#380: Dying Before Our Time?

Americans are likelier than people in other wealthy nations to think they are in good health. But they would be wrong…

In recent years, I have asserted that both scandal and mismanagement by the Catholic hierarchy have led to the loss of influence for Catholic Social Teaching. Thus one of the great sources of public wisdom in our culture ends up getting ignored or even dismissed. But no matter how badly the custodians of this tradition perform their duties, we American Catholics ignore that wisdom at our peril.

Now comes evidence that ignoring the lessons of Catholic Social Teaching is costing people their lives. A recently released study by the National Research Council and the Institute of Medicine (U.S. Health in International Perspectives: Shorter Lives, Poorer Health ) attempts to determine why the U.S. ranks last in life expectancy among all wealthy nations. (see http://www.nap.edu/openbook.php?record_id=13497&page=1)

The Gospel of John makes it clear that Christian faith and a full life are closely linked, when Jesus says, “I came that they may have life, and have it abundantly.”

Catholic Social Teaching includes “Health Care” (one key to a full life) on its list of human rights. As one commentator explained: “Human fulfillment requires health, work, education, access, leisure, resources, security and many other things, which we define as human rights.”

But this massive study expands the reality behind these principles. Part 1 begins with this basic fact:

The United States ranks at or near the bottom on multiple measures of mortality and morbidity, in all age groups up to age 75, in males and females alike, and in virtually all other subgroups of the population. 
                                          
Then Part 2 it asks why. And Part 3 explores ideas for changing our course.

Last week’s wide media coverage of the report focused on its account of firearms deaths--the most newsworthy item, of course, in the wake of the Newtown tragedy.

But this 424-page study is bigger than that. It is a landmark that offers for the first time a comprehensive answer to why Americans suffer a health disadvantage. For Catholics who believe good public health is a human right, this analysis touches not only on social justice, but on life and death.

The evidence shows that the U.S. health disadvantage is pervasive across people’s lifespan, gender, class, and even race: “Americans face shorter lives and greater illness at all ages.” In a word, we are sicker and we die sooner--even if we don’t know it.

The breadth of our health inferiority is stunning:

When compared with the average for other high-income countries, the United States fares worse in nine health domains: adverse birth outcomes; injuries, accidents, and homicides; adolescent pregnancy and sexually transmitted infections; HIV and AIDS; drug-related mortality; obesity and diabetes; heart disease; chronic lung disease; and disability.

Think a good medical care system is enough to guarantee “healthcare”? Think again! This pervasive disadvantage is determined by far more than our Medical Care System. The study outlines four more key areas that affect our health:

Life-styles and behaviors, social and economic circumstances, environmental influences, and public policies can also play key roles in shaping individual and community health. And a number of these factors may be critical to understanding why some high income countries experience significantly better health outcomes than the United States.

When all five are added up, the tally is bleak. This raises the question of whether our “American way of life” is killing us.

It is true that “ObamaCare” should expand the number of insured Americans, but its broad impact is to be determined.

As for personal behaviors, the study finds that 40% of all U.S. deaths are linked to tobacco, diet, inactivity, or drinking. I wonder: why are these behaviors more dangerous in the U.S. than elsewhere?

Certain important unhealthy or injurious behaviors are more common in the United States than peer countries, including high-caloric intake, drug misuse, unsafe driving practices, high-risk sex, and the use of firearms. Poverty, unemployment, and income inequality are more prevalent than in comparable countries, education has not kept pace with other countries, and social mobility is more limited.

On firearms, the data is appalling.

There is little evidence, the study says, that violent acts a more frequent here than elsewhere. Yet they cause more deaths. 48% of violent U.S. deaths (homicide, accidents, suicide) involve firearms. US citizens own 35 to 50% of all the civilian owned firearms in the world--four times as many semiautomatic and automatic weapons as the U.S. Army! Globally, 80% of the firearms deaths occur in the U.S. The U.S. homicide rate is 20 times higher than our peer countries, and 43 times higher for people aged 15-24. (Note: that’s not 20 % and 43% higher, it’s 2000% and 4300% higher).

The U.S. firearms suicide rate is 5.8 times higher than elsewhere and unintentional firearm deaths are 5.2 times higher. All these grim numbers produce a chilling conclusion:

The prevalence of firearms in the United States looms large as an explanation for higher death rates from violence, suicidal impulses, and accidental shootings.

As for social factors in the U.S. health inferiority, the study collected data on income and wealth, on education, on the occupation, and on racial and ethnic identity. Observing that, relative to other wealthy countries, the U.S. possesses a “weak social safety net,” the study finds that our decline in health and life expectancy since 1975 coincides with a 40-year decline in social conditions, and concludes we need to explain the connection:

Life expectancy and other health outcomes…in the United States began to lose pace with other high-income countries in the late 1970s, a trend that has continued to the present. During this same time…there has been a potentially important co-occurrence of worsening social conditions in the United States, notably a rise in income inequality, poverty, child poverty, single-parent households, divorce, and incarceration--all more pronounced than other rich nations.

