The most significant “lifestyle” cause of death and disease

Rachel at the F-Word posted about a British “reality” TV show that sounds … well, to me it sounds both boring and dreadful.  Valerie, in the comments, linked to this Guardian article on the Brit TV celebrity “nutritionist” featured on the show.   Apparently the “nutritionist” is fairly outrageous in a “I know about science because I read fashion magazines” way, but this bit from the end I thought worth thinking about:

In reality, again, away from the cameras, the most significant “lifestyle” cause of death and disease is social class. Here’s a perfect example. I rent a flat in London’s Kentish Town on my modest junior doctor’s salary (don’t believe what you read in the papers about doctors’ wages, either). This is a very poor working-class area, and the male life expectancy is about 70 years. Two miles away in Hampstead, meanwhile, where the millionaire Dr Gillian McKeith PhD owns a very large property, surrounded by other wealthy middle-class people, male life expectancy is almost 80 years. I know this because I have the Annual Public Health Report for Camden open on the table right now.

This phenomenal disparity in life expectancy – the difference between a lengthy and rich retirement, and a very truncated one indeed – is not because the people in Hampstead are careful to eat a handful of Brazil nuts every day, to make sure they’re not deficient in selenium, as per nutritionists’ advice.

And that’s the most sinister feature of the whole nutritionist project, graphically exemplified by McKeith: it’s a manifesto of rightwing individualism – you are what you eat, and people die young because they deserve it. They choose death, through ignorance and laziness, but you choose life, fresh fish, olive oil, and that’s why you’re healthy. You’re going to see 78. You deserve it. Not like them. […]

How can I be sure that this phenomenal difference in life expectancy between rich and poor isn’t due to the difference in diet?  Because I’ve read the dietary intervention studies: when you intervene and make a huge effort to change people’s diets, and get them eating more fruit and veg, you find the benefits, where they are positive at all, are actually very modest. Nothing like 10 years.

We focus so much on weight, especially women. Magazines, TV shows, news, advertising, government programs.  We focus on diet and exercise to “improve” our weight, but really we’re trying to improve ourselves.  Yet we often don’t focus on getting richer or better educated.   Richer people can afford more medical care, even in a socialized medical system.  Their lifestyles are more likely to include things like education and fresh food and vitamins,  and less likely to include smoking or violentand unsafe  neighborhoods.  These things affect life expectancy.   Yet we don’t have a public campaign to teach everyone about basic personal finance or thriftyness or how “tax rebate loans” are rip-offs.   Why not?   Is it because “improving” our weight is a sexy, exciting thing to do, but education so you can get a safer, better-paying job is boring?   Is it that saving for emergencies (so you can repair a broken water heater, say, or pay your COBRA premium between jobs) not only isn’t sexy, but isn’t appropriate for someone who wasn’t born well-off?

10 thoughts on “The most significant “lifestyle” cause of death and disease

  1. My grandparents farmed when they were younger, then grandpa worked in a smelter til he retired, and grandma worked in a garment factory until she retired. Grandpa lived to be 90, grandma lived to be 86 (they were born between 1900 and 1910). I remember the meals grandma cooked, not very much different than how I eat today (dinner was meat, potatoes, 2 veggies, maybe bread & butter, breakfast was either cereal [hot or cold] or eggs, bacon, toast, lunch was a sandwich of some kind). She didn’t worry about fats, salt, sugar, or anything else when she cooked. They weren’t poor, by any means, but weren’t well-to-do either (they raised 2 sons). I don’t know what their health insurance was like, since by the time I was old enough to know about those kinds of things, they were retired and had Medicare coverage, so I don’t know what kind of health care they got when they were working and raising my dad and his brother. But for blue-collar working people, they lived longer than was expected, given when they were born and life expectancies back then (they’ve both been gone for about 20 years, grandma died about 8 months after grandpa). So even a modest increase in one’s social and economic standards can significantly increase life expectancy, I would think. So making education more affordable, and making more and better-paying jobs available for everyone would go a long way toward improving health, without all the hysteria of weight loss and exercise and eating all the “right” foods.

