Over 100 years after the sinking of the RMS Titanic, we're all familiar with the significance of this event. The sinking in 1912 represents one of the biggest maritime disasters in our history. Even back then, the Titanic became instant news and has since been the subject of much fascination. The grandeur of the boat, the idea that it was “unsinkable,” and the pure scale of the disaster have captured the hearts and minds of people ever since.
Yet the Titanic disaster also represents a very concrete and extreme demonstration of how social class (wealth and status) impacts health. That is, the richer you were, the more likely you were to survive. Although we’d like to believe that this is the relic of days gone by, this is unfortunately not the case. Wealth is still the greatest predictor of life expectancy.
Social Class and Survival
Only 37% of Titanic’s passengers survived. Yet 63% of first class passengers survived, 42% of second class, and just 24% of third class. Put another way, passengers traveling in first class were 40% more likely to survive and passengers in second class were 16% more likely to survive than those traveling in first class.
Why were first class passengers more likely to survive than second or third class passengers?
Many factors contributed to first class passengers having a better chance of getting off the Titanic alive, but by far the greatest was the physical structure of the ship itself. The Titanic had 11 decks, eight of which were used by passengers. The top deck had all of the boat’s first class amenities, such as a promenade, restaurants, a gymnasium, a squash court, a swimming pool, a cafe, and a reading room. Most importantly, this top deck also held all of the ship’s lifeboats. The next level down was the first class passenger cabins. As the deck levels descended, so did the class of the passengers, with most third class passengers and crew occupying a deck five levels lower than the first class passengers. Passengers from lower classes were not allowed on to certain parts of the ship, including the top deck where the lifeboats were.
When Titanic hit the iceberg, first class passengers were physically closer to the lifeboats than their second and third class counterparts, giving them quicker access to these life-saving devices. In fact, the poorer the passenger, the farther away they were from the lifeboats. Navigating the ship’s many levels was also somewhat challenging, so the passengers lower down had a harder time finding their way to the top. Since second and third class passengers were not allowed onto the first class areas of the boats (where the lifeboats were), they did not know where they were and could not find them as easily.
Case in Point
To illustrate how class can impact the neighborhoods in which people live, take a look at two suburbs near Boston (that are adjacent to each other), one significantly richer than the other.
What Does This Have to Do With Class?
While it may not be as blatant as sunning oneself on the upper decks, class today still greatly influences health outcomes. In fact, wealth is the strongest predictor of health and life expectancy in the United States, with wealthier Americans living an average of 4.5 years longer than poorer Americans. At the extreme, affluent caucasian women are expected to live 14 years longer than poor African American men.
It is well known that wealthier people have access to better healthcare options and can more easily afford related healthcare costs, such as copayments, transportation to and from care, and optional or elective tests and procedures.
But access to healthcare is only one piece of the puzzle.
Just like those passengers on the Titanic, wealthier Americans today have more ready access to physical environments (neighborhoods) that are health-promoting. Take access to healthy foods as an example. Wealthier neighborhoods have higher numbers of grocery stores selling fresh fruits and vegetables, health food stores, and farmer’s markets. Low-income neighborhoods boast more convenience stores, which have very limited fresh food options, and more fast food restaurants.
Studies make it clear that access to fresh fruits and vegetables improves diets and improve related health outcomes (for example, obesity and diabetes), but little has been done to change access in low-income neighborhoods, and people living in those communities continue to suffer the health consequences.
Newton is about 25 percent bigger than Waltham, both in terms of population and land mass. Yet Newton has 250% more grocery stores as Waltham (5 versus 2), and boasts two Whole Foods Markets, whereas Waltham has none. Waltham, on the other hand, has almost twice as many national fast food chains as Newton: Newton has 2.4 fast food chains per 50,000 people whereas Waltham has almost 6 fast food chains per 50,000 people. Note that this chart only looked at three of the major US fast food chains.
Why this difference? Both cities are about the same distance from Boston. But the major differences is that Newton is a wealthier community. This example isn’t even that extreme—Waltham is a relatively wealthy community located about the same distance from a major city. Even so, residents of the wealthier community have much greater access to healthier options than do their neighbors living in the less well off neighborhood. Imagine the differences we would see if we compared the most affluence with the lowest income neighborhoods.
Access to healthy food is just an example. The same analysis could be done for multiple factors that impact health, such as the availability of open green spaces to walk or bike in, safer streets, or the availability of alcohol.
Have Things Changed?
While the Titanic disaster seems like a phenomenon unique to another era, many of the same problems that led to the scale of that disaster, especially for the poor, continue to exist today. On Titanic, poor people were literally trapped on a sinking ship. Wealthy passengers had easy access to fresh air, dining options, and other health-promoting amenities, while poor people were trapped below deck far away from those amenities and, importantly, from lifeboats that could literally save their lives. Today, wealthier Americans live in safer communities that boast healthier food options, and safer streets, making it easier for them to make healthy decisions about diet and exercise. Indeed, social class continues to play an important role in the health and well-being of all Americans.
This content reflects the personal opinions of the author. It is accurate and true to the best of the author’s knowledge and should not be substituted for impartial fact or advice in legal, political, or personal matters.