A Matter of Life and Death

Cindy Casey
7 min readMar 8, 2021


Pandemic Diary Entry #80

Photo by author

March 8, 2021

The Lancet put together a commission to study the “Public Policy and Health in the Trump Era.” Their report concludes that 200,000 fewer Americans would have died if the US had treated COVID with the same level of competence as our peer developed nations.

The sad thing is America’s health has been in decline for quite a while.

This phenomenon is called stagnant longevity and in previous studies this stagnation has always been an indicator of serious societal problems.

According to the Lancet study the Trump administrations policies were not unique, they merely accelerated the decades-long trend that reflects deep and long-standing flaws in United State’s economic, health, and social policies. The ACA left “nearly 30 million uninsured” and funneled new public dollars “through private insurers whose exorbitant overhead and profits drain funds before they reach the clinic.”

America’s rising medical costs far surpass those of any other country in the world. US medical costs are now more than twice as high as the second largest spender, Switzerland. These costs are eating into America’s disposable income compromising the ability for many to satisfy their basic needs.

It is not as simple as prescribing a good diet and exercise. Research shows that taking care of ones health accounts for only 10% to 20% of one’s overall health. Social determinants, or our living conditions, account for the rest.

These Social determinants of health (SDoH) are defined by the World Health Organization as “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels”

Citing a report issued by the Journal of American Medicine looking at SDoH and other factors, Dr. Jesus Ramirez-Valles, director of the Health Equity Institute at San Francisco State University, says, the study does a good job of showing that when it comes to health outcomes, “it’s not always [immediately] about health.” He goes on to say that the study’s findings indicate a need for two broad policy recommendations: a revision of the minimum wage and a rethinking of our current taxation system, “inequality is at the bottom of this.”

A report issued by the National Academy of Science, laid out some of these various factors with more detail.

Health systems. Unlike its peer countries, the United States has a relatively large uninsured population and more limited access to primary care. Americans are more likely to find their health care inaccessible or unaffordable and to report lapses in the quality and safety of care outside of hospitals.

Social and economic conditions. Although the income of Americans is higher on average than in other countries, the United States also has higher levels of poverty (especially child poverty) and income inequality and lower rates of social mobility. Other countries are outpacing the United States in the education of young people, which also affects health. And Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages.

Health behaviors. Although Americans are currently less likely to smoke and may drink alcohol less heavily than people in peer countries, they consume the most calories per person, have higher rates of drug abuse, are less likely to use seat belts, are involved in more traffic accidents that involve alcohol, and are more likely to use firearms in acts of violence.

This disparity follows us in death as well.

Between 2014 and 2018, the United States experienced the first three-year decline in life expectancy since World War I and the 1918 flu pandemic. And yet the richest men in America live 15 years longer than the poorest men, for women it is 10 years. From 2001–2014, the richest Americans gained approximately three years in life expectancy while the poorest Americans saw no gain in life expectancy.

The reason for this discrepancy is not just about access to quality health care. Much of this is driven by what is called “deaths of despair” which has been growing since 1980. In other words this is caused by poverty.

Fatal drug overdoses for people in midlife have increased 386.5% between 1999 and 2017.

For obesity, midlife mortality rates increased 114%. Deaths due to hypertension for this same age group, increased by 78.9%. Mortality rates linked to alcohol-related problems, such as chronic liver disease and cirrhosis, increased 40.6% overall during that same time period.

For people between the ages of 25 and 34, the rate of alcohol-related disease deaths increased by 157.6% from 1999 to 2017. Suicide rates increased by 38.3% for people ages 25 to 64, and by 55.9% for people ages 55 to 64.

American’s all too often put profit ahead of humanity. In this case there is very little health in the health care system. In this rush to increase profits we are witnessing a growing gap between rich and poor. As the gap grows ever wider, so does the gap in health.

COVID has made the situation more obvious to many, but it has also exacerbated the problem. How corporations have handled the health of their essential workers has been a glaring example of how the push for riches is made on the backs of these employees and in a way that is a severe detriment to their health.