  2. I expect real poverty & consistently not having enough to eat can affect health & life expectancy, as can habitual dieting & self-starvation (enough so that dieting in people my age {I am 59} & older increases mortality risks seriously, despite the fact that AARP promotes weight loss dieting for people up to 80, a good reason why I will never join). However, in my own family & others around me I have seen that genetics plays a huge role…not only in our body types & sizes, but in what kind of diseases we do or not get & how long we live. I am from a lower class to lower middle class background, many of my relatives lived in poverty or dangerously close to it, I have never known what it is to be comfortably well-off. However, most of the people on my mother’s side of the family, especially the women, & especially the fat women, have lived well into their 80’s to mid-90’s, with one aunt living to 101. And they cooked big meals, rich desserts, high fat meats, some fresh or home-canned veggies when they were available, frozen ones in later years, fresh fruit when they could get it but it was more of a treat than part of the daily diet, they used a lot of eggs, butter, whole milk, & most cooked with lard.

    My grandmother, who lived to be 90, hated exercise & got the rest of us to wait on her as much as possible. She would only eat real butter, loved fatty meats, & adored sweets. My mother, whose father & grandfather both died of kidney disease, lived to be 85 despite a lot of poverty, years of alcoholism, too many pregnancies, & living her last 40 years with one kidney. As Sandy has tried to tell us for years & has been shouted down &/or ignored for it in many so-called ‘fat acceptance’ forums, as have several others of us, “lifestyle choices” really have damn little to do with how healthy we are or how long we live. And, yes, having enough money to live on in some comfort & being able to have ENOUGH to eat can make a difference, as can some things such as not smoking. But there are no magic or ‘super’ foods, no m transforming amount of exercise, which will make you live a minute longer than you are supposed to & I really wish we could all understand that & that more of us could really appreciate that we do not owe it to anyone…the media, government, insurance companies, or whoever…that we are “EARNING: rights & acceptance because we are ‘good fatties’ or that anyone ever “earns’ the right to live to be 100 by his or her behavior.

    However, being able to keep a roof over your head & keep yourself fed is beneficial to everyone & I suppose that it is likely that those who do not actually have to fight daily to survive live longer on average than those who do.

    Oh, &, Vesta, my Nana was born in 1888, my mother in 1914. My naturally lean father, who used to insult & ridicule my mother for being fat while he ate two to three times as much as she did, killed himself with tobacco & alcohol at age 63; it took too long.

  3. Vesta & Patsy, yes, genetics plays a *huge* role, and I probably should have noted that. My point is that education and standard of living have huge effects too, and are things we can change over time. Not completely, of course, and your past choices affects (and sometimes limits) your options and abilities. It’s harder to go back to college once you’ve had kids, for example. But it is possible.

    Heck, I not only got my student loans and credit cards paid off in 4 years, but the only debt I’ve had in the past 14 years since is 1 car loan (now paid off) and my mortgage. Between keeping my debt load low and having an emergency fund, I’ve been able to maintain my health insurance whenever I’ve been between jobs, which makes it easier for me to keep the coverage in the future. Some of that was luck and getting a good tech job after college, some of it was learning to spend less than I had. I do know it’s lasted longer and probably helped my health more than any of the times I’ve lost weight! :)

  4. You have done very well for yourself & you are to be congratulated. It took my son about twelve years to pay off his student loans, but they are managing okay. We usually lived from paycheck to paycheck & when my boys were small, money was very tight. We got WIC for awhile, food stamps for a few years, but at times we just scraped by with what we had & nine years ago, we went through bankrutpcy. When they were little, I often went to bed hungry because my husband made sure he got his share, then I fed the boys, & I ate what little was left. (I never got thin, btw.) Now I do have enough to eat on a regular basis & no credit card debt, but I can live without credit better than most people, since I live in rented apartments, have no license, & do not drive a car.

    I have cerebral palsy & now arthritis & getting work was always problematic for me. I was last to be hired, first to be fired (usually for being too slow), & now that I am not only disabled but pushing 60 hard, my chances of finding employment are virtually nil. I am doing alright, though, keeping myself housed, clothed, & fed. As I said, all the women in my family have lived around the poverty line all their lives (I am from Maine & that is extremely common, as we have one of the poorest economies in the country & it is not uncommon for people to work two, three, four jobs to make ends meet), but still lived considerably longer than the average person.

    That is also quite common here in Maine & most of it is genetics & dumb luck, but some is also attitude. As Sandy has also pointed out, people who have something to do & something to care about, interaction with others, etc., function better & tend to live longer. So, apparently, do those who are strong-willed & independent, somewhat cantankerous, & not afraid to tell the nannies where to go & how to get there. We have a lot of those here in Maine, especially down on the coast in the fishing communities. I am becoming more that way myself as I age & the nannies are not finding a cooperative pigeon in me. I have a feeling that they are only finding a receptive audience here among the young college-educated crowd who believe everything they read.

