl developers.
The bill is aimed at making it difficult for municipalities and zoning
boards to control large developments or enforce their environmental or
safety regulations.

The Congressional Budget Office said that it would likely impose
additional costs on the federal government by increasing both the
number of cases heard by federal courts and the number of claims
brought against the United States.

Corporate interests have been hurt by the national smart growth
movement and the attack on uncontrolled suburban sprawl. They want
federal courts to rule. Whatever happened to minimizing the role of
the federal government among Republicrooks? The bill would prohibit a
federal district court from refusing to hear claims of takings by
states and localities until a final decision has been rendered by a
state court. The bill also would make other changes to existing law
applicable to takings claims, such as defining "final decision" for
the claims, thereby relaxing the standards by which such claims are
found ripe for adjudication in federal district courts or in the U.S.
Court of Federal Claims. This is legalese for saying that corporate
interests could bypass local and state authorities.

Word is that the Senate will not consider the bill this term. But who
knows what tricks the Senate Republicrooks might pull. House Democrap
Jerrold Nadler said: ""Nobody's going to be able to go to their local
zoning board and complain. They'll have to go to the Supreme Court,
which won't have time for them."

The Sacramento Bee editorialized: "Courts no longer would be able to
look at the 100-acre parcel as a whole, but would have to look at each
lot. So, local government would have to pay developers not to build on
every inch in the 100-acre parcel. Taxpayers would pick up the tab for
this extortion. If developers didn't get what they wanted from local
zoning boards, they'd be able to bypass state courts and go to federal
court. Judge Frank Easterbrook, a Reagan appointee in the 7th U.S.
Circuit Court of Appeals, dismissed such special pleading in a 1994
case. 'Federal courts are not boards of zoning appeals,' he wrote.
Those who 'neglect or disdain' their state remedies should be thrown
out of court, period."

So if you care about sprawl and local government authority -- and
corporate corruption of our government -- pay attention to this
corporate attempt to screw we the people. Even if the Senate does not
consider it this term, watch out for what happens in the next
congress.

Author's Website: www.delusionaldemocracy.com

Authors Bio: Joel S. Hirschhorn is the author of Delusional Democracy
- Fixing the Republic Without Overthrowing the Government. His current
political writings have been greatly influenced by working as a senior
staffer for the U.S. Congress and for the National Governors
Association. He advocates a Second American Revolution.

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From: New York Times (pg. A23), Sept. 28, 2006
[Printer-friendly version]

A PLATFORM OF BIGOTRY

By Bob Herbert

George Allen, the clownish, Confederate-flag-loving senator from
Virginia, has apparently been scurrying around for many years,
spreading his racially offensive garbage like a dog that should be
curbed. With harsh new allegations emerging daily, it's fair to ask:

Where are the voices of reason in the Republican Party -- the
nonbigoted voices? Why haven't we heard from them on this matter?

Mr. Allen has long been touted as one of the leading candidates for
the Republican presidential nomination in 2008. But this is a man who
has displayed the quintessential symbol of American bigotry, the
Confederate battle flag, on the wall of his living room; who put up a
hangman's noose as a decoration in his law office; who used an ethnic
slur -- macaca -- in an attempt to publicly embarrass a 20-year-old
American student of Indian descent; and who, according to the
recollections of a number of his acquaintances, frequently referred to
blacks as niggers.

The senator has denied the last allegation. But his accusers are low-
keyed, straight-arrow professionals who have no obvious ax to grind.
They, frankly, seem believable.

Dr. R. Kendall Shelton, a North Carolina radiologist who played
football with Mr. Allen at the University of Virginia in the 1970's,
recalled a number of incidents, including one in which Mr. Allen said
that blacks in Virginia knew their place. Dr. Shelton said in a
television interview that he believed then, and still believes, that
Mr. Allen was a racist.

Beyond the obvious problems with the senator's comments and his
behavior is the fact that he so neatly fits into the pattern of racial
bigotry, insensitivity and exploitation that has characterized the
G.O.P. since it adopted its Southern strategy some decades ago. Once
it was the Democrats who provided a comfortable home for public
officials with attitudes and policies that were hostile to blacks and
other minorities. Now the deed to that safe house has been signed over
to the G.O.P.

Ronald Reagan may be revered by Republicans, but I can never forget
that he opposed both the Civil Rights Act and the Voting Rights Act of
the mid-1960's, and that as a presidential candidate he kicked off his
1980 general election campaign in Philadelphia, Miss., which just
happened to be where three civil rights workers -- Andrew Goodman,
Michael Schwerner and James Chaney -- were savagely murdered in 1964.

During his appearance in Philadelphia, Reagan told a cheering crowd,
"I believe in states' rights."

The lynching of Goodman, Schwerner and Chaney (try to imagine the
terror they felt throughout their ordeal) is the kind of activity
symbolized by the noose that Senator Allen felt compelled to put up in
his office.

One of the senator's Republican colleagues, Conrad Burns, is up for
re-election in Montana. He's got an ugly racial history, too. Several
years ago, while campaigning for a second term, Mr. Burns was
approached by a rancher who wanted to know what life was like in
Washington. The rancher said, "Conrad, how can you live back there
with all those niggers?"

