Unnatural Causes: Is Inequality Making Us Sick?

Unnatural Causes: Is Inequality Making Us Sick? is a four-hour documentary series, broadcast nationally on PBS in spring 2008, that examines the role of social determinants of health in creating health inequalities/health disparities (which the film considers health inequities) in the United States. Based on extensive research by a wide variety of academics, public health experts, and medical practitioners, the seven-part series explores how class and racism can have greater impacts on one's health outcomes than genetics or personal behavior.

The opening 56-minute episode, In Sickness and In Wealth, presents the series’ overarching themes. Each supporting half-hour episode, set in a different ethnic/racial community, provides a deeper exploration of how social conditions affect population health, and how some communities are extending their lives by improving them.

Produced by Christine Herbes-Sommers and Llewellyn M. Smith; Co-produced by Julie Crawford; Directed by: Llewellyn M. Smith

The first hour of the series presents a general framework for understanding the relevance of social determinants of health in creating health inequalities in the United States. The episode introduces the U.S.’s poor health statistics (according to the film) compared to other wealthy industrialized countries, then presents research from Michael Marmot’s Whitehall studies, which found that health status and wealth correlate on a continuous gradient from the poor to the wealthy. To understand why this gradient exists, the program looks at the negative health effects of chronic stress, and at evidence that those lower on the social spectrum suffer more from exposure to “toxic stress.” Throughout the program, these fairly academic and complex arguments about stress, class, and health are humanized through the stories of four residents of Louisville, Kentucky, from four different socio-economic levels. Through looking at the lives of a hospital CEO, a lab supervisor, a janitor, and an unemployed mother, the program illustrates how stress increases and control over one’s life decreases as one moves down the socio-economic ladder, with very real consequences for health.

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