Health Research (2)
Health Research examines the evidence that most chronic disease is preventable through addressing social determinants, environmental factors, and psychosocial conditions. The research demonstrates that health outcomes are shaped far more by the systems people live in than by individual choices or genetic predisposition -- and that OMXUS's community infrastructure directly addresses the root causes of poor health.
The Core Insight
We tolerate monstrosity when it is slow, abstract, and profitable.
A woman poisons someone with mushrooms and goes to prison for life. We respond with total moral clarity.
Yet we collectively tolerate systems that knowingly increase cancer risk across entire populations.
Same outcome for bodies. Different optics.
The difference is not moral. It is speed, visibility, and attribution.
Social Determinants of Health
The World Health Organization defines social determinants of health as "the conditions in which people are born, grow, live, work and age" -- shaped by the distribution of money, power, and resources.[1]
These determinants account for 30-55% of health outcomes -- more than clinical healthcare (which accounts for only 10-20%), individual behaviour (30-40%), or genetics (20-30%).[2]
The Key Determinants
| Determinant | Health Impact | Mechanism |
|---|---|---|
| Income and wealth | 10-15 year life expectancy gap between richest and poorest[3] | Chronic stress, reduced access, poor nutrition, housing instability |
| Education | Each additional year reduces mortality risk by 2-3% | Health literacy, employment, income, social networks |
| Employment | Unemployment increases all-cause mortality by 63%[4] | Loss of income, purpose, social connection, routine |
| Housing | Homelessness reduces life expectancy by 20-30 years | Exposure, stress, inability to manage chronic conditions |
| Social connection | Social isolation increases mortality risk comparable to smoking 15 cigarettes/day[5] | Immune suppression, inflammation, behavioural pathways |
| Food security | Food insecurity doubles risk of diabetes | Nutritional deficiency, stress, reliance on cheap processed food |
| Early childhood | ACEs increase chronic disease risk 2-4x | Toxic stress, altered brain development, epigenetic changes |
The Marmot Review
Sir Michael Marmot's landmark research demonstrated that health inequality follows a social gradient -- it is not simply a matter of the very poor being sick and everyone else being fine. Health improves continuously at every step up the social ladder.[6]
The Whitehall Studies
Marmot's Whitehall studies examined British civil servants -- all employed, all with access to the NHS, all in non-dangerous office work. Yet:
- Top grade civil servants had the lowest mortality rates
- Each descending grade had progressively higher mortality
- Bottom grade had three times the mortality rate of top grade
- The gradient persisted after controlling for smoking, cholesterol, blood pressure, and obesity
The variable that explained the gradient was control -- the degree of autonomy people had over their work and lives. Those at the bottom had the least control, the most monotonous work, and the least decision-making authority. Their bodies responded with chronic stress activation.[7]
Marmot's Six Policy Objectives
The 2010 Marmot Review ("Fair Society, Healthy Lives") identified six priority areas:
- Give every child the best start in life -- the highest priority
- Enable all children, young people and adults to maximise their capabilities
- Create fair employment and good work for all
- Ensure a healthy standard of living for all
- Create and develop healthy and sustainable places and communities
- Strengthen the role and impact of ill-health prevention
Each of these aligns directly with OMXUS design principles.
