Opinion Piece
As I’m sitting here at my childhood home penning these thoughts, I can’t help but hate today’s America.
Long gone are the days of quality manufacturing, made in America, old grain wood floors, grocery stores filled with whole foods, pension plans, and white picket fences. Today’s America is overly processed and frankly hard to stomach. It’s a bitter pill to swallow knowing that your socioeconomic status largely dictates your health and wellbeing.
Have you ever seen those memes with rich people who had glow ups? They are often captioned with, “remember you’re not ugly, you’re poor.” Unfortunately, I think the same logic for beauty being bought is now part of health, “remember you’re not unhealthy, you’re poor.”
Let’s take a look at a few examples for how health and wellness have been commoditized and quantified in America.
- Blue Zones
The Blue Zones Project was founded by Dan Buettner, where he gallivanted around the world to places where people live longer. Then he tried to figure out what the societies had in common and distill those down to a checklist based on 9 principles, which he described in detail in his book.
Then, these principles were further atomized out and repackaged into a concept of a Life Radius that could be sold to communities via public private partnerships. The idea was a checklist or a how to guide to become a “Certified Blue Zones” Community. Boiling down community wellness to box checking: get 4,000 pledges, 5 grocery stores to carry a fruit at checkout, 10 parking spots to walk further and brand, etc. Do all of these tasks and you’ve done it! You’ve created a Blue Zone.
Blue Zones may have started with some small nonprofit component, but now it’s a huge for profit brand. It’s a how to guide around health, wellness and living to 100 that is built on little science and a lot of sizzle. Capitalizing on people’s desire to live longer, a fountain of youth-esque appeal to its approach. It’s a marketing machine, but a wellness solution? Questionable at best.
One benefit of Blue Zones, is an advertising tool for communities to attract health minded individuals with more money to move in, in turn raising housing prices for the locals, gentrifying the area and skewing the health metrics.
In 2015, Klamath Falls, OR was considered the first Blue Zones Project Community of the Pacific Northwest to much fanfare. The community received the coveted certification in 2020, but 8 years after starting the work and 3 years after receiving the certification, the licensing period expired and the community decided not to renew.
So how are the health metrics in Klamath since the Blue Zones? The jury’s still out, but the most recent data has shown that life expectancy has gone down.
Moral of the story you can sell checklists, but you can’t really replicate an environment, a diet, and a lifestyle. You can preach and the choir will come, but what about the existing community?
- Social Determinants of Health (SDOH)
My grandma used to say that you can’t squeeze blood from a turnip, and I’d like to think that’s the root cause (pun intended) of a lot of issues in America today. In 2022, Medicaid represented $1 out of every $6 spent on healthcare according to National Health Expenditures data. At the same time, 61% of Medicaid recipients are working.
We’ve got Capitalism squeezing the blood out of working Americans. These workers are subsidizing the health insurance of underpaid workers and footing a bill that should fall to the corporations employing these workers.
Adults who work full-time may still be eligible for Medicaid in expansion states because they work low-wage jobs and still meet income eligibility criteria. An individual working full-time (35 hours/week) for the full year (50 weeks) at the federal minimum wage ($7.25 per hour) earns an annual salary of $12,688, below the Federal Poverty Level (FPL) for an individual in 2023 ($14,580) and the Medicaid eligibility limit of 138% FPL for nonelderly adults in states that have expanded Medicaid under the Affordable Care Act (ACA). Thus, an adult with this income would be eligible for Medicaid in an expansion state.
–Understanding the Intersection of Medicaid & Work: A Look at What the Data Say
As corporations in America have consolidated and grown in size, the burden has been increasingly shifted to workers. Whether it’s the switch from pension plans to 401ks, the move away from PPOs to High Deductible Health Plans, or in this case Medicaid, the onus has been placed increasingly upon the shoulders of Americans to pay more in taxes while receiving less benefits.
Social Determinants of Health (SDOH) are a group of metrics that essentially look at how people from disadvantaged socioeconomic groups are more unhealthy. It boils down to trying to measure why poor people have poor health. According to the US government, SDOH are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks..
America has moved to such a specialized service economy with our white collar thinkers that there are specialists spending hours trying to quantify common sense when 50 or 100 years ago these specialists might have been family farmers producing the food that kept people well. Now, they sit around pontificating on solving food insecurity. Want a read that is bordering poetic about the shift of our economy and food system in America? Check out Wendell Berry’s, “The Unsettling of America.”
According to a letter from the Center for Medicaid & CHIP Services to state health officials.
States have flexibility to design an array of services to address SDOH. However, the services and supports that states can cover tend to fall within several categories of services, including housing-related services and supports, non-medical transportation, home-delivered meals, educational services, employment, community integration and social supports, and case management.
–RE: Opportunities in Medicaid and CHIP to Address Social Determinants of Health
These are all wraparound services designed to help alleviate the woes of poverty caused by the lack of a living wage. All nice ideas, but at the end of the day who is funding them? Once again the burden of caring for others is placed onto the American workers and taxpayers.
As corporations forever look to cut costs and maximize profits, the number of underpaid, unemployed, and at risk Americans is only going to rise. Instead of hiding behind the layers of performative box checking, could we maybe just eliminate the idea of SDOH and focus on an idea of a living wage?
Wealth is Health
You can create checklists and metrics till the cows come home, but at the end of the day wealth is health in modern America.
Until you can solve the issues of a livable wage, you can’t solve the growing health issues plaguing Americans. If people can only afford in time and money, the overly processed food choices that’s what they will buy and the market will oblige. If corporations can avoid paying benefits or higher wages and turn it into shareholder profits, then they will continue to do so.
The best healthcare plan for America is an economic one.