March 27, 2008 — Vol. 43, No. 33
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GBH series to explore social link to sickness

Victoria Cheng

There’s a hierarchy implied in the traditional toast to health, wealth and happiness. As the first item on the list, health is set up as a prerequisite for the latter two. Economic and emotional well-being cannot be attained, according to this adage, without basic physical well-being.

But in a strange reversal, the United States — the single wealthiest country in the world — suffers from an egregiously long list of poor health outcomes. It has, for starters, the highest infant mortality rate, the highest child poverty rate, the highest teenage birth rate and the highest number of people living alone of any industrialized country.

“Unnatural Causes: Is Inequality Making Us Sick?” — a four-hour documentary series premiering tonight on WGBH — does not seek to rehash this litany of statistics. Rather, it asks another, potentially more profound question: Why?

Why do so many Americans suffer from poor health when this country spends a mind-boggling $2 trillion a year on medical care, an investment that accounts for almost half of the health dollars spent the world over?

Why are low-income individuals 50 percent more likely to suffer from heart disease than individuals in the highest income brackets?

How is it possible that Latino immigrants arrive in the U.S. in better health than the average American, yet see their health decline the longer they live here?

While the U.S. is the only industrialized country in the world without universal health care, series co-executive producer Llewellyn Smith notes that causes for illness run deeper.

“‘Unnatural Causes’ took us to deconstructing our very ideas about health in society,” he says. “Many believe that being healthy is as simple as making smart choices: exercising, eating well, taking a vacation every so often to reduce stress.”

But, adds Smith, who also runs a film production company in Brookline, “when we look at populations and entire communities, you begin to see that there are larger forces at work beyond what an individual can control.”

“Here in Boston,” for example, “research shows that people in Louisburg Square [in the Beacon Hill district] live 10 to 15 years longer than folks in some parts of Dorchester and Roxbury — and we have to ask ourselves why. It’s not simply a function of genes or better health choices.”

Poverty, employment insecurity and racism take a physical toll on the body, according to “Unnatural Causes,” revving it into a constant and punishing state of stress. These factors are known as the social, as opposed to the biological, “determinants of health.”

In other words, as Smith narrates in the first episode, “Written into our bodies is a lifetime of experience shaped by social conditions even more powerful than our genes.”

To reinforce this argument, the series marshals a wealth of research and statistics, convincingly articulated by experts with impeccable credentials from academic institutions like Harvard, UCLA and the University of California-Berkeley. A host of officials and researchers from public health departments and community health organizations further ground the testimony in data and insight gathered from decades of field experience.

Most gripping, however, is the way in which the array of statistics and research is channeled through accounts of how individual Americans live — these personalized, humanized accounts make for compelling, and convincing, television.

“The biggest challenge was finding the stories to illustrate the data findings,” Smith says. “But we had great producers, almost all of whom are here in Boston … we had Latino producers, Native American producers, Asian producers, black producers. People wanted to tell their stories.”

In the series’ first episode, viewers are introduced to four individuals in different income brackets, from an affluent executive earning “well into the six-figure range” to an unemployed mother of three who suffered a heart attack in her mid-40s.

“Unnatural Causes” follows them into their homes and to their places of work; through footage of them playing with their children, buying groceries and driving to night class, we get a sense of what their lives are like and how they are affected by their socioeconomic status. The camera catches every detail, from the fabric of the couch to the size of the driveway, and the individuals themselves speak candidly about their lives, all with a degree of intimacy that even the most reality-television-addled viewer will realize is a privilege to watch.

As one expert says in the series’ first hour, “It’s not as if we don’t die. We all die. The question is: At what age? With what degree of suffering? With what degree of preventable illness?”

Our encounters with, and growing attachment to, the people we meet on the screen generate an understanding that answering such questions is not simply a matter of crunching numbers and quoting new statistics; it is a matter of helping people we care about, whose lives are integrally intertwined with our own.

“Unnatural Causes: Is Inequality Making Us Sick?” premieres tonight at 10 p.m. on WGBH 2, with the debut episode re-airing several times on both WGBH 2 and WGBH 44. For airdates and more information, visit

“Unnatural Causes: Is Inequality Making Us Sick?” — a four-hour documentary series created by Larry Ademan (left) and featuring co-executive producer Llewellyn Smith — premieres on WGBH 2 tonight. It considers the complicated answers to a simple question: If the U.S. is the world’s richest country, why is health care poor for so many? (Annette K. Beecham photo)

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