Adverse Childhood Experiences (ACEs)
The ACE Study, conducted by the CDC and Kaiser Permanente from 1995-1997 with over 17,000 participants, established that childhood adversity has a dose-response relationship with adult disease.[8]
The Ten ACE Categories
Abuse:
- Physical abuse
- Emotional abuse
- Sexual abuse
Neglect:
- Physical neglect
- Emotional neglect
Household dysfunction:
- Domestic violence
- Substance abuse in household
- Mental illness in household
- Parental separation or divorce
- Incarcerated household member
The Dose-Response Relationship
| ACE Score | Health Impact (compared to ACE score of 0) |
|---|---|
| 1 | Moderate increase in risk of depression, substance use |
| 2-3 | 2x risk of heart disease, 2.5x risk of hepatitis[9] |
| 4+ | 4-12x risk of alcoholism, drug abuse, depression, suicide attempt; 2-4x risk of smoking, STIs, cancer, heart disease, lung disease, liver disease, skeletal fractures |
| 6+ | 20-year reduction in life expectancy |
ACEs in Australia
Australian data shows:
- Approximately 1 in 4 adults report experiencing 3+ ACEs
- 1 in 6 children currently lives in poverty -- a primary ACE risk factor
- Indigenous Australians face disproportionate ACE exposure due to intergenerational trauma from colonisation, the Stolen Generations, and ongoing systemic disadvantage
- The annual cost of child abuse and neglect to the Australian economy is estimated at $30+ billion[10]
Cancer Prevention: The Evidence
Genetic vs Environmental Causes
Large-scale studies demonstrate that cancer is overwhelmingly an environmental disease:
- "Intrinsic" causes (unavoidable random mutations) account for only 10-30% of cancers
- 70-90% of cancers are extrinsic -- influenced by environment and lifestyle[11]
World Health Organization Findings
According to the WHO:
- 30-50% of all cancers are preventable using existing knowledge
- Tobacco contains 69 known carcinogens
- Obesity, physical inactivity, alcohol, diet, UV exposure, and environmental toxins are established contributors
"Prevention offers the most cost-effective long-term strategy for the control of cancer." -- World Health Organization[12]
The Broader Picture
Across chronic disease -- cancer, cardiovascular disease, diabetes, neurodegeneration:
- 40-90% of risk is linked to modifiable lifestyle and environmental factors
- This shifts the probability of never developing serious chronic disease to the 45-75% range
This is not a guarantee. It is a massive change in expected outcomes.
Psychoneuroimmunology
Most cancer prevention models do not fully account for the field of psychoneuroimmunology (PNI) -- the study of how psychological states influence the nervous and immune systems.
Decades of research demonstrate:
- Chronic stress dysregulates immune surveillance -- the ongoing monitoring that identifies and destroys abnormal cells[13]
- Stress suppresses natural killer (NK) cell activity -- NK cells are a primary defence against tumour formation
- Stress impairs DNA repair mechanisms -- allowing mutations to persist
- Stress alters inflammatory pathways involved in tumour growth and metastasis
- Psychosocial interventions can measurably alter immune parameters
Stress does not "cause cancer" in isolation. But it changes the terrain in which cancer either emerges or is suppressed.
Stress and Immune Function
Chronic psychological stress is reliably associated with:
- Suppression of both innate and adaptive immune function
- Reductions in cellular immunity (T-cell proliferation)
- Impaired lymphocyte proliferation in response to antigens
- Diminished natural killer cell cytotoxicity
- Elevated inflammatory markers (IL-6, CRP, TNF-alpha)[14]
Quality of Life Predicts Survival
Large-scale systematic reviews demonstrate:
- Baseline quality-of-life measures are independent predictors of survival in cancer patients
- Fatigue, pain, appetite loss, and functional capacity predict survival across cancer types
- Subjective experience captures biologically relevant information that clinical measures miss[15]
- Social support quality predicts cancer survival independently of tumour stage
Community Engagement and Health Outcomes
A growing body of research links community participation directly to health:
The Evidence
- Civic participation (voting, volunteering, community organisations) is associated with better self-rated health, lower depression, and reduced mortality[16]
- Social capital -- trust, reciprocity, and networks within communities -- predicts population health outcomes independent of individual-level factors
- Community gardens improve nutrition, physical activity, mental health, and social connection
- Participatory budgeting (a form of direct democracy over public spending) has been associated with improved health outcomes in Brazilian municipalities[17]
The Mechanism
Community engagement improves health through multiple pathways:
| Pathway | Mechanism | Health Effect |
|---|---|---|
| Sense of control | Agency over community decisions | Reduces chronic stress (Marmot's key variable) |
| Social connection | Regular interaction with neighbours | Reduces isolation, improves immune function |
| Purpose and meaning | Contributing to something larger | Reduces depression, increases longevity |
| Mutual aid | Practical support in emergencies | Reduces acute stress, improves recovery |
| Information sharing | Health knowledge within networks | Improves health literacy and preventive behaviour |
Why Don't We Act?
Why do we allow substances with known carcinogenic potential in our food? Why do we tolerate economic systems that produce chronic stress in the majority of the population?
Not because we need them. Not because there are no alternatives. Not because the science is unclear.
But because:
- Harm is slow
- Harm is statistical
- Harm is diffuse
- Harm is profitable
We optimise for shelf life, yield, appearance, convenience, and cost -- not for immune stability or long-term cancer risk.
