Spiritual_Wellness_Holistic_Health_and_the_Practic

The Role of Health Education Advocacy in Removing Disparities 323
Generally, minorities, who are among the lowest - paid, poorly educated working
class, continue to have morbidity and mortality rates higher than those who are well -
educated and well - paid. In addition, the low - paid population ’ s standard of living has
been deteriorating due to the growing inequity in income and wealth between the
upper and lower classes. Navarro (1997) reports that the lower class of the population
(40 percent) received 15.7 percent of the total income while the wealthiest of the population
(20 percent) received 42.9 percent of total income. Thus, the growing gap in
the nation ’ s health clearly cannot be understood and remedied by examining individual
differences by race and ethnicity alone.
The relationship of poverty to poor health is well established (Kawachi, Kennedy,
Lochner, & Prothrow - Smith, 1997; Wilkinson, 1997). Being impoverished, however,
not only results in destruction of individual health, but also in the social, physical and
mental decay of generations. High mortality rates for both children and adults are
directly related to poverty as well as income inequality. For example, the population
death rate in North America attributable to poverty increased between the early 1970s
and early 1990s. Moreover, the surge in the local incidence of some diseases, such as
tuberculosis in New York City, during the last decade has been linked to poverty
(Hamburg, 1993). Hence, it is not surprising to find observers such as Poland, Coburn,
Robertson, & Eakin, (1997) and Tesh (1988) arguing that the political economy is a
major determinant of health and illness.
Choice of occupation may also influence health (Karasek & Theorell, 1990; Tesh,
1988). For example, occupations that are characterized as high demand and low control
have been correlated with coronary heart disease. In addition, low - paying jobs
often involve exposure to harmful substances, require potentially repetitive motion or
entail exposure to potentially dangerous equipment and machinery, or other unhealthy
situations. Thus, improvements in occupational health should not only focus on redesigning
jobs but examine why many current work designs generally result in such an
excessive demand and insufficient level of job control.
Unfortunately, the scientific, multi - causal approach to analyzing the etiology of
diseases often does not specify the contribution of fundamental factors, such as social
condition, in the causal nexus of poor health (Tesh, 1988). Historical records support
the notion that the origins of diseases have been largely social in nature. In the case of
epidemics, what data are available suggest a clear linkage between disease and the
conditions under which people live. For example, Lantz, House, Lepkowski, Williams,
Mero, & Chen (1990) indicate that socioeconomic differences in mortality are due to
social - structural factors and that high mortality could persist despite improved health
behaviors among the poor. Similarly, Minkler (1999) has argued that while we need
not abandon concepts of personal responsibility for health, focusing on the broader
social responsibility for health is necessary if we are to improve health.
The foregoing suggests that effective disease prevention not only seeks to identify
the specific agent, web of causation, or personal actions, but also the more fundamental
political and economic causes of disease and those factors that may result in an