We have all heard the aphorism "Health is wealth." It is often proffered as consolation for the financially impoverished. "Never mind that you're not rich," some well-meaning counselor would say. "At least you're healthy, and that's better than all the money in the world."
It's a nice little phrase to toss, but it glosses over a big sad truth: poor people are seldom as healthy as the rich. In the real world, wealth is health. If you're not wealthy, no matter how healthy you seem to be right now, your rich counterparts will probably stay healthy far longer than you will.
Why is this so?
A Growing Gap
A 2016 paper published by The Brookings Institution reports that even among people born as early as the 1920s, the level of one's income already correlated with one's life expectancy. The researchers found that among people born in those years, the poorest 10% had a life expectancy of 73 to 74 years, while the richest 10% had a life expectancy of around 79 years.
A quick calculation shows a 5- to 6-year advantage for rich people in terms of life expectancy.
But that was for people born in the 1920s. What about those born later?
For them, the gap grew wider.
Thanks to all the advances in medicine and health care, the researchers found that among men born in the 1950s, the richest 10% gained 9 years in their life expectancy—but for the poorest 10%, the gain was less than 1 year.
And if you think that sounds bad, remember that, so far, we have only seen the figures for men born in the 1950s. What about the women?
For women, the picture is worse: While the rich 1950s-born ladies gained 10 years of life expectancy, their poor sisters actually lost 7 years compared to the 1920s-born group.
What caused this disparity?
The obvious 10%
Let's start with the obvious reason: health care access, or better medical care.
The rich can afford more health insurance, and what their insurance does not cover, they can afford to pay for themselves. Also, they have emergency funds and passive income, so they can afford to take a day off from work.
Therefore, when they feel sick, they are able to do that one thing that can spell the difference between a disease treated on time and one that festers until it is too late: They see a doctor.
When they are prescribed medication, they buy it so they can take it.
Compare that with patients who cannot even imagine taking time off from work because doing so will mean losing the day's much-needed wages. Or what about the patients who, upon hearing the prescribed treatment regimen, know they will never be able to afford it?
These patients end up leaving the doctor's clinic with the heavy resignation that their disease cannot be cured practicably—therefore, it cannot be cured at all.
Health care access is undeniably a factor in people's longevity.
But you may be surprised to know that, according to a 2007 paper published by the New England Journal of Medicine, access to health care actually accounts for a mere 10% of preventable deaths.
In other words, our greatest killer is not our inability to get treatment for our diseases. What is it then? What accounts for the other 90%?
The hidden 90%
Most people die sooner than they should because of genetic predisposition (30%), behavioral patterns (40%), and social/environmental conditions (20%).
We will not discuss the genetic factor because that cuts across social classes and income levels.
But what behavioral patterns and social/environmental conditions contribute to earlier death?
1. Unhealthy eating. It seems counterintuitive that the poor are more likely to end up obese, considering that they can afford to buy less food. But obesity is not just a product of how much we eat but also the quality of our food intake.
When your food budget for the day is severely limited, you are far more likely to spend it on the cheapest, bulkiest food source you can find. In Asia, this would be white rice.
Because fruits and vegetables are more expensive than rice, they are unlikely to be the first choice.
Rice will keep you feeling full for hours, while a salad will be gone in half an hour, so you will be compelled to spend on food again. This is a situation that people with limited food budgets strive to avoid.
It is worth noting, though, that obesity rates between the rich and the poor are actually decreasing, according to a 2015 report from the National Academies of Sciences, Engineering, and Medicine.
But unhealthy eating is not the only behavioral pattern that causes poor people to die earlier.
2. Smoking. Considered to be the world's top cause of preventable deaths, the ill effects of smoking are widely known in all social classes. However, the rich are smoking less, while the poor are smoking just as much as before, if not more.
What causes this difference in smoking behavior? Educational attainment.
As people reach higher levels of education, they are more likely aware of the dangers of smoking. They have higher occupational status with higher income to afford smoking cessation aids and therapies, thus they are more likely to leave off the habit.
So who is left puffing? It is those who could not afford college degrees.
3. Environmental hazards. These include
unsanitary home environments,
unsafe sources of drinking water,
exposure to structural toxins, and
cramped living quarters facilitating the spread of communicable diseases.
Are these problems of the rich? No. We all already know who faces hazards like these on a daily basis. Perhaps the real question is, what does this mean for the poor? Are they—are we—trapped helplessly in this vicious cycle of poor physical and financial health?
When we realize we are in a cycle, we gain the ability to choose to get out of it: We stop smoking. We can replace some of our rice with, say, bananas, which are similarly inexpensive but are far healthier to eat. We can make little changes in our lives that, bit by bit, will add up to change the direction of our lives.
We can do all these once we stop believing that empty promise that we're okay as long as we're not sick, that "health is wealth"…
Because the truth is, at the end of it all, we're not really wealthy just because we are—so far—healthy. We have it all wrong. It's the other way around.