Time and time again, research has shown that the poor and minorities come up on the short end of the longevity stick.
Some of the blame can be placed on inactivity and dietary choices.
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But a four-part PBS documentary, Unnatural Causes: Is Inequality Making Us Sick, which first aired in March, shows mounting evidence that sometimes economic status, race and environment can be better predictors of health than our own poor choices.
The documentary demonstrated how at each economic level — rich to middle class to poor — health declines at the same rate as our money.
In two weeks, on Oct. 1, Dr. Adewale Troutman, executive director of the Louisville Metro Health Department, will lead a community forum in Lexington at which those indicators and others will be discussed.
Troutman, featured in part one of the PBS film, collaborated with former U.S. Surgeon General David Satcher on a 2005 paper — "What If We Were Equal? A Comparison of the Black-White Mortality Gap in 1960 and 2000" — that also concluded health inequalities exist along racial and economic lines.
According to the PBS documentary, as inequality grows and as the number of children living in poverty increases, the life expectancy for the richest country on Earth continues to decline. In 1980, we ranked 14th worldwide in life expectancy. In 2007, we were 29th.
That is not all lousy eating habits and exercise avoidance. Other factors include stress and all the tangents associated with poverty, such as under-education, under-employment and being overlooked by our health care system.
For the PBS documentary, filmmakers went to Louisville to explore patterns of illness, race and socioeconomic status.
Troutman said the health community talks about eating more fruits and vegetables, but what if you live in an area in which fresh foods are rare?
"We have one in the west end of Louisville," he said. "You find them in poor communities."
Then, good health is not a personal choice, he said, but is reliant on "structural and systemic factors."
Those factors include a deficient education, unemployment and violence.
Troutman said a 10-year difference in life expectancy can be found between one council district and another in Louisville.
It is time to look upstream for causes instead of simply treating resulting diseases such as diabetes, high blood pressure, cancer and heart disease, he said.
Government agencies and leaders in Louisville have recognized the need to change perspective, Troutman said.
In 2006, Louisville opened the Center for Health Equity, created by Mayor Jerry Abramson to eliminate health inequities based on race, ethnicity or socioeconomic status. The center is a collaboration among community members, local government, private business and health care organizations.
"Dr. Troutman is really trying to focus on the root causes of why minorities and the poor are sicker in our society," said Camille Watson, health educator at the Lexington-Fayette County Health Department, one of the forum sponsors. "Getting people healthier is the end result."