Inequality kills

One of the nastiest things about the years after the Republicans took control of the Congress in 1994 and Bush the White House in 2001 was the increase in inequality in the US. The rich not only got richer and the poor, poorer, but rich got more comfortable and led better lives. The idea that they got rich because all they did was work is nonsense. They had plenty of time to spend their money and relax. Moreover the prosperity in the economy didn't accrue to everyone. It was the folks at the top that benefitted. We all know that the rising tide only lifted the yachts, but we sometimes forget that this can also be measured in non-monetary ways, too. This week the CDC released a "Quickstat" comparing the percentage of adults over 25 reporting regular recreational physical activity of at last 30 minutes of a moderate level at least five times a week or 20 minutes of vigorous activity three times a week. We don't have the data by income or social class but we are given it by a reasonable proxy, educational level. Here is the comparison between 1997 and 2007, adjusted for a standard population:


Over both time periods you can see that the proportion of adult Americans who exercised for pleasure was directly related to educational level: the higher your educational level (which is correlated with income), the more likely a person was to engage in leisure-time physical activity. Not a surprise. But we also see something else. The gap widened, with the highest educational level having an increased proportion while each of the lower levels decreasing. If you completed college you were three times as likely to have exercised than if you had not completed high school.

Inequality is also a public health problem. Inequality kills.

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I completely agree with this, but you have to take into factor percent obese. What if you were to have percent obese to education level, I would guess that you will not have as significant results. Or look at it in relative numbers. What percent of people at each eduction level exercise for pleasure? Overall, it is just the fact that Americans are fat.

There is also a question of access to exercise facilities. Most Americans get little or no exercise conducting their everyday lives: they sit behind a desk all day, and live (and too often work) in places where nothing is within walking distance, so they drive to everything. That leaves the gym and the golf course as the only places most people can go to get exercise. But gym memberships cost money, which poor people don't have. Golf club memberships are even more exclusive: often the existing members have a say in who can join, and they are less likely to let Joe Sixpack (even if he can come up with the money) join than somebody they know from work or college. So they don't have a chance to get anywhere near enough exercise.

By Eric Lund (not verified) on 23 Mar 2009 #permalink

Indeed Meg, it could be construed also as to say that if you exercise you might be motivated to become a fat cat rich bastard with a college degree.

One thing to remember.... You aint going anywhere without that sheepskin fella. So how about this, all you slovenly pigs need to exercise so that you will be motivated enough to do something with your life rather than sit around and listen to class warfare/warfear diatribes and believe that its all a Republican plot. It also means that Republicans are smarter and richer... Come on in for the big win.

That way multi-millionaires like Franks and Dodd can tell you one thing and then do another. Then you'll be smart enough to go the other way and make some real cash.

By M.Randolph Kruger (not verified) on 23 Mar 2009 #permalink

There is a lot of different things going on in a study like this but denying the obvious correlation is not being helpful. People without college degrees are in far less control of their time (even when college educated people work the same as those with a HS education they have more control over WHEN they work) and thus less able to schedule regular exercise. Less educated people generally have less money so they also have less control over their time in providing the necessary domestic labor (they cannot choose to pay for stuff they do not want to or have the time to do).

The lack of control of lives is a pick part of why less educated and to some extent less well-off have negative health effects. Lack of control is highly correlated with stress and stress further correlated with adverse health results.

If you cared about people you would care about this correlation. If you did not you would conveniently try to change the argument and start blaming individuals.

By floormaster squeeze (not verified) on 23 Mar 2009 #permalink

Are these adjusted for age? there are better examples of economic inquity and health than a simple bivariate presenatation of something that involves multiple mediating/moderating factors.

Rich: Yes (as noted). Directly adjusted to the US pop in 2000. There are certainly better, but this is the Quickstat that CDC just presented in MMWR and I made an observation about it (an observation that CDC did not make).

Is this corrected for people whose *job* is physical? Spend all day digging ditches or paving roads and you probably won't exercise for "recreation".

I'm not sure you can extrapolate to income inequalities from this study (if indeed that is your intention by your introduction). Regardless of one's theories of wealth distribution within populations - health is not transferable. While a person might work for an hour and give the proceeds of his or her labor to someone else, one individual cannot exercise for 30 minutes on behalf of another. Here the correlation between education level and exercise suggests that educated people have learned that exercise is good for you. And that educated people are better at turning this knowledge to action. But then aren't educated people better at putting ALL of their knowledge to use, since they have more knowledge?

I suspect that even with our less than ideal elementary and primary education system - just about everybody knows that exercise is good for you. Is the solution more universal higher education - or mandatory exercise for those with high school diplomas or below? Perhaps better health and physical education at the public school level? Are we failing here?

If it is a difference of personal motivation - can people be forced to be motivated?

By Tom in Iowa (not verified) on 23 Mar 2009 #permalink

I think that the "effect" of education (of course correlation is not causation) seen here has much less to do with education per se and much more to do with the class status of people who do attend college. I think that revere's point is that, as income inequality has spread, so too have the differences between the well-off and less fortunate in other areas of life, such as health behaviors and outcomes. Even if someone knows that physical exercise is good for them, as floormaster squeeze points out, the ability to turn that knowledge into something actionable is much more difficult for the less affluent.

Socioeconomic status has a similar effect on obesity at least among whites and especially among females. There are strong socioeconomic effects (using education or income) on predicting obesity, at least using BMI as an indicator.

I agree with floormaster squeeze. It is hard for people who have professional degrees to understand that many people, besides not having the extra money to join fitness clubs and not having safe places to walk, also do not have autonomy over their time. Being able to have an early-morning run or an early-evening trip to the gym suggests that a person's work hours are somewhat regular or possibly that no one will care if that person arrives a little late for work or leaves a little early to go exercise.

Furthermore, if someone can afford to have a nanny, a cook, and a housekeeper, that person does not need to spend a lot of time with child care, cooking, and cleaning, three things that would eat into exercise time for many ordinary folks.

Where I live, the governor's wife came to the local country club and said something along the lines of "If my husband can find time to exercise, anyone can." She completely ignored the fact that her husband can pretty much do what he pleases when he pleases.

The biggest drop, in the category "high school equivalent", is likely the lowest echelon of people with employee provided health insurance. As the cost of this insurance becomes a larger and larger percentage of payroll, people in this category have been forced to work more and more hours in order to qualify for benefits.

Health insurance or exercise? I think most of us would choose to keep our health insurance, figuring we'll carve out some time for exercise somewhere.......