These unsettling trends present a potentially important explanation for the U.S. Health disadvantage… An examination of these underlying causes can shed light on why the United States appears to be losing ground.

On policy, the study reviewed the nine key health factors from Part One and concluded that each factor has policy implications:

Policy is also relevant to the unfavorable social, economic, an environmental conditions identified of this report as potential contributors to the U.S. Health disadvantage. A variety of policies can contribute to high poverty rates, unemployment call-up, inadequate educational achievement, lost social mobility, and the absence of safety net programs to protect children and families from the consequences of these problems. However, identifying and implementing policy solutions is a formidable challenge.

This means that policy reform is key to longer life for Americans. Not just government policy, but also the policies of corporations and communities and nonprofit agencies and even churches. Those peer countries are ahead of us for a reason: they have instituted social systems aimed at the common good--aimed at a longer, healthier life for all their people. And they are succeeding:

In countries with the most favorable health outcomes, resource investments and infrastructure often reflect a strong societal commitment to the health and welfare of the entire population…Choices about political governance structures, and the social and economic conditions they reflect and shape, matter to overall levels of health.

The sad truth is that our health inferiority does not mean we have failed to achieve what they have achieved. Rather, the truth is this: we have not even tried! The study is clear about the consequences of doing nothing:

The consequences of not attending to the growing U.S. health disadvantage and reversing current trends are predictable: the United States will probably continue to fall further behind comparable countries on health outcomes and mortality. In addition to the personal toll this will take, the drain on life and health may ultimately affect the economy and the prosperity of the United States as other countries reap the benefits of healthier populations and more productive workforces. With so much at stake, especially for America’s youth, the United States cannot afford to ignore its growing health disadvantage. 

We Catholics claim to serve life. We inherit a moral tradition that requires an option to promote the common good. We belong to an institution that believes we all have a human right to the best health and fullest life possible.

From this viewpoint, too many of us have allowed this basic right of ours to be violated by inaction at all levels. Worse than that: we haven’t even noticed it happening. As if we were victims of mass anesthesia, we have slept through the decline in our health and our lifespan, dreaming that all was well. This study sounds a loud alarm that offers no snoozing. It is time we wake up and face the nation that is allowing its people to die before their time--before our time.

© Bernard F. Swain PhD 2013

#379: The Money Scam

As we move from the Christmas season into Epiphany, one look back suggests how far we have YET go to honor the Christmas promise of Peace.

Traditionally, Christians celebrate the Feast of the Holy Innocents on the Fourth Day of Christmas, December 28 (http://www.catholicculture.org/culture/liturgicalyear/calendar/day.cfm?date=2012-12-28).  Thus for centuries Christians have used the Christmas season (December 25 to January 5) as a time to not only celebrate the birth of Jesus, but also to honor the suffering of innocent children as well. 

But this year, in the wake of the Newtown tragedy, some people are dishonoring those children with disingenuous arguments and self-serving proposals.

The NRA leadership says “The only thing that stops a bad guy with a gun is a good guy with a gun.” This reminds me of the popup on my PC screen from a company offering, for a fee, to rid my computer of the very virus that same company had sent to my computer!  The scam is: cause the problem so you can offer to fix it.

If banning combat-style weapons is not a practical option, it is mainly because there are already 300 million guns owned by private citizens--some of them bad guys.  So now the NRA offers a solution (armed guards in every school) to the very problem they have promoted for decades: widespread easy legal ownership of weapons designed for mass killing.

It’s an old Fascist trick, of course.  In 1939, the Nazis invaded Poland in response to a supposed Polish attack against a German radio station, which in fact they had themselves faked. Hitler said: “In order to put an end to this frantic activity no other means is left to me now than to meet force with force.” Sound familiar?

The NRA is of course the main lobby for the weapons industry--and their efforts over the years have enabled the flood of weaponry that that now engulfs us.  Having succeeded in shaping a nation literally armed to the teeth, they now conveniently trot out the hypocritical notion that the only solution is more weapons in more places.

Supposedly appealing to common sense, they compare guns in schools to banks with armed guards. security in American airports, power plants, courthouses, sports stadiums and Secret Service agents.  But all analogies limp, and this one too: mostly those people have chosen to put themselves in harm’s way.  Would the NRA have us accept that the same is true of our schoolchildren?  That parents place them in harm’s way? That going to school, like being President or handling massive sums of money, inevitably brings a high risk that requires armed protection?

The underlying worldview is obvious: there is no such thing as a safe place, there is only a well-protected (i.e well-armed) place.  This implies that we are all in harm’s way, all the time, everywhere.  The inevitable alternative is armed protection for everyone at all times.

This idea of a fortress-culture, constantly threatened and vulnerable and surviving only by the force of arms, reflects a vision of lawless society unmatched even by the towns of the “wild west” (where, e.g., schoolmarms were not armed, and people checked in their guns on arrival).  It denies the long-held notion that in a civilized society public safety is the norm, and that police are capable of protecting the citizenry from widespread violence.

