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Comment by yummyfajitas | Hacker News Reader

A black man in Harlem is 4.11 times as likely to die in a given year as the average American male.

This fact brings to mind an anecdote illustrating the fact that people have no clue about relative risks.

While jogging, I passed by a protest near Harlem Hospital. Signs mentioned this death rate disparity. I asked someone what the protest was about, and was told that they wanted more funding for the hospital.

Most of the protesters were sitting on lawn chairs, smoking, and eating fast food. Many were obese, few were of healthy weight. They didn't seem to realize that running in circles around the hospital would do far more to reduce the disparity in death rates than any amount of funding.

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I'll see your anecdote and raise you a couple of years of experience.

I've worked as an ER nurse for 15 years in over 30 hospitals in 5 states. A lot of that work was contract work in hospitals in poor neighborhoods that had a lot of trouble staffing their departments. I now work in a very, very nice upper middle class neighborhood in Silicon Valley.

Absolutly, unequivocally I can say that if you're sick and want the best medical care, go to the hospital in the neighborhood where the rich people live. The difference in care is night and day. Well to do hospitals have patients with private insurance that pay a lot more than Medicare or public health insurance. They also tend to expect more from their medical care, and are usually a lot more educated and can be more proactive in their care.

One ER that I worked at in Chicago, I drove past a funeral home. And almost every single shift, there was a group of kids standing on the street corner outside of the funeral home "tipping a forty" for a friend that had just died.

I've worked in ER's that were so overcrowded, that when a patient died, we'd have to shove the body into a dirty utility room to make room for patients we could still help. That would * never * fly in a rich hospital.

In poor neighborhoods, people are used to dying young. They are used to the crappy care that's given them, and yes, they tend to have a lot more lifestyle diseases.

But, why do they have more lifestyle disease? In Silicon Valley, I can go to my local farmers market, and I can afford to spend money on organic produce. When I didn't have a car, and lived on the edge of the ghetto in Chicago, it was really easy to get my calories at McDonald's down the street or get crap food at the 7-11 down the block instead of walking 12 blocks each way to the grocery store.

Poverty does kill, for many reasons. Please dont just chalk it up to "they should stop eating crap and get some excercise."

I suspect you're right that you do get better care from hospitals in better neighborhoods and that there are differing expectations, but other factors may have much larger effects that have little or anything to do with social advantage.

From a recent article on infant mortality: http://www.chicagotribune.com/news/columnists/chi-oped0823ch... "African-American babies are far more likely to die than white ones, which is often taken as evidence that poverty and lack of health insurance are to blame. That's entirely plausible until you notice another racial/ethnic gap: Hispanics of Mexican or Central or South American ancestry not only do consistently better than blacks on infant mortality, they do better than whites. Social disadvantage doesn't explain very much."

The Latino infant mortality rate differs from the non-Hispanic white one by 0.1 per 1000. This is largely attributed to methodological issues around getting appropriate records and the selection bias of immigration.

Scratch all that stuff that defines the where and the why, and just focus on the what. You eat produce: fruits and veggies. That alone is likely why you are much less likely to develop a lifestyle disease than those who chow down McD's. The fact that it is local farmers or organic produce is at best trivial, and likely is statistical noise comparatively.

I realize, searching around in the HN history, that this is a matter of identity for some people; I have no intention of starting another pro-con propaganda war regarding organic food in yet another thread. But can we at least concede that produce, regardless of its source and classification, is significantly better than a Big Mac and fries?

The last thing we need is for people to decide that, because they can't afford the high class choice in food -- which organics are -- they might as well not bother at all, because someone is going to heckle them for not caring about their health enough. Enough people, especially in neighborhoods like the ones we are discussing, can't decide that organic food is better for them than conventional food. The added cost may drive them into eating sufficiently little they start suffering from malnutrition. The McD's food might do that too, but if you're going to end up in poor health either way...

The main reason poor people tend to suffer from obesity is because it's much more expensive to buy organic vegetables than it is to buy some McDonald's. (Organic food stores don't even tend to open in poor neighborhoods.) Running around in circles burns very few additional calories; certainly not enough to deal with this fact.

If the poor are obese, they are already spending more on food than they need to be. They could simply purchase fewer big macs, right?

But I really don't buy this theory. If it were true, it would imply that graduate students should be fat too (which they usually are not). The fact is, big macs are cheaper than most other foods per calorie. They are not cheaper per meal.

Incidentally, Harlem has plenty of produce (organic and non). But (based on my anecdotal observations) it's mainly purchased by the yuppies.

Humans need calories, it's true, but more than that we need nutrients. McDonald's food is carefully processed and stripped of its natural nutrients, so that you need to eat much more of it to get the nutrients you need. It's also packed full of calories, so that it tastes good, so eating enough of it not to be malnourished requires eating a lot of calories as well.

I rarely see grad students eating at McDonald's.

That's my point: grad students are poor but eat well. There is no reason the poor can't afford the same diet as poor grad students.

A meal at McDonald's winds up costing, what, six or seven bucks? That's quite a lot by home-cooking standards. You can easily put together a nutritious meal at home for that kind of money (grilled chicken + rice + fresh vegetables, frinstance). Don't get me started on the alleged nutritional benefits of so-called "organic" vegetables over the cheap-ass vegetables you can buy at my local ghetto Safeway.

Poor people are fat for the same reason they're poor: they have a lack of self-control and are not very good at making decisions.

Or if that sounds cruel, an alternative formulation: some people lack self-control and aren't very good at making decisions, and they tend to wind up being both fat and poor.

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