The Moral Double Standard
| Fast Harm | Slow Harm |
|---|---|
| Criminalised | Legalised |
| Clear attribution | Diffuse attribution |
| Moral outrage | Normalised |
| Individual punishment | System acceptance |
| Rare events | Millions of deaths annually |
| Front page news | Buried in epidemiology journals |
Prevention Through System Design
The evidence supports conscious ecological design -- building health into the systems people inhabit rather than treating disease after it emerges:
| Factor | Health Impact | System Design Response | OMXUS Implementation |
|---|---|---|---|
| Chronic stress | Immune suppression, cardiovascular disease | Economic security | Universal resource allocation |
| Social isolation | Comparable to 15 cigarettes/day | Community connection | 60-second response, community governance |
| Food environment | Cancer risk, diabetes, obesity | Regulation and transparency | Community-voted food standards |
| Work stress | Health degradation across all systems | Meaningful work, autonomy | Work by choice, not survival |
| Childhood adversity | 2-12x chronic disease risk | Family support, poverty elimination | Economic security for all families |
| Lack of control | Marmot's primary determinant | Agency over decisions | Direct participation in governance |
Connection to OMXUS
OMXUS is, at its core, a health intervention -- not because it provides medical services, but because it addresses the upstream determinants that produce disease:
| OMXUS Component | Health Mechanism | Expected Outcome |
|---|---|---|
| Economic security | Reduces chronic stress, food insecurity, housing instability | Lower rates of cardiovascular disease, diabetes, mental illness |
| Community response | Reduces social isolation, creates mutual aid networks | Improved immune function, reduced depression, faster recovery |
| Direct participation | Restores sense of control (Marmot's key variable) | Reduced chronic stress activation |
| Justice as Prevention | System designed for health, not reaction to illness | Prevention at population scale |
| Telemetry for Humans | Personal health insights owned by the individual | Improved health literacy and self-management |
| Environmental design | Healthy defaults, community norms | Population-level behaviour change without coercion |
Key Conclusion
From everything we know, there exists a possible world where cancer is not a daily background gamble -- where risk is radically lower because we refused to normalise what we already understand.
Pretending that world is unrealistic is the real fantasy.
The science is clear: health is made in communities, not in hospitals. OMXUS builds the community infrastructure that produces health as a natural consequence of how people live, rather than a commodity purchased after disease has already taken hold.
See Also
- Justice as Prevention
- Behavioral Plasticity
- Economic Analysis
- Human Agency
- Drug Policy Reform
- Emergency Response
- Main Page
References
- ↑ World Health Organization. (2008). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. WHO Commission on Social Determinants of Health.
- ↑ McGinnis, J. M., Williams-Russo, P., & Knickman, J. R. (2002). The case for more active policy attention to health promotion. Health Affairs, 21(2), 78-93.
- ↑ Chetty, R., et al. (2016). The Association Between Income and Life Expectancy in the United States, 2001-2014. JAMA, 315(16), 1750-1766.
- ↑ Roelfs, D. J., et al. (2011). Losing life and livelihood: A systematic review and meta-analysis of unemployment and all-cause mortality. Social Science & Medicine, 72(6), 840-854.
- ↑ Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7), e1000316.
- ↑ Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365(9464), 1099-1104.
- ↑ Marmot, M. G., et al. (1991). Health inequalities among British civil servants: the Whitehall II study. The Lancet, 337(8754), 1387-1393.
- ↑ Felitti, V. J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245-258.
- ↑ Felitti, V. J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245-258.
- ↑ Australian Institute of Health and Welfare. (2023). Child Protection Australia 2022-23. AIHW.
- ↑ Wu, S., et al. (2016). Substantial contribution of extrinsic risk factors to cancer development. Nature, 529(7584), 43-47.
- ↑ World Health Organization. (2022). Cancer Prevention and Control. WHO Fact Sheet.
- ↑ Kiecolt-Glaser, J. K., & Glaser, R. (2002). Depression and immune function: central pathways to morbidity and mortality. Journal of Psychosomatic Research, 53(4), 873-876.
- ↑ Cohen, S., & Herbert, T. B. (1996). Health psychology: Psychological factors and physical disease from the perspective of human psychoneuroimmunology. Annual Review of Psychology, 47(1), 113-142.
- ↑ Montazeri, A. (2009). Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to 2008. Health and Quality of Life Outcomes, 7, 102.
- ↑ Kim, E. S., & Konrath, S. H. (2016). Volunteering is prospectively associated with health care use among older adults. Social Science & Medicine, 149, 122-129.
- ↑ Touchton, M., & Wampler, B. (2014). Improving social well-being through new democratic institutions. Comparative Political Studies, 47(10), 1442-1469.