Worth $188.3 Billion Jeff Bezos is now the richest man in the world. His wealth has increased by 62% during the pandemic. He made this on the backs of his workers who’s conditions and pay are problematic and where an estimated 20,000 workers have contracted COVID.

According to the study published by the Institute of Policy Studies Billionaire Wealth vs. Community Health Bezos could have paid each of Amazon’s 876,000 employees a $105,000 bonus and would still be as wealthy as he was at the onset of the pandemic. Invested over 25 years at 6 percent interest rate, this bonus would increase to $450,000 in retirement savings for each employee

Gig workers, such as Instacart shoppers and Uber and Lyft drivers, have been on the front lines during the coronavirus outbreak. They do our shopping and deliver our food to our front doors. They taxi us around and even take sick people to hospitals.

Because gig workers are classified as independent contractors, rather than employees, they don’t qualify for company health insurance, sick leave, family leave, disability or workers compensation. While some of these companies have offered workers two weeks sick leave if they get COVID-19 or are mandated to quarantine, they do not seem to actually provide it.

While gig workers toil in tough conditions, the CEO of Instacart, Apoorva Mehta became a billionaire in June of 2020.

One can be fairly certain that many of the workers at Instacart have Tyson Chicken on their shopping lists. John Tyson saw his wealth grow by $600 million, one-half of a Billion of that during COVID. During this time an estimated 11,000 Tyson workers have come down with COVID. While Tyson threatened to close their plants, placing a full-page ad in The New York Times, they never closed a single one. Instead, they increased line speeds and increased exports to China, while making record profits and putting tens of thousands of workers’ lives at risks.

The Kroger grocery conglomerate has a net worth of around $40 billion, with $1.7 billion of that accruing since the beginning of COVID. And yet they closed two stores, a Ralphs and a Food 4 Less, citing the City of Long Beach’s new law requiring some grocery retailers to give workers a temporary $4 an hour pay increase during the pandemic. They cited lower profits as a reason, and yet Trader Joe’s announced it would increase a “thank you” pay bump for all hourly, non-management workers by $4 an hour during the pandemic.

Dollar tree has been in the news for a variety of attacks on their employees, including one murder, who were trying to enforce mask wearing by patrons. Their stores are understaffed, and have very little security. Their CEO Gary Philbin makes 690 times his median paid worker and CEO Todd Vasos of Dollar General is paid 824 times his median paid worker.

This burden is not shared equally across race or sex. People of color, particularly Black workers, are overrepresented in many essential occupations. Essential workers are overwhelmingly female, and nearly a quarter live in families struggling below the poverty line.

What all of this research and studies point to is that health is not just a matter of having access to health care. Poverty and inequality are now helping to determine your health and your life span. What can we do about it?

It is time to close this egregious gap in wealth and health in America. We need to be looking at policies that provide a living wage, examine the serious burden of student debt, as well as, the lack of affordable housing and expanding workers rights.

This is not just about individuals. Researchers estimate that the racial wealth gap has cost the US economy $16 trillion since 2000. If the gap closed today, the GDP would see a $5 trillion boost in the next five years. Inequality stifles growth. It also makes you sick and kills you.

Trivial Things

San Francisco weather: 54 degrees and cloudy

NYSE DOW compared to one year ago: +6520

COVID cases in the US: 29,698,246

Deaths from COVID in the US: 537,854

Vaccines administered in the US: 90,351,750

OED word of the day: sister — A woman or girl considered in relation to another person or other people, as the child of the same parents; a female sibling. More generally: a woman or girl who has either parent in common with another sibling; a half-sister. Also as a form of address. (The female counterpart of brother n. 1a)’]

Days since Shelter In Place was initiated: 364

Reading: Between the World and Me by Ta-Nehisi Coates

My Black and White Picture of the Day

Something Silly From the Internet:



Cindy Casey

My travel blog www.PassportandBaggage.com and my www.ArtandArchitecture-sf.com blog are quiet due to the Pandemic. I need to write, so here I go.