    There don’t seem to be any magic answers to longevity, as people who live a long time comes from all backgrounds & lifestyles, as do those who die young. Certainly we hear of plenty who do everything “right”, according to popular wisdom, but die early, often while running. And if you see those interviews with people who live to be 100 or more, you see that they list things like Big Macs, KFC & Twinkies as their favorite foods, or say they always had bacon & eggs or sausages & pancakes for breakfast every morning…some have smoked a lot, some drink on a regular basis. But I do agree that it cannot hurt to have some degree of financial security…as long as we remember that many of the very rich & famous also die young, sometimes VERY young…& it definitely helps to have enough to eat every day.

    My own experience with medical insurance is that what we have had pays very little. My own experience with the medical community since early childhood has been such that I NEVER go near medical personnel unless I simply have no choice. We have no family history of heart disease or cancer, so I live one day at a time & cross my fingers. But then I am libertarian & more than a little contrarian by nature.

  5. Great post, but there’s something about the comments here that irritates me. I’m not sure what it is, actually. Perhaps it’s because some of this sounds eerily like diet speech – you know, the good old “But our weight is something that we can change over time!” Eh. Most of the poor people I know, including myself, are not poor because they made bad choices in the past. And most of them are not strong enough to pull themselves up by their bootstraps, either. Coaching wouldn’t do them (or me) any good, but better medical care would … which we can’t afford. In many cases it’s not poverty leading to bad health, but bad health leading to poverty.

  6. Sometimes being in relative poverty doesn’t necessarily mean bad health, either, as I was trying to point out. And I agree that we cannot all become wealthy or upper middle class & able to save a lot of money, etc., etc. I certainly have never had that capacity in my life; it has been lived from paycheck to paycheck without much for emergencies. As you say, things are not that way just because of bad choices. Many of us do all we can & I know a lot of people here in Maine where I love do all we can to support ourselves & be responsible, yet we really never have enough to get out of debt (except, as in my case, if we go through bankruptcy & maybe credit counseling works for some) & be able to have lots of savings for the future. I agree, Tiana, that for some of us at least, living in uncertain financial circumstances is no more completely within our control than being fat. But I also agree that those with more financial security do usually get better medical care, just as thin people usually get better & more respectful medical care than fat people of any financial status. (Well, I suppose Oprah can get good medical care when she is fat, especially since she makes it clear that she hates herself for being fat & intends to get thin yet AGAIN as soon as possible.) Most of us who have limited funds cannot promise those from whom we request medical treatment that we plan to ‘do something about ourselves’ & get rich soon.

  7. I am totally with you on the education and learning good money skills being extremely valuable to better health and longevity. Didn’t cavemen once throw rocks at the moon? Education means more than just the formal sense of the word. Education, to me, includes real knowledge about the world, cause and effect, understanding your own body signals and health issues, having solid social skills, being able to know and ask for what you want and need, and so on. These lessons are invaluable to helping one understand what they want and how to achieve it.

    I also believe that stress is a major factor in play here. Being able to manage, deflect, prevent and/or deal with stress can prevent the negative effects it has on one’s health. I have lived a life of poverty as a single parent putting myself through college and though I was younger, I was still under a great deal of stress and my body responded to it. I can still remember what it FEELS like to worry about paying the bills, keeping the lights on, fixing the car, etc. It inflitrated my dreams, creased the skin between my eyebrows, and caused stomach aches and depression.

    Being firmly in the middle class today, I can honestly say my stress has reduced greatly. The ability to pay for the life I lead now, without heaps of stress, has decreased and even reversed the toll it has had on me, especially mentally. This is not to say that wealthy people don’t stress about things, but the basics are pretty much covered and probably don’t even garner much thought or concern unless and until crisis occurs.

    So, I believe stress could be the common denominator at play here in regards to life expectancy. I realize there are exceptions to every rule, but good stress management and coping skills can’t hurt.

  8. Amen. Stress is the most likely the biggest factor in health, aside from genetics, dumb luck, & maybe smoking & excessive alcohol/drug use, for people of all sizes & shapes. It is probably my own single biggest negative health factor, because I am, partly because of the nervous system damage from cerebral palsy, partly genetics & inborn nature, & partly from abuse, an extremely tightly-wound, hyper, highly-strung person, who can get very overwrought & anxious at times, & I know that cannot be a positive thing. My mother had much the same natural temperament & she made it to 85, so I am working on managing the stress & anxiety as well as I can.’

    Today we are having a nice winter day, in the upper 30’s, mostly sunny, with a smell of Spring in the air, & I was able to take a good walk, so that is helping for now.

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