Cooperation needed to close social divide for better world

Socioeconomic inequality is among the greatest ills of modern society. Disparities in health, education and crime share a common root. Our collective ability to close this great divide is a prerequisite to peace on earth. We must re-imagine our role in society as co-producers of a better world, not simply as competitors for personal gain.

Among the 34 Organization for Economic Co-operation and Development countries, the United States recently ranked 26th in math, dropped to 21st in science and 17th in reading. In contrast, according to most ranking agencies, the majority of the world’s top-ranked universities are American. The problem, said a Finnish educator who recently lectured in Hawaii, is that although the United States is home to outstanding innovation and excellence in education, these treasures are not uniformly accessible.

Last month, the United States Health, Education, Labor, and Pensions Committee, Subcommittee on Primary Health and Aging held a hearing, "Dying Young: Why Your Social and Economic Status May Be a Death Sentence in America." The meeting was held to understand the link between poverty, decreased life expectancy and increased rates of chronic disease. One researcher, Dr. David Kindig, spoke of the association between poverty and poor health outcomes. He asserted that while health insurance is necessary for health, it is not the most essential factor. Instead he reported that good health, longevity and quality of life are shaped largely by socioeconomic and behavioral factors.

Health care reform is focused on creating access to quality care delivered with cost efficiency, but this assumes that those without current access can and will now avail themselves. The Affordable Care Act also sanctions Medicare to contract with accountable care organizations made up of hospitals, primary providers and specialists to assume collective responsibility for large populations in an incentivized effort to improve clinical outcomes. Among the greatest challenges are those who do not utilize a primary care doctor and instead repeatedly present themselves to the emergency department for costly hospital readmissions. The toughest patients often carry a dual diagnosis of mental health and substance-abuse disorders and need far more than health care reform alone could ever deliver.

By default, the penal system shares this burden. In fact, studies have shown that more people with severe mental health diagnoses are in prisons than in hospitals. Data also continue to confirm that people of color are arrested more often and serve longer prison terms for the same crime.

Likewise, our local criminal justice system incarcerates Native Hawaiians at a disproportionate rate. Year to year, Native Hawaiians compose as much as 40 percent of the jail and prison population in the state. In addition, Native Hawaiians and other Pacific Islander adults have twice the risk of developing obesity and diabetes compared to the rest of the population.

The perspective that we are co-producers rather than staunch competitors is articulated by the Slow Food Society, an international organization established in Italy in response to the first fast-food restaurant in that country. Slow Food emphasizes the relationship between what we eat and its impact on health, culture, politics, agriculture and the environment. We are all co-producers, and through our food choices we can collectively influence how food is cultivated, produced and distributed.

The spirit of living life as a co-producer can travel all the way up and down the food chain literally and figuratively, and as a socioeconomic strategy begin to heal the great divide. At a recent gathering of the Slow Food Society at Town restaurant, Paul Reppun of Waiahole Taro Farm and Poi Factory and Ed Kennedy, owner and chef of Town, spoke about their experiences when they represented Slow Food Hawaii at Tierra Madre, an international gathering of Slow Food co-producers. As co-producers, we work to shepherd the land and the water and to preserve the culture that has kept people well for generations. Co-producers create jobs for farmers, grocers, restaurateurs, drivers and carpenters and have the capacity to heal disparities in health, education and crime.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.