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Tuesday, June 7, 2011


I would like to introduce you to my friend Oscar.  Upon first glance, you will see a rugged, aged man, his thin frame always covered in clothing a size too big for him.  Most of his teeth are missing, and those that remain are black and jagged.  Long thin gray hair and an untrimmed, wiry beard frame his weathered face and watery hazel eyes.  Although he is only 51, most would guess him to be in his 70’s. Oscar lives in the outskirts of society.  He is homeless, poor, and has little formal education. Life has been this way for Oscar since birth.  He grew up in a disadvantaged home, the child of parents who had also been poor their entire lives. It probably does not surprise you to find that Oscar is also sick.  He suffers from heart disease, high blood pressure and a blood disorder that causes extreme fatigue.  What may surprise you, however, is that Oscar is not sick simply because of the lifestyle he leads, the choices he has made, or because he has no health insurance.  Oscar is sick because he is poor.
Arguing effectively that wealth and health are related and that being poor actually causes one to become sick is very difficult in 2011.  Health care reform has been in the front of political agendas in the U.S. for the past decade, with no apparent solution in sight.  The pundits have approached the debate of reform from the economic standpoints of big business profits, pharmaceutical contracts, health insurance plans, and an attack on our fast food driven dietary habits.  These arguments have been led by respected experts in the field of medicine, and lobbyist protecting the well lined pockets of those who stand to lose or gain large amounts of money.  Produced in 2008 by California Newsreel with Vital Pictures, and presented by the National Minority Consortia of public television, “In Sickness and in Wealth,"(part one of the seven part documentary Unnatural Causes), argues quite effectively that genes, behavior and medial care are not the underlying precipitates of health.  Instead, the film proposes it is the social, economic and physical environment in which we are born, live, and work in that determine our overall health and longevity.  The film succeeds in its exigence by providing thorough counterpoint, an intentional reversal of racial and class stereotypes, and direct human examples to represent numerical statistics and correlations. Click here for Documentary Web-site and ordering information
”In Sickness and in Wealth” begins by providing its viewers with statistics stating that while the U.S. ranks first in the world in terms of overall wealth, it ranks 30th in overall health.  While recognizing that diet, exercise and health insurance can improve one’s health, the film states very clearly from the beginning that one's wealth is the number one determining factor of one’s health. Using biological twins who lived together until early adulthood but went on separately to live in different economic classes, the film tracks the health of the disadvantaged twin and their rather steady health decline. Another in-depth study that was featured focused on the city and suburbs of Louisville, KY.  In this study, a geographic map of the 25 Districts of Louisville was created to indicate by color the wealth of each district.  Several more maps were generated, this time reflecting by color the geographic incidence of health issues such as heart disease, cancer, diabetes, and immune deficiencies.  The maps even went so far as to track deaths, determining excess death and predicting life expectancies.  The study found with very clear, defined results that the wealthier the district, the healthier it’s residents.   The film then continues by presenting the biological and medical causes for this now established argument of the correlation between health and wealth.  Taking the Louisville study to the next level of detail, the researchers went to the city’s main hospital.  The Chief Director of the hospital was a resident of the city’s most affluent District.  Stepping from the top and walking down the economic class ladder (and corresponding residential Districts), the researchers then studied people who worked at the hospital in jobs that mirrored their social level in society.  This included the Chief Director of the hospital mentioned earlier, an ER nurse, a lab assistant, and so on and so forth all the way down to the man who cleaned the hospital bathrooms.  One would assume that the man at the top with the highest demand job had the most stress.  This study proved that to be incorrect.  The highest levels of stress hormones were found at the lowest rung of the social ladder, (and lowest paid position) and these levels of stress actually decreased all the way to the top, where the lowest level of stress was found to correlate to the highest paid position.  This study was compared to a study done in the 1980’s, evaluating stress hormones of dominant monkeys and their clans.  Its findings revealed that the dominant alpha monkey had the highest demand role in the group, yet he had the least amount of stress hormones in his body.  The documentary concludes by stating that it is the individual lack of control a poor person has over his life, specifically in regards to education, income, social policies and the ability to make individual choices, that causes the release of the stress hormone cortisol from the adrenal gland.  Long- term release of cortisol has numerous denigrating effects on the body, eventually causing poor health.
One of the most effective rhetorical strategies “In Sickness and in Wealth” uses to defend its exigence is counterpoint.  In classical rhetoric, counterpoint is the presentation of potential opposing arguments or opinions in order to squelch any doubts on the part of the reader, or in this case, the viewer.  Counterpoint is used in this documentary in the proffering of the gradient scale of health and wealth in London, England.  This scale indicated that just like in the U.S., health and wealth are directly proportional.  What is most relevant about this finding is the emphasis that is placed on the fact that everyone in England has equal access health care, yet this access and opportunity for care did not affect the participant’s health.  The poor were still far unhealthier and far more likely to die young than the wealthy. This use of counterpoint is a very effective strategy by the filmmakers as it presents a direct rebuttal to the opinion most commonly expressed by the mainstream media and elected politicians that the poor in this country are sick because they often have no health insurance and have unequal access to health care. This use of counterpoint leaves the audience questioning all that they have been told by the mainstream media and politicians.  It also incites a desire to research alternative forms of health care.
