A magic pill for poverty’s health impacts is coming. Who needs a social safety net?  

There is now a pill to treat postpartum depression. Public health professionals hope that this pill will make a dent in the nation’s astronomical maternal mortality rate, because postpartum depression is a major risk factor for maternal death.

Maternal mortality is one of a constellation of contributors to America’s abysmal public health statistics — the U.S. has the lowest life expectancy of any developed nation, and it was declining year-on-year even before COVID-19.

What if there were a pill for that?

It turns out that postpartum depression and the bad health of Americans can be pinned to very similar risk factors: low educational attainment, poverty, weak social networks and drug use. Less than half of Americans possess a college degree. So, the “disadvantaged” are the majority, and most premature disease and death is concentrated in this group.

Social inequality kills in part by exposing low-income families to toxic stress and environmental toxins. Toxic stress comes from worrying about paying the bills, how to get to work without a car and the feeling that the educated elite are treating everyone else without fairness or respect (think outsourcing high-paying jobs to robots and foreign workers). This activates the fight or flight system in the body, causing wear and tear that leads to premature aging. Lead in water or pollutants in the air — problems common in low-income neighborhoods — compound these problems.

The less advantaged die from a wide array of causes and most of these causes of death can be boiled down to rapid aging. As with postpartum depression, there may be a pill for that.

Over a lifetime, these exposures add up. Inequality contributes to more deaths and diseases in the U.S. than smoking and obesity combined. The threat begins in the womb as mothers are exposed to stress and toxins. It then slowly unfolds over the baby’s life, producing gradual wear and tear on the body that makes us grow old before our time.

Just as emergent mRNA technologies allowed us to rapidly develop a medical solution for the urgent public health threat of COVID-19, new technologies are allowing us to test the effect of income inequality on health and to identify ways of treating it.

There are two ways of dealing with this public health problem. One is to devise a comprehensive strategy to combat social inequality that will prevent disease before it happens. Another way is to develop a pill that treats the wear and tear of stress and toxins on the body. 

Believe it or not, there are experiments on such pills underway. 

Candidates include dasatinib, quercetin, metformin, rapamycin and fisetin among many others. These drugs may slow or even reverse aging in anyone, but they hold the greatest promise for improving America’s health because they disproportionately help the disadvantaged. This population bears the greatest burden of disease by far, so even small health gains in this population can go a long way.

Until recently, it has been difficult to study a threat that begins in the womb and slowly unfolds over a person’s life. Faster aging takes place over the span of decades, but we can’t study the effects of a pill or policy over that much time. Thanks to Dan Belsky, my colleague at Columbia University’s School of Public Health and the Aging Center, we now have a way of measuring the pace of aging over short periods. This innovation allows us to test a welfare policy or drug almost in real-time.

There are plenty of ideas outside of the realm of medicine for tackling social inequality. If done right, an intensive early education and parenting program could have dramatic effects on income inequality. Even more promising is a “digital identity,” which can allow people to apply for welfare without the need for extensive paperwork. Such schemes work even in very large countries with weak governments. For instance, India’s national digital infrastructure “India Stack” provides an innovative way of verifying a person’s income, providing banking and payments. It could drive down rates of poverty in the world’s largest nation.

However, social policies are difficult to enact in the face of inequality. An effective policy aimed at income inequality would treat the cause of America’s sky-high maternal mortality rates and rock-bottom life expectancy rather than treat the symptoms. But humans seem to prefer finding treatments for diseases over the hard work of prevention. Americans would much prefer a pill or a vaccine over a contentious policy battle.

Once approved, the pill for social disadvantage will treat one of its symptoms (rapid aging of less educated Americans) and not the core problem (anger, political instability and fear). We have a sense of what it takes to get the job done on the policy front today. Yet, be it for maternal depression or rapid aging, we instinctively reach for the pill bottle in the medicine cabinet rather than look in the mirror. 

As with postpartum depression, perhaps the best we can do is wait for the clinical trials to conclude and for the FDA to approve the pill.

Peter Muennig, MD, MPH, Professor, Department of Health Policy and Management. Columbia University, Mailman School of Public Health

Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Source link

Leave a Reply

Your email address will not be published. Required fields are marked *