How many U.S. deaths are caused by poverty, low levels of education and other social factors? A new study finds that the numbers are in the same range as deaths from heart attacks and stroke.
Mailman School of Public Health
How researchers classify and quantify causes of death across a population has evolved in recent decades. In addition to long-recognized physiological causes such as heart attack and cancer, the role of behavioral factors—including smoking, dietary patterns and inactivity—began to be quantified in the 1990s.
More recent research has begun to look at the contribution of social factors to U.S. mortality. In the first comprehensive analysis of such studies, researchers at Columbia University’s Mailman School of Public Health found that poverty, low levels of education, poor social support and other social factors contribute about as many deaths in the U.S. as such familiar causes as heart attacks, strokes and lung cancer.
The full study findings are published online ahead of print in the American Journal of Public Health.
The research team, led by Sandro Galea, MD, DrPH, chair of Epidemiology, estimated the number of U.S. deaths attributable to social factors using a systematic review of the available literature combined with vital statistics data. They conducted a MEDLINE search for all English-language articles published between 1980 and 2007 with estimates of the relation between social factors and adult all-cause mortality. Ultimately they considered 47 studies for meta-analysis.
After calculating for the relative risks of mortality from social factors, researchers obtained prevalence estimates for each social factor using primarily Census Bureau data. Individual social factors included education, poverty, health insurance status, employment status and job stress, social support, racism or discrimination, housing conditions and early childhood stressors. Area-level social factors included area-level poverty, income inequality, deteriorating built environment, racial segregation, crime and violence, social capital and availability of open or green spaces.
The investigators found that approximately 245,000 deaths in the United States in the year 2000 were attributable to low levels of education, 176,000 to racial segregation, 162,000 to low social support, 133,000 to individual-level poverty, 119,000 to income inequality, and 39,000 to area-level poverty.
Overall, 4.5% of U.S. deaths were found to be attributable to poverty—midway between previous estimates of 6% and 2.3%. However the risks associated with both poverty and low education were higher for individuals aged 25 to 64 than for those 65 or older.
“Social causes can be linked to death as readily as can pathophysiological and behavioral causes,” points out Dr. Galea, who is also Gelman Professor of Epidemiology. For example, the number of deaths the researchers calculated as attributable to low education (245,000) is comparable to the number caused by heart attacks (192,898), which was the leading cause of U.S. deaths in 2000. The number of deaths attributable to racial segregation (176,000) is comparable to the number from cerebrovascular disease (167,661), the third leading cause of death in 2000, and the number attributable to low social support (162,000) compares to deaths from lung cancer (155,521).
“These findings argue for a broader public health conceptualization of the causes of mortality and an expansive policy approach that considers how social factors can be addressed to improve the health of populations,” observed Dr. Galea.
This study was funded by the National Institutes of Health. June 16, 2011
The homeless way of death: Frozen to the floor, no money for a funeral
by Wilson Dizard | March 24, 2015 | AL JAZEEERA
Harvey Dell Harmon Jr., homeless in Chicago, died of cold this winter. To family and friends, he was no John Doe
From left, Harvey Harmon’s mother, Elizabeth Harmon; sister Sheila Harmon; and nephew Kerry Harmon in their apartment. Saiyna Bashir
Harvey Harmon, left, with nephew Kerry Harmon the night in December they saw the rapper Birdman. Kerry bought the tickets for both of them. Courtesy Harmon family
CHICAGO — A Cook County coroner noted two pairs of socks, two pairs of gloves, black sneakers, a pair of pants, two pairs of underwear, a scarf, a T-shirt, a blue sweatshirt, a black sweatshirt, another blue sweatshirt, a yellow sweater, another black sweatshirt and a light brown jacket.
But for Harvey Dell “Squeek” Harmon Jr., even that wasn’t enough.
Harmon succumbed to Chicago’s cold in the hallway of an abandoned apartment complex sometime between Jan. 8 and Jan. 12.
The medical examiner’s report also recorded the condition of his body: “frozen to ground.”
It wasn’t his friends in the homeless community who came across him in that state. They couldn’t find him over the frigid winter weekend.
Instead, a Chicago Water Department worker, arriving at 1:50 p.m. on Jan. 12 to inspect a vacant red-brick apartment building at 11209 S. Vernon Avenue, found him. The 53-year-old’s lifeless body was lying in a hallway.
The worker called 911 to report his discovery and left the scene when police and firefighters arrived at the three-story building, which lacked heat and electricity.
Unable to open the front door, firefighters broke into the property to retrieve him. Police alerted city building authorities to board up the dwelling's windows and doors to prevent others from entering. The city would soon demolish the derelict building.
