When asked about President Trump’s insane idea to end social distancing in two weeks, Larry Kudlow, Trump’s Director of the National Economic Council, said “public health includes economic health.” I am not much of a fan of Kudlow’s thinking about the economy, but as a behavioral scientist, I have to admit that Kudlow is right; our economy has a huge impact on public health. However, I don’t think Kudlow was talking about the facts that came to mind for me.
About twenty percent of our children are being raised in poverty. Children raised in poverty are significantly more likely to die from cardiovascular disease in midlife. One reason is that living in poverty is stressful and stress promotes inflammatory processes that contribute to obesity, metabolic syndrome, and cardiovascular disease.1 Another is that poor children are more likely to live in high poverty neighborhoods that lack social cohesion2 and have schools with inadequate resources.
Then there is economic inequality. Thanks to fifty years of relentless free market advocacy by people like Kudlow, America has evolved the most economically unequal country of all developed nations. Since 1978, the top one tenth of one percent of the wealthiest in the U.S. have gone from having about 7% of all the wealth to having about 22%. Unequal countries have significantly poorer health, not just among the poorest, but among all but the very highest levels of wealth and income. Here too, the reason is stress. In unequal societies, people have more stressful interactions with people above and below them in the economic hierarchy.
There are many other ways that free market economics has harmed American’s health. For fifty years we have been told that government regulation is bad for the economy. As far back as the 1990s it was claimed that regulation costs the American economy more than a trillion dollars. And so thanks to effective opposition to regulating business, we have numerous industries that are engaging in highly profitable activities that harm public health. The tobacco industry accounts for more than 400,000 deaths per year.3 The gun industry contributes an average of about 35,000 deaths a year.4 The pharmaceutical industry’s marketing of opioids led to the more than 630,000 overdose deaths since 1996.5 The food industry markets high sugar and high fat foods to children with impunity, despite the fact that it has led to an epidemic of obesity that is, for the first time in a century, lowering the life expectancy of our children.6
Economics can also promote public health. But I doubt that Larry Kudlow had the benefits of taxing products when he said that public health includes the economy. There is solid evidence that taxing unhealthy products such as tobacco and alcohol will reduce youth use of these products and prevent addiction.7 Taxing sugar sweetened beverages also appears to reduce their consumption, although the evidence is not as good, because the sugar and beverage industries have so far limited the implementation of such taxes.
As you have undoubtedly heard, people with pre-existing medical conditions are more likely to die if they get infected. Thanks to a health care system that does little to prevent unhealthful behavior and an economic system that stresses millions of American’s we have a larger pool of people who have medical conditions that put them at greater risk if they get the Covid-19 virus. If we had an economic system that worked for everyone, we would have fewer people living in poverty, more people with health coverage, less stressful social relations, fewer companies marketing harmful products and a healthier and more resilient population.
1. Miller GE, Chen E, Parker KJ. Psychological stress in childhood and susceptibility to the chronic diseases of aging: moving toward a model of behavioral and biological mechanisms. Psychological Bulletin. 2011;137(6):959–997.
2. Sampson RJ. Racial stratification and the durable tangle of neighborhood inequality. Annals of the American Academy of Political and Social Science. 2009;621(1):260–280.
3. Biglan A. How cigarette marketing killed 20 million people. The Evolution Institute. Social Pathologies Series Web site. https://evolution-institute.org/how-cigarette-marketing-killed-20-million-people/. Published 2020. Accessed March 12, 2020.
4. Biglan A. The right to sell arms. The Evolution Institute. https://evolution-institute.org/the-right-to-sell-arms/. Published 2020. Accessed March 12, 2020.
5. Biglan A. Big pharma and the death of Americans. The Evolution Institute. Social Pathologies Series Web site. https://evolution-institute.org/big-pharma-and-the-death-of-americans. Published 2020. Accessed March 12, 2020.
6. Biglan A. How and why the food industry makes americans sick. The Evolution Institute. Social Pathologies Series Web site. https://evolution-institute.org/how-and-why-the-food-industry-makes-americans-sick. Published 2020. Accessed March 12, 2020.
7. Pechmann C, Biglan A, Grube JW, Cody C. Transformative consumer research for addressing tobacco and alcohol consumption. Transformative consumer research for personal and collective well-being. 2012:353–390.