Health in the USA Today: What we used to have and how we can reclaim it.

Text of a talk given to the Coalition of Labor Union Women's 12th Biennial Convention in Seattle.
October 9, 2003, Westin Hotel, by Stephen Bezruchka, MD, MPH, Senior Lecturer, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, USA.

THANK YOU sisters and brothers for the opportunity to present some new ideas to you. My message is simple and can be stated briefly. We people living in the United States of America, the richest and most powerful country in world history, are sick, we die much younger than we need to. The way out of this sickness will come through organized labor's efforts as population health doctors to fight for economic justice and seeing their mission as making America healthy again.

I begin by asking you how the United States of America compares to other countries in measures of our health. To measure health let's consider average number of years lived by people in a country and use United Nations data. First note that we spend half of the world's health care budget, that is of all the money spent world-wide on medical services and public health, we spend half of that in this country. If we rank all the countries in the world using average number of years lived, where does the US stand? Are we the healthiest country in the world? If you think so, raise you hands? are we in the top 5 do we stand 6 to 10 11 to 15 16 to 20 21 to 25 below 25? The answer is that we are tied for 26th! Behind all the other rich countries.

Thomas Pynchon wrote in Gravity's Rainbow "If you can get them asking the wrong question, the answers don't matter." The question we should be asking is why is our country so unhealthy. Because health and health care sound so similar, we think the two terms mean the same thing. But they don't Labor unions should be asking. "Why are we so unhealthy?" The answer will do much more to produce health than access to all the medical care in the world. Health care, at best has only a very small role in producing health as we can see since we spend half of the world's health care bill, and aren't very healthy, so health care can't be that important.
There are some 25 countries in the world that are healthier than we are. Consider that if we won the war on heart disease and no one died from our number one killer, the condition that will put almost half of us hu know Japan has been having a recession and deflation and great economic turmoil for over 7 years. Has it hurt their health? No, in fact, Japanese health continues to improve despite economic setbacks. What has been the response of their business leaders, and managers to the economic downturn? It may surprise you that rather than laying off workers as we do, and taking pay raises for increasing efficiency, the CEO's and managers in Japan take pay cuts, rather than lay off workers. Can you imagine that in America?

As you know, union workers are facing pay and benefit cuts. In this country, we reward our CEO's by huge "compensations" despite their doing a terrible job. Around $350,000 an hour is the maximum wage in the US. Nice work if you can get it, and in America, most people believe you can get it if you try. That is the rags to riches myth which is just that, a myth. We love to subsidize the rich as our current government is doing with its tax relief programs. But you are not getting any relief are you? You, the real workers of America pay the price with lower wages, fewer benefits and shortened lives. You might ask: but surely Japan must have increasing homeless and other signs of societal distress. Yes, there are a few homeless people in Tokyo. What do people do there about them? They make shelters for them outside their homes, and bring them food to eat. COULD YOU IMAGINE THAT IN THE USA? But that is what a caring sharing society such as Japan does and what we used to do when unions had more members.

The rate of labor unionism is related to how sharing and caring a society is, and the USA has the lowest percentage a country's workers unionized. That is the reason for our poor health. So you people are our nation's hope for health as you take on the role of becoming population health doctors! The more successful you are in getting collective bargaining to advance the pay and benefits for ordinary people in this country, and the more you can create a maximum wage and a minimum wage that aren't very far apart, the more USA will be on the road to health. And we as citizens in this country will owe our health to you, whether or not we belong to a union. You will be truly population health doctors.

To Summarize: Because of the way wealth and power is concentrated in a few hands, rather than widely shared in the USA, you and I die much younger than we need to. The difference is vast, as I said, if we won the war on heart disease, and no one died from our number one killer today, we still wouldn't be the healthiest country in the world.

So what can labor unions do? You need to present the idea that increasing unionization and union strength will improve our health, regardless of whether or not we have better health plans or even universal health insurance. I'm not against universal health insurance, but it won't insure our health. As the gap between rich and poor is brought down from today's obscene levels, we will all be healthier. That is tough concept to sell, but if you can pitch joining a union to making us as a country healthier, it is a great selling tool.
I want you to become America's Population Health Doctors. Unions are the only group that can bring down our record gap between the rich and poor, by ORGANIZING, which is what you do best. Union organizers say one of the greatest challenges they face is that many workers don't want to admit they're workers because someday they may be rich and signing a union card would be an admission that good fortune will never strike, but if you point out the health benefits of organizing and of bringing down the gap between the rich and poor by signing a union card, you will literally be saving millions of lives, the equivalent of winning the war on heart disease. Your focus should be on organizing among lowest-wage workers in the private sector, both men and women, and continue the good work you are doing in the public sector.

September's issue of The American Prospect had an article about three progressive union presidents out to transform American labor entitled, ORGANIZE OR DIE. These people all see the need to focus on organizing given the lowest unionization rates in history that we have today. I think for of us in the USA, at least as far as our health is concerned, we must Organize or Die. Unions not MD's, or I should say M Deities are our hope for saving lives. It is you women out there that must give us the population medicine we need to regain our health relative to other countries. There are materials in your packet on these ideas The Coalition of Labor Union Women stands to make major inroads in pushing for increasing membership by presenting the health benefits to society of unionization. Your work for getting a fairer share of the income and benefits pie is population medicine for all of us. That produces more caring and sharing in society and our health improves. It is no secret that women do this much better than men, is it? No one has ever asked you to be a population health doctor before, have they? But that is what you have to do if we are going to live long enough to enjoy our grandchildren. I will be in the health Workshops to discuss these ideas.

Gloria Steinham said "The first problem for all of us, men and women, is not to learn, but to unlearn." So I hope it will be for you about health and health care. Mother Jones said: "mourn for the dead but fight like hell for the living". and as we do so, recall what my heroine, Angela Y. Davis, the radical leader of the 1970s, said, "We must lift others as we climb." And that is what I want to leave you with. We must organize for our health! Thank you.

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