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The socio-economic divide between cigarette smokers and non-smokers
Smoking reflects a deep divide in American society.
It may seem like you barely notice anyone smoking cigarettes any more — a bad habit consigned to the trash heap of history, sent there by a 1966 surgeon general's report. If you're educated and reasonably well-off — and live in suburban or urban area — you're right. The number of people who smoke has dropped considerably among the well-educated. This is great news, right? Troublingly, it's only half the story, and it's a story of privilege. According to new CDC data, the socioeconomic disparity with which America is struggling in so many ways extends to this dangerous habit: Americans of lower socioeconomic status, or SES, are still smoking, and dying in ever-more disproportionate numbers.
SES is generally measured using four criteria: education, occupation, income, and wealth. Of these, only occupation does not indicate a greater number of smokers than the general population.
The number of smokers has dropped since 1966, but more than twice the number of people without a high school diploma smoke than those with a college degree.
- Smoking among college graduates is down 83%.
- Smoking among people who've had some college is down 61%.
- Smoking among people with just a high school diploma is down 52%.
- Smoking among people without a high school diploma is down 39%.
In this graph and the one below, “Current Use" is defined as self-reported consumption of cigarettes, cigars, or smokeless tobacco in the past 30 days (at the time of survey). Data is taken from the National Survey on Drug Use and Health, 2012, and refer to adults aged 18 years and older. (CDC)
If we combine the lack of two other SES factors — income and wealth — and look at the people living below the poverty line, the numbers are also concerning, in another CDC graph:
Not only do more folks with low SES smoke, but they do so more heavily, according to the CDC.
- People living in poverty smoke cigarettes for a duration of nearly twice as many years as people with a family income of three times the poverty rate.
- People with a high school education smoke cigarettes for a duration of more than twice as many years as people with at least a bachelor's degree.
- Blue-collar workers are more likely to start smoking cigarettes at a younger age and to smoke more heavily than white-collar workers.
Even for non-smokers, second-hand smoke continues to be a problem, especially for bartenders and wait staff, whose workplaces in poorer areas often lack smoke-free regulations. Blue-collar workers are also more regularly exposed to tobacco smoke at work than white collar workers.
What all this adds up to is that people with less education and less money are more likely to suffer, and die, from lung cancer and other smoking-related illnesses.
“It's like there's two worlds now," Debbie Seals, a volunteer for the American Lung Association, tells the Washington Post. In her hometown of Martinsville, in Virginia's Blue Ridge Mountains, cigarettes are everywhere. When she goes north to visit family in suburban Alexandria, however, they're nowhere to be seen. And as smoking disappears from the more well-off sectors of society, the urgency of the problem also disappears from view, so federal funding of smoking cessation programs is dropping. It's as if the problem is solved, except it's not.
Robin Koval, president of Truth Initiative, tells the Post, “There's this tendency now to blame the ones still smoking. The attitude is: 'You're doing it to yourself. If you were just strong enough, you'd be able to quit.' "
Tobacco companies, though, are now focusing their marketing efforts on Martinsville and communities like it. On one hand it makes sense that these companies are interested in targeting the people most likely to buy their products, but on the other, it reinforces the stark differences in smoking habits among people from different educational and economic strata.
A spokesperson for the largest tobacco company in the U.S. Altria reminded the Post of the $112 billion his and other companies have paid in settlement money to states, blaming local governments for not funneling that money back into local anti-smoking efforts. He also claims poorer communities aren't being targeted.
Truth Initiative, among others, isn't buying it: “It's not a coincidence. It's profiling," according to their ads.
The CDC is also producing ads that discourage smoking.
“Poorer people don't smoke because anything's different or wrong about them," says Koval. “Their communities are not protected like others are." Local governments, especially in the poorer areas of the southern U.S., have been lobbied hard by tobacco companies, and have been less likely to institute disincentives such as the creation of smoke-free areas and the levying of cigarette taxes.
Koval notes that making things even worse is that, “They [poorer smokers] don't have access to good health care and cessation programs. If you have a bull's eye painted on your back, it's harder to get away."
Seals, who teaches smoking-cessation classes, says there's also a deeper reason lower-SES smokers have trouble quitting. “People down here smoke because of the stress in their life. They smoke because of money problems, family problems. It's the one thing they have control over. The one thing that makes them feel better. And you want them to give that up? It's the toughest thing in the world."
The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
COVID-19 deepens U.S. health disparities<p>Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> reduces access to quality food, leading to poor health and communal endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and Type 2 diabetes, as increasing the risk of developing a severe case of coronavirus.</p><p>The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.</p><p>The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair the prefrontal cortex and other brain functions through anxiety, depression, and cognitive load. </p><p>"Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.
Working to close the health gap<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />
Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health<p>Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.</p><p>How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."</p><p>"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.</p><p>Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.</p><p>These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.</p><p>While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.</p><p>"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.</p><p>"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."</p>
Philosopher Nick Bostrom's "singleton hypothesis" predicts the future of human societies.
- Nick Bostrom's "singleton hypothesis" says that intelligent life on Earth will eventually form a "singleton".
- The "singleton" could be a single government or an artificial intelligence that runs everything.
- Whether the singleton will be positive or negative depends on numerous factors and is not certain.
Want to Retain American Jobs? Stop Blaming Globalization<div class="rm-shortcode" data-media_id="oxK8j1xN" data-player_id="FvQKszTI" data-rm-shortcode-id="2cf425d7b91ed2a6fc4fe19d065f3408"> <div id="botr_oxK8j1xN_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/oxK8j1xN-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/oxK8j1xN-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/oxK8j1xN-FvQKszTI.js"></script> </div>
The rites we give to the dead help us understand what it takes to go on living.
As the coronavirus pandemic hit New York in March, the death toll quickly went up with few chances for families and communities to perform traditional rites for their loved ones.
Shannon Lee shares lessons from her father in her new book, "Be Water, My Friend: The Teachings of Bruce Lee."
- Bruce Lee would have turned 80 years old on November 27, 2020. The legendary actor and martial artist's daughter, Shannon Lee, shares some of his wisdom and his philosophy on self help in a new book titled "Be Water, My Friend: The Teachings of Bruce Lee."
- In this video, Shannon shares a story of the fight that led to her father beginning a deeper philosophical journey, and how that informed his unique expression of martial arts called Jeet Kune Do.
- One lesson passed down from Bruce Lee was his use and placement of physical symbols as a way to help "cement for yourself this new way of being, or this new lesson you've learned." By working on ourselves (with the right tools), we can develop the skills necessary to rise and conquer new challenges.