« More 'Pro-Lifers' for the Health Insurance Reform Bill | Main | Dear Legislation and Cheap Politics »



Feed You can follow this conversation by subscribing to the comment feed for this post.

Patrick S. O'Donnell


Thanks for visiting and the kind words.

And of course I happily recommend your Medical Humanities blog to our readers: http://www.medhumanities.org/

Best wishes,

Daniel S. Goldberg


Great post and great blog!


The ethical implications of the social determinants of health is the center of my research and scholarship. Patrick has wonderfully captured some of the highlights in this blog, and in reference to your wondering re the health consequences of boring repetitive effects, the answer, to the best of my knowledge, is absolutely. Sir Michael Marmot, among many others, has shown robust and persistent correlations between exactly those kinds of occupational demands and deleterious health over the lifespan. Based on the evidence I am familiar with, the key factors are not so much boredom but are rather more connected to particularly high occupational stress (i.e., quotas of widgets, etc.) coupled with a lack of occupational control over one's own schedule and work patterns. These two latter phenomena have an enormous effect on health over the lifespan; an effect significantly greater, for example, than access to acute care services.

Last point is it is always important to understand that the research Patrick discusses above is not reducible to the virtually self-evident proposition that poor population health and inequities are driven by poverty. This is true, but relative deprivation matters as well. (This is the social gradient of health). Thus the GDP of an African-American male in Harlem is 26k, compared to about 7k for the average male in Costa Rica. The life expectancy for these two groups is 62 and 73, respectively.

Even those who are not in abject poverty will have their own health substantially determined by inequity and by social and economic conditions.

Patrick S. O'Donnell

[I've deleted my original response to Steve and turned it into a post above.]

Steven Shiffrin

Patrick, two points. I, of course agree that poverty is a major contributor to poor health and that the failure to consider this as a part of the general debate about the nation's health speaks volumes about our politics. I wonder whether middle class factory workers who engage in boring repetitive tasks at work suffer poorer health in the long run than those with more interesting work. I suspect they do and wonder what changes should be made to address the issue. More generally, I wonder how you conceive the differences between the left and liberalism beyond the remarks you make in this post.

The comments to this entry are closed.