Senator Burns said he told the rancher it was "a hell of a
challenge."

The senator later apologized. But he has bounced from one racially
insensitive moment to another over the years, including one occasion
when he referred to Arabs as "ragheads."

You don't hear President Bush or the Senate majority leader, Bill
Frist, or any other prominent Republicans blowing the whistle on the
likes of George Allen and Conrad Burns because Republicans across the
board, so-called moderates as well as conservatives, have benefited
tremendously from the party's bigotry. Allen and Burns may have been
more blatant and buffoonish than is acceptable, but they have all been
singing from the same racially offensive hymnal.

From the Willie Horton campaign to the intimidation of black voters in
Florida and elsewhere to the use of every racially charged symbol and
code word imaginable -- it's all of a piece.

The late Lee Atwater, in a 1981 interview, explained the evolution of
the Southern strategy:

"You start out in 1954 by saying, 'Nigger, nigger, nigger! By 1968
you can't say 'nigger' -- that hurts you. Backfires. So you say stuff
like forced busing, states' rights and all that stuff. You're getting
so abstract now [that] you're talking about cutting taxes, and all
these things you're talking about are totally economic things and a
byproduct of them is [that] blacks get hurt worse than whites."

It's been working beautifully for the G.O.P. for decades. Why would
the president or anyone else curtail a winning strategy now?

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From: Yes! Magazine, Oct. 15, 2006
[Printer-friendly version]

BETTER HEALTH THROUGH FAIRER WEALTH

By Brydie Ragan

[DHN editors' introduction: We have added some links within this story
to make it more informative for our readers.]

I recently saw a billboard for an employment service that said, "If
you think cigarette smoking is bad for your health, try a dead-end
job." This warning may not just be an advertising quip: public health
research now tells us that lower socio-economic status may be more
harmful to health than risky personal habits, such as smoking or
eating junk food.

In 1967, British epidemiologist Michael Marmot began to study the
relationship between poverty and health. He showed that each step up
or down the socio-economic ladder correlates with increasing or
decreasing health.

Over time, research linking health and wealth became more nuanced. It
turns out that "what matters in determining mortality and health in a
society is less the overall wealth of that society and more how evenly
wealth is distributed. The more equally wealth is distributed, the
better the health of that society," according to the editors of the
April 20, 1996 issue of the British Medical Journal. In that issue,
American epidemiologist George Kaplan and his colleagues showed that
the disparity of income in each of the individual U.S. states, rather
than the average income per state, predicted the death rate.

"The People's Epidemiologists," an article in the March/April 2006
issue of Harvard Magazine, takes the analysis a step further.
Fundamental social forces such as "poverty, discrimination, stressful
jobs, marketing-driven global food companies, substandard housing,
dangerous neighborhoods and so on" actually cause individuals to
become ill, according to the studies cited in the article. Nancy
Krieger, the epidemiologist featured in the article, has shown that
poverty and other social determinants are as formidable as hostile
microbes or personal habits when it comes to making us sick. This may
seem obvious, but it is a revolutionary idea: the public generally
believes that poor lifestyle choices, faulty genes, infectious agents,
and poisons are the major factors that give rise to illness.

Krieger is one of many prominent researchers making connections
between health and inequality. Michael Marmot recently explained in
his book, The Status Syndrome, that the experience of inequality
impacts health, making the perception of our place in the social
hierarchy an important factor. According to Harvard's Ichiro Kawachi,
the distribution of wealth in the United States has become an
"important public health problem." The claims of Kawachi and his
colleagues move public health firmly into the political arena, where
some people don't think it belongs. But the links between socio-
economic status and health are so compelling that public health
researchers are beginning to suggest economic and political remedies.

Richard Wilkinson, an epidemiologist at the University of Nottingham,
points out that we are not fated to live in stressful dominance
hierarchies that make us sick -- we can choose to create more
egalitarian societies. In his book, The Impact of Inequality,
Wilkinson suggests that employee ownership may provide a path toward
greater equality and consequently better health. The University of
Washington's Stephen Bezruchka, another leading researcher on status
and health, also reminds us that we can choose. He encourages us to
participate in our democracy to effect change. In a 2003 lecture he
said that "working together and organizing is our hope."

It is always true that we have choices, but some conditions embolden
us to create the future while others invite powerlessness. When it
comes to health care these days, Americans are reluctant to act
because we are full of fear. We are afraid: afraid because we have no
health care insurance, afraid of losing our health care insurance if
we have it, or afraid that the insurance we have will not cover our
health care expenses. But in the shadow of those fears is an even
greater fear -- the fear of poverty -- which can either cause or be
caused by illness.

In the United States we have all the resources we need to create a new
picture: an abundance of talent, ideas, intelligence, and material
wealth. We can decide to create a society that not only includes
guaranteed health care but also replaces our crushing climate of fear
with a creative culture of care. As Wilkinson and Bezruchka suggest,
we can choose to work for better health by working for greater
equality.

==============

Brydie Ragan is an indefatigable advocate for guaranteed health care.
She travels nationwide to present "Share the Health," a program that
inspires Americans to envision health care for everyone.

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