ECONOMIC inequality is a matter of life and death ...

Population and mortality studies in several cities in the United States have shown that the part of town in which you are born, the well-off section or the poor part, influences how long you will live.

People born in the poor section have an average life-span of 68.1 years, while those born into prosperity live to the age of 81.3 years - a 13-year difference. How can this be?

A few years ago I met with Kate Joblin, then chairwoman of Whanganui District Health Board, after she was quoted as perplexed by the statistics that showed a similar significant disparity in mortality rates in Maori as compared with non-Maori. Following that meeting I undertook other interviews of those involved in provision of healthcare, particularly where that care involved Maori people.

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A series of essays followed that included suggestions to improve the quality of health for people of every ethnicity.

The implicit idea, valid enough in itself, was that making the health experience more user-friendly - acknowledging people by name, and introducing oneself as a healthcare person for a start - would encourage more appropriate use of the health system, with emphasis on preventive medicine and early diagnosis and would contribute to better treatment outcomes and help extend those lives.

From the vantage point of distance and a wider lens for understanding, I'm persuaded that provision of better healthcare is an important piece of the puzzle. But it's only a part. It turns out that the overarching issue, reflecting the disparity in economic status and in longevity is poverty.

Children born in poverty experience recurrent levels of anxiety similar to those exposed to the danger of life-threatening events such as war.

The violence may not be overt, may not be physical or materially recognisable, but the uncertainty of basic sustenance - of food, of habitation, of regularity of family and its support structures - creates a potentially pervasive atmosphere of violence.

Sudden, unexplained shifts of habitation, of mood in stressed parents and siblings, of overt acts of violence, of lawlessness, drug and alcohol abuse, all add their toll. The neuro-anatomic effect is the failure of normal development of those brain functions that foster delay of impulses so necessary to social development, and to structures in brain that enable planning for future, necessary for productive living in society.

Part of the violence helping to perpetuate multi-general poverty is, indeed, a by-product of the failures in adequacy of habitation. Sleeping in cold, wet, drafty houses, or worse, in a car, makes for that violence, that deep uncertainty and the physical substrates that diminish immunity, increasing likelihood of physical illness (bringing the medical care back to the picture) and inhibit the possibility of making use of educational opportunities to encourage first, an improved, personal, intellectual integrity, and second, improved problem-solving, enabling choices toward productive work life.

Clearly the effect in poverty of uncertain and poor nutrition would justify its own essay.

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The housing crisis in New Zealand, which finds our government in denial, is enhancing, not diminishing the already unacceptably high 25 per cent child poverty rate.

While realists like Westpac bankers and ANZ bankers recognise the Auckland housing bubble as unsustainable, even they are not willing to hold the government accountable for its schemes to privatise state housing, thus diminishing even more the available housing stock for the poor. Instead, our Minister for Social Housing Paula Bennett would practise economic cleansing of the poor of Auckland with a bounty of $5000 to relocate to provinces where jobs have disappeared as a result, in part, of that same government's policies.

She seems to want to assure that poor families remain in the poor part of town or country, their housing needs unmet, condemning them to a reduction in quality as well as longevity of life. Because again, economic inequality is a matter of life and death.

-Jay Kuten is an American-trained forensic psychiatrist who emigrated to New Zealand for the fly fishing. He spent 40 years comforting the afflicted and intends to spend the rest afflicting the comfortable.