Although we don't have permission to discuss it, Americans live in two different health worlds depending on their race, social class, and the region in which they live. These differences are unmentionable--funny even--and they determine life, health, and death.


The Stanton Peele Addiction Website, November 30, 2010. This blog post also appeared on Stanton's Addiction in Society blog at

Living and Dying in America - Two Different Worlds

We're not allowed to discuss--perhaps even to believe--there are social class differences in the United States. To paraphrase Hemingway: "Yeah, people in lower economic classes are different; they have less money." Ha-Ha!

Yet these differences determine much about how you live--and how soon you will die. But it's about more than that. The November 28th Newsweek cover story was "The Dinner Divide: How Our Foodie Obsession Is Driving Americans Apart." It's about how people in places like Park Slope Brooklyn obsess about every morsel they put in their mouths, purchase organic and homegrown veggies, and would never touch junk food or go to McDonalds.

Despite the fact that we read about foodies all the time, most Americans aren't like that. Oh, a fair number shop for low-fat foods, but that's a passive supermarket activity. And another substantial proportion think only of putting good-tasting calories in their mouths. These attitudes and approaches are not about food and eating, they reflect whole sensibilities and outlooks on life.

The results? A lot of Americans are obese, but some are more obese than others. Four of five African American women are overweight or obese. It's 80% for African-American women, 72% for Latino women, 58% for White women.

There are substantial social differences between fat and non-obese white women. If you walk through Manhattan, you are impressed by how thin many-most people are; you don't get the same impression walking through Southern-Midwestern cities. Here are the ten fattest American cities: Corpus Christie, TX; Charleston, WV; El Paso, TX; Dallas, TX; Memphis, TN; Kansas City, MO; San Antonio, TX; Baltimore, MD; Houston, TX; Birmingham, AL. (Catch the pictures of the fattest cities at the Hip Hop Wired Web site - funny - huh?)

These differences entail a lot of misery, health problems, and premature death.

I have reviewed in PT how, the lower people's education and income levels, the more likely they are to smoke, the less likely they are to drink. People are inclined to respond: "See, better-off people have their own unhealthy weaknesses," meaning they drink too much. They don't. College grads are the most likely to drink, the least likely to binge drink; they are the least likely to smoke .

It's almost as though people are choosing between smoking and drinking--and where you are placed socially determines which choice you make.

Okay, we can ignore these differences. I mean, so what if the five least healthy states (according to the United Health Foundation) are: Mississippi, Oklahoma, Alabama, Louisiana, South Carolina? Who cares? And we can make jokes about where these five states rank in terms of moderate drinking : Mississippi (#47), Oklahoma (#43), Alabama (#46), Louisiana (#42), South Carolina (#40). Here's how these same states rate in terms of obesity: Mississippi (#1), Oklahoma (#6), Alabama (#2), Louisiana (#5), South Carolina (#8).

All of the unhealthiest states are in the bottom fifth of social drinking, the top fifth in overweight. It's almost as though people are choosing between moderate drinking and overeating depending on where they live.

The largest cause of death in America is heart disease--the three greatest contributors to it are smoking, abstinence from alcohol, overweight. The image of a healthy person presented by Psychology Today and other publications for the educated is someone who eats well-designed meals of healthy foods accompanied by wine, who exercises, and who doesn't smoke cigarettes. That's the best you can do for yourself--if you have money and education, you will live this way and live longer, healthier, and better.