“In Sickness and in Wealth” also uses a very intentional reversal of stereotypical roles within class and race. This reversal of roles catches the viewer off balance, causing us to take a second look and listen more intently.  This strategy is unspoken, and successfully completed visually in the film; a silent yet powerful strategy. For example, all of the sociologist, medical doctors and scientist presenting the studies and statistical findings in the film are either female or black.  Both of these qualities place them in a minority group typically known for its lack of power and as victims of unequal treatment. Instead we see them in this documentary as the powerful, highly educated leaders of society. The disadvantaged poor, who are commonly stereotyped as lazy, unwilling to work and making poor dietary choices are represented by a hard working Caucasian, who is shown volunteering for the local museum, and grocery shopping for milk, vegetables and other healthy staples.  This strategy appeals to the pathos, or emotions of the viewers. Could what we have come to accept as true instead be false?  If the poor and disadvantaged are not what we conceptualize them to be, could they, in turn, someday become us? This loss of equilibrium is somewhat unsettling to the viewer, and is a persuasive way to dispel some of the stereotypes that may be held of the poor, of blacks, and of women.
Documentaries often are presented with the difficult task of including graphs and other statistical information that were intended to be read from the written page unto the moving format of the film genre. This is most frequently done in such a way that the viewer overlooks, or at best takes in and then readily forgets the presented information.  “In Sickness and in Wealth” uses the necessity of including statistics as an opportunity to connect the viewer with real human beings who are living, breathing examples of the very numbers the graphs and charts are attempting to represent. For example, in the study of Louisville, KY that was previously mentioned, rather than just presenting the color-coded maps of socioeconomic classes by location, the film introduces the viewers to an actual resident from each of the Districts.  We meet their family, learn a little of their past, and see their homes.  Each of these “statistics” now has a name, a face and a story.  The viewer continues to connect with these names and faces as we meet them again at the City Hospital, this time as the very employees presented in the study about stress levels in higher and lower end jobs.  The “working poor” is no longer the second to the bottom rung on a poorly digitized image of a socioeconomic ladder, but instead he is Corey, the janitor at the City Hospital who lives in District 7, has a teenage son, lost his mother to cancer, has hyper tension, and had to save for three years just for a three day bus-ride vacation with his wife.
This use of replacing a statistic with a real human that has a story to tell is a very successful rhetorical strategy on the part of the filmmaker.  The statistics “as-is”, without the human connection, appeals to the logical reasoning of the viewers.  Are the poor really sicker than the wealthy? Yes, and the numbers prove it. However, proving something to the viewer and inciting a reaction from the viewer that may lead to an active response, are two very different things.  The creation of the connection between the viewer and the actual people the numbers represent appeals to the viewer's emotions, lighting a fire within that might spread to further discussion, or even activism. Although the filmmaker never actually suggests that the viewers become involved in health care reform, he does in fact leave us with the notion that it would be unconscionable to continue the way things are.
Reversing the effects of being poor and being sick would require a reconfiguration of our very societal organization.  This is a task so monumental it almost seems impossible.  Yet, “In Sickness and in Wealth” does an outstanding job of appealing to its viewers through its use of thorough counterpoint, intentional reversal of racial and class stereotypes, and direct human examples to represent numerical statistics and correlations.  There are many, many Oscars and Coreys in this world. They are poor, and they are sick because of it.  


  1. Do you think that education can change this....what type of education did the poor have in the documentary? If they knew how to stay healthy even though they were poor (basic things like exercise/eating right etc) would it have made a difference? I say yes it would!
    As a pediatric nurse I take every opportunity to educate my kids and their parents on leading a healthy life - not smoking around the kids, wearing seat belts, eating healthy, exercise, etc etc....some of our poor youth who are young parents are not equipped to care for their children. I see baby bottles with pop in them, chips for dinner, McDonalds 4 and 5 times a week - they don't know how to shop, how to cook, or where to go near their homes for fresh foods. Have you noticed that Walgreens now has fresh fruit and veggies???
    In my opinion, it all has to do with education, not necessarily wealth. Although, the two do go hand in hand sometimes!!
    We ALL need to do a better job of caring for ourselves and each other.
    Thanks for your thoughts!!

  2. the structure of the paper is excellent. the only issue that i saw was the last two paragraphs seemed argumentative, and the paragraph where you are humanizing statistics needs to state the effect that this rhetorical technique has in its audience. Andrew