Marco Sanchez/UCSF
When I read about the recent death of Dr. Nancy E. Adler, a health psychologist whose work was instrumental in transforming understanding of the relationship between socioeconomic status and physical health, I thought about how much modern medicine has enabled us to live longer, healthier lives. And how much we still have to learn to make this true for everyone. No matter where they live or where they come from.
It is hard to believe that just 30 some years ago the connection between your social status and your life expectancy was virtually unknown. Dr. Adler was one of the first to bring to light what is now widely accepted as conventional wisdom: that life expectancy is determined more by your ZIP code than your genetic code. And while it’s encouraging that this glaring inequality is squarely on the public agenda, it is a sobering fact that should make us all take pause.
Even in Israel, with a strong public health system, the inequalities are glaring. From severe shortages in oncology beds to alarmingly worse outcomes in rural communities, inequalities and disadvantages remain one of our country’s most formidable healthcare challenges.
One of Dr. Adler’s biggest contributions is the MacArthur Ladder. This tool remains a reliable predictor of worsened health and early disease. By asking people how they perceived their income, education and socioeconomic status on a 10-step ladder, the tool proved that self-perception of status is a meaningful, and significant, marker for life-expectancy. In a 2007 report for the MacArthur Foundation, she wrote, “Premature death is more than twice as likely for middle-income Americans as for those at the top of the income ladder, and more than three times as likely for those at the bottom than those at the top.”
It’s no surprise that our work in the Lemonade Fund proves her findings true time and again. It is why we created the Empowering the Periphery program. Today, in the shadow of the ongoing war in Israel’s rural north and south, the needs there are so much more acute. But it is encouraging that perhaps one day our work will be able to help shape policy to reverse these trends and change lives for the better.
“The grant was like life-saving oxygen that allowed us to live through such a difficult period with respect. Without needing to beg. We could hold our head high, care for our children, heal and dream about a better future.” – L., Lemonade Fund grantee from Israel’s north
Rest in peace Dr. Adler. Your legacy remains an inspiration.