"The research of Lucie Kalousová: does poverty shorten life?"
Why is the population healthier in some countries and weaker in others? Which is worse for our health — prosperity without stress, or poverty and modest means? Why do poor people in the USA live on average ten years less than the rich, while in the Czech Republic this difference between the two groups is only slight? Lucie Kalousová, a laureate of the 2019 Neuron Award, explains in an interview for the magazine Téma.
Lucie Kalousová works as an assistant professor at Vanderbilt University in Nashville in the USA. She has focused her research on the relationship between social inequality and the health of the population in developed economies and in developing countries. And she studies how a whole range of factors from health care and genetic disposition to education or income influence the health of the population. In an interview for the magazine Téma she explains the results of her research. We summarise the most interesting parts of it.
In which countries is the gulf between the health of the poor and the rich greatest?
The greatest differences in health between the rich and the poor are generally in those countries where few public services function and people have to pay dearly for basic needs. In the USA, for instance, the differences in the quality of private and state education, health care and the environment in rich and poor neighbourhoods are enormous. Investment in public services — those we all share — such as city parks or state schools is minimal in many parts of the country and is not set at national level. Too often the state cuts spending in areas that have long been underfunded anyway.
The differences in health between the poor and the rich are far smaller in Sweden and the Netherlands. Why is that?
Besides a market economy, these countries also have a strong government that provides citizens with health and social care in a way based on the principles of solidarity and equality. All citizens have access to quality health care, regardless of their social status or income.
How is it in developing countries such as India or the poor African states of Somalia, Sudan and Ethiopia? Does a country's prosperity influence the health of its population?
There is a lot of research showing that the state of a country and the health of its population are closely connected. For instance, a study published in the journal The Lancet found that people living in countries with a low gross domestic product (GDP is the final total monetary value of production and services in a given period in a given territory — ed.) are more likely to die at a young age than people living in countries with a high GDP. The study also found that people living in countries with a low GDP are at greater risk of being affected by chronic diseases such as heart disease, cancer and diabetes.
Your studies show that even in the Czech Republic the differences in health between the poor and the rich are not so great. Why is that?
It is true that they are not as great as in some other countries. That is for several reasons: for instance, thanks to the fact that the Czech Republic has universal health insurance, which means that all citizens have access to health care. Another reason is that the Czech Republic has a relatively strong social system that provides support to people on low incomes. It helps with social benefits and contributes to housing and education. But it is also important to mention that among men the differences are considerably greater than among women.
How do you mean?
If we compare, for instance, men with a university and with a basic education at the age of 25, then for the university-educated we expect them to live on average another 56 years or so, whereas for those with a basic education we assume they will live only about 42 years. Among women the differences are smaller: for the first group it comes out that they will live another 59 years, and for the second 54 years. That means that the lifestyles of the two groups of men mentioned differ more markedly than the ways the same two groups of women live.
You have found that poorer people live to a lower age. In your research you state that in the USA this difference is as much as ten years. Why is that?
It is for several reasons. Firstly, they have worse access to health care, because their chance of paying for health insurance is smaller. And if they do have insurance, it is often of lower quality than that paid for by the rich. That means poorer people do not get to preventive care and treatment for chronic diseases as easily as their well-off fellow citizens.
What are the other reasons?
Poorer people live in a less healthy environment and often in areas with a high level of pollution of air, water and soil, which can lead to a range of health problems such as respiratory diseases, cancer and heart disease. Besides that they usually have fewer opportunities for exercise, because where they live there tend not to be as many parks and sports facilities. Without exercise they can quickly arrive at obesity, diabetes and other chronic diseases.
"The Neuron Award is a joy and an honour for me that will motivate me to further work in the future too. It is also valuable proof for me that the Czech scientific community values interdisciplinary research that tries to contribute to solving complicated social problems located outside laboratories."
— — Lucie Kalousová, Ph.D., M.A., laureate of the 2019 Neuron Award for promising scientists —
What share in a person's health do their genetic dispositions have compared with the socioeconomic aspects that determine their status?
Both genes and social factors decide how our health develops. Genes play a more significant role in cases where the question is whether someone will develop some genetic disease such as anaemia or cystic fibrosis and so on. Social aspects influencing health, on the other hand, are more fundamental in cases where chronic diseases of civilisation such as diseases of the heart and blood vessels or diabetes might develop. A study published in the journal Nature found that genes are responsible for about twenty per cent of the health problems that appear in the population. The remaining 80 per cent of illnesses are caused by social aspects that influence health — such as income, education and access to health care.
Education, income and the place where we live — does any one of these three social factors have a more fundamental influence on our health than another?
All three of the factors mentioned are closely connected. Education gives people information about health and a healthy lifestyle. Income allows access to healthy food, shelter, water and transport. The place where we live is important because it influences the level of pollution, noise and violence we are exposed to. People with a higher education have better access to information about health, a healthy lifestyle and health care, and are also more likely to have a job that provides them with health insurance; at the same time they get to healthy food, shelter and transport more easily. And conversely: people living in poorer areas are exposed to a higher risk of exposure to pollution, noise and violence. They are also less likely to get easily to healthy food, quality housing and transport.
Edited and abridged. The article appeared in the magazine Téma on 25 August 2023 — text by Pavla Matějů, Téma newsroom