This repugnant vision surrenders all hope of a peaceful society in which the average citizen can “hang up his gun at the sheriff’s office” and live secure from lethal attack. As both social vision and practical program, this approach is a scam.

Criminologists know from long study that there are three ways to protect the public against the kind of mass violence that struck Newtown.

First, we can better identify and control people who pose a threat to themselves and to others.  Time after time the killers turn out to fit the profile typical of sociopaths: reclusive, socially maladjusted loners, usually young white males, unable to function among their peers.  We have repeatedly failed to identify such people and provide the treatment, help, and control they need before their behavior becomes dangerous. (The NRA is at least right on one point: our media and video-game culture, by fetishizing gun violence, probably makes such people even more dangerous.)

Second, we can prevent the ready access of such people to victims.  No doubt this may mean tightening security in key places, including schools.  And given the entire NRA-fueled flood of guns in America, it may even require armed guards (after all, while I never purchased the virus spreaders’ “solution,” I still had to pay someone to fix my PC).

Third, we can reduce the ability of dangerous people to inflict harm.  The actual damage they do depends on the lethality of their weapons--and today’s weapons are far more lethal than any in our history.  The same week as the Newtown attack, a man in China armed with a knife attacked a school, stabbing 22 children.  Four were seriously hurt, but none died.  The main difference between that outcome and the 26 dead in Newtown was the weapon itself.

To get serious about protecting our citizenry, we must address all three of these conditions.  We must build a civil society where (1) dangerous people are identified and their behavior is controlled, (2) reasonable security systems are in place, and (3) weapons of mass murder are no longer a commonplace threat.

Behind such common sense principles are some controversial truths.

First, this is not a Second Amendment problem.  For one thing, the right to bear arms is no more absolute than any other right; it can be limited and regulated in the interest of public safety.  But more importantly, the Second Amendment applies to gun owners, not to gun makers or gun sellers. As Justice Scalia explained in his majority opinion in the Heller case:

Like most rights, the Second Amendment right is not unlimited. It is not a right to keep and carry any weapon whatsoever in any manner whatsoever and for whatever purpose...The Court’s opinion should not be taken to cast doubt on longstanding prohibitions on the possession of firearms by felons and the mentally ill, or laws forbidding the carrying of firearms in sensitive places such as schools and government buildings, or laws imposing conditions and qualifications on the commercial sale of arms.

 Thus:  A citizen’s right to bear arms does not give any particular weapons manufacturer the right to make or sell any particular weapon.  In short, citizens can bear whatever arms they can buy--but combat-style weapons should never be on the market in the first place!

The old IRA bumper sticker read, “If guns are outlawed, only outlaws will have guns.” But where do outlaws get their guns?  Obviously, they get them from the same gun makers everyone else does!  The only reason bad guys have combat-style weapons is because we allow their manufacture and sale to the general public. The real issue here is not gun control at all—it is the regulation of gun commerce.

Second, it takes no genius to explain why such weapons are on the market, in defiance of all logic and common sense.  The answer is: money.  The industry for which the NRA lobbies is perfectly content to sell us more weapons to prevent the very carnage that its previous sales made possible--but it is not willing to curtail any sales that limit its profits, and it spends millions annually on the lobbying to protect those profits.  The sad truth is, we are governed by leaders who have already been bought by an industry for which trafficking in arms trumps public safety.

Third, the money behind guns reflects a much deeper problem than mere private sales to individual consumers.  The attachment to guns is deeply imbedded in our public policy as well.  Since World War II, the U.S. has consistently been the world’s largest manufacturer, seller, and trafficker of all weapons from handguns to nuclear missiles.  Many of the world’s trouble makers (such as the Taliban in Afghanistan) rely on the firepower of U.S. weapons.  Many of the world’s trouble spots are fueled by “Washington bullets.” Weapons building brought the U.S. economy out of the Great Depression, and we have been the world’s arsenal ever since.  Indeed, worldwide U.S. weapons sales tripled in 2011, to $66.3 billion--more than three-quarters of the global total!

  The horrific truth is that our inability to stop the spread of guns is merely the byproduct of living in “Arsenal America.”

Fourth, people who tell us the problem is the “monsters” out there are deceiving both themselves and office.  While it is true that we cannot create peace and security by eliminating all evil, we are nonetheless wrong to buy the notion that America’s widespread violence is inevitably built into human nature.  This crisis is not natural, it is national.  No other civilized nation comes close to our violent crime rate, and few allow the sale of combat-style weapons.  Americans typically live in a bubble that defines our life in our own isolationist terms, without reference to the experience of other countries.  But in this case, to ignore how other countries have achieved the secure, pacific life we are failing to provide is nothing less than criminal blindness.

In future Decembers, the remembrance of the “Holy Innocents” will include not only those babies in first century Israel, but those schoolchildren for whom modern day America was a death trap.  We dishonor them, their families, their peers, and ourselves if we do not finally insist that their lives are more worth more than all the money in Arsenal America.

 © Bernard F. Swain PhD 2013