That afternoon, news of Harmon’s death filtered through to those who knew him. He likely died alone, but in life he kept in touch with a wide circle of friends and family, most of whom lived around Palmer Park on Chicago’s South Side, near where he died and where he spent the last years of his life.
In Cottage Grove, about 30 blocks north, his sister Sheila Harmon, 54, received official notification of her brother’s death that day. Another relative had already told Kerry Harmon, Harvey Harmon’s nephew and close friend.
“I cried,” Sheila Harmon recalled. "I went into a frenzy from that point. I was just crying.”
A week before, she and Kerry Harmon helped him put together the paperwork necessary to obtain a state ID card.
It was through that documentation that authorities were able to contact the Harmon family within minutes of the discovery of his body.
If Harvey Harmon had lacked identification, officials would have looked through the missing person files to try to link his body to a name. Sometimes they fail, and the dead remain John or Jane Does. Cook County currently has descriptions of 29 unidentified bodies on its website.
Sheila Harmon said she had hoped the ID would help him get a temporary job. She didn’t expect it to help news of his death reach her faster.
She said she was disappointed in him the last time she saw him. He was drunk on a day when he was supposed to be looking for work. Now, she said, she just wishes she could tell him how much she loved him.
“It’s what it is,” she said. “It seems like he was getting ready to get it together. Then this happens.”
The building where authorities found the body of Harvey Harmon stood at 11209 S. Vernon
Ave. in the Roseland section of Chicago. The city had slated it for demolition before his death.
Before Sheila Harmon found out what happened, Valerie Ezell, a cousin by marriage, arrived at the Vernon Avenue building that afternoon. She lives near Palmer Park and heard from neighbors of a dead body. First responders asked her to take a look to see if it was her missing relative, she said.
“Nobody believed that he froze to death, because nobody understood why he let himself freeze to death. He had lots of places to go,” she said, though she knew at the time that he had gone longer than usual without making contact with his family.
As warm and friendly as Harvey Harmon was, friends and relatives said he was a loner, harboring a pride that kept him from seeking refuge with others. He had no spouse, girlfriend or children to look after him.
“We had seen him that Thursday. He was drunk. He was with his friends. He said just ‘Hi,’” Ezell said. She believes he died that day or Friday. A police report notes Thursday, Jan. 8, as the last time someone spoke to him.
On those two days, temperatures never rose above 20 degrees in Chicago, with the mercury dropping to 7 degrees below zero Thursday night. At the time Harvey Harmon was found, the temperature had crawled up to 22 degrees.
“He didn’t even make it up the stairs,” Ezell said. On arriving at the vacant building, she was able to tell it was him, she said, from the light brown jacket he had. It was covering his head and face.
Despite his modest frame — 5 feet tall and 139 pounds — he looked larger than usual.
“He was big. He was swollen like he had froze to death,” she said. “We could tell he froze, because when they tried to pick him up, he was heavy.”
A University of Chicago physician pronounced Harvey Harmon dead at the scene at 2:19 p.m. on Jan. 12, records show.
In an autopsy conducted two days after his discovery, the medical examiner listed “hypothermia due to cold exposure” as the primary cause of death, with chronic alcoholism a contributing factor.
Decades of heavy drinking left Harvey Harmon with fatty liver disease and an enlarged heart. Aside from that, he appeared well. And even though he was missing most of his original teeth, the ones that were left were in good condition, according the medical examiner’s report.
“The manner of death is accidental,” the report concluded, ruling out foul play after inspecting his body for signs of strangulation, skull fracture or poisoning.
He died alone because of the effects of extreme cold on a body weakened by years of alcohol abuse. Among America’s nearly 390,000 homeless, about 700 die of hypothermia each year, according to the National Coalition for the Homeless’ winter services report.
This winter, at least 26 people are known to have died in Chicago’s often brutal weather conditions, many of them homeless, local news reports say.
Cold ranks alongside hunger, violence and lack of medical attention in bringing down the average life expectancy of someone living on the streets to between 42 and 52 years. The national average is 78.
At just 53, Harvey Harmon lived longer than the typical homeless man.
His path to homelessness started in the first years of his life, Sheila Harmon said.
When he was 2, while living in the Ida B. Wells housing projects in Chicago’s South Side, he was hit by a car. After that, she says his distinctive stutter and habit of repeating words began.
He earned his nickname, “Squeek” or “Squeeky,” after a high-pitched sound he made as a baby. Many of his street friends didn’t know his real name.
Vehicles struck him two more times before he reached the age of 12 — events that may have contributed to his learning difficulties as a child, his sister said.
Sheila Harmon remembers her brothers Ivory, David and Angie and sister Sheliana covertly helping Harvey sound out words as their father, Harvey Harmon Sr., taught them all how to read.
“Harvey has never had his own apