Unnatural Causes: Is Inequality Making Us Sick?

There is no better time than now to take advantage of the offerings of the documentary film series Unnatural Causes: Is Inequality Making Us Sick? (Adelman, Fortier, Smith, Stange, & Strain, 2008). Health care, its reform, and related attention to health disparity is topical, and our nation is at a historical turning point with the Obama administration having identified addressing health disparity as a necessary component of providing health care for all (Council on Social Work Education, 2010). Currently, communities are provided with new investment opportunities to address health from the Patient Protection and Affordable Care Act's (P.L. 111-148) (2009) Title IV: Prevention of Chronic Disease and Improving Public Health. Unnatural Causes has much to offer those who want to have a deeper understanding of health disparity in the United States and how equity can be sought. However, it is misleading to describe Unnatural Causes as merely a film series; creator and executive producer Larry Adelman has a much larger goal, intending to "change public discourse about health" (Adelman et al., 2008). Unnatural Causes aired on PBS in the spring of 2008 and is now available on DVD from California Newsreel. The series, designed to act as a springboard for a public engagement campaign, takes on an ambitious set of seven objectives: (1) to increase awareness of health inequities, (2) to advance understanding of how social determinants of health affect health outcomes, (3) to exemplify how these outcomes are associated with social conditions, (4) to reveal how health inequities affect the entire population at various levels, (5) to effect a change from an individual way of thinking about health to a concern for holistic prevention, (6) to assess social and economic policies in terms of their impact on health outcomes, and (7) to offer promising solutions for health equity (Adelman et al., 2008). Although such dynamic aims are only partially addressed by the film itself, the Unnatural Causes Web site (http://www.unnaturalcauses.org) takes media consumers beyond the film to inspire action. In both the film and Web site, the creators present a gently balanced blend of biology, environment, social conditions, and health outcomes, giving each dimension the impartial attention necessitated by the complexities of this topic. Perhaps most important, Unnatural Causes offers hope by also looking at health equity successes and providing materials to realize community change. Unnatural Causes puts a human face on and ease of insight into the ways in which racial and socioeconomic inequality affect health from a diversity of American perspectives. This approach makes complex material comprehensible. Furthermore, the Unnatural Causes Web site goes even deeper into this content by providing a wealth of resources for those seeking to apply the information in different contexts. THE FILM This four-hour documentary consists of seven episodes, the first of which is titled "In Sickness and in Wealth." It presents an overview of themes that are explored in the six succeeding episodes. Each following episode, approximately half an hour in length, depicts personal details and specific contexts to exemplify the inner workings of how race and socioeconomic inequality affect health. Specifically, the opening episode demonstrates connections between health, race, and income by comparing a CEO, a lab supervisor, a janitor, and an unemployed mother, examining how class results in a health-wealth gradient. Here, the filmmakers define class as "access to power, resources, and opportunity" and demystify the health-wealth gradient through the everyday experiences of various individuals in their communities (Adelman et al., 2008). The second episode, "When the Bough Breaks," examines African American infant mortality rates by challenging viewers' thinking about the strength of contributing factors. Here, the filmmakers question what has more impact on birth outcomes--income and education or race. …