Movin’ on up (or not)

1920s dancers

Set in the roaring 1920s, the Great Gatsby novel shows how little upward mobility there was. It’s still true today.

If your parents came from the franks-n-beans crowd, how likely are you to grow up and hob nob with the caviar-and-champagne set?  Jay Gatsby would tell you “not very likely”.

The tragic hero of love thwarted by money, Jay lives on in the “Great Gatsby Curve” — an economic graph that shows how little upward mobility Americans have compared to other countries.  And since social-economic status is intertwined with health status, you probably won’t have better health or longevity than your parents either.

If a person cannot go from rags to riches, can he be as healthy as the upper classes?  In other words, if people are not moving up the economic ladder, can we push better health down the social economic scale?  I doubt it.

The reasons that a low economic status person has poor health are not simple.  It’s not just that he earns less money.  He probably has less time to get medical care; most low-paying jobs do not have flexibility or paid-time off for personal appointments.  When he does go, he is less able to follow a treatment plan.

For all of these reasons, people of low social economic status are more prone to

  • Complications of type 1 diabetes
  • Worse outcomes of HIV treatment
  • Higher levels of stress hormones
  • Cardiovascular disease and
  • Depression, among other things.

Even where a person lives makes a difference.  One study found that obesity and diabetes risk went down when a family moved out of a poor neighborhood into a better one.  Moving in next door to Daisy’s cousin was Gatsby’s way of establishing himself in her social circle.  He put himself into the high society environs, trying to distance his humble past.

To get everyone medical care that is the same quality – despite obstacles or opportunities created by each patient’s social-economic situation – would be a feat, but perhaps not a miracle.  Highly educated, highly paid medical providers would need to learn the language and protocols of their patients.  Picking up a drug at the pharmacy may seem simple to a nurse, but be difficult for a single mother who speaks little English.  Changing a dressing three times a day is easy for someone working a white collar job, not so easy for someone covering the counter at a shop.

Even if we could somehow get everyone the same medical care, medical care is a small part of a person’s overall health.  We could not counter the impact that physical labor, high stress, and low esteem have on a person’s body.  We cannot erase the impact of a person’s daily life.

In the end, Gatsby is shot for a crime he did not commit.  Living among the elites, he dies a beggar’s death.

Like Gatsby, we can all travel some distance from our starting points, from our parents’ upbringing.  We can improve our lives, even improve our health.  Yet we will always be what we were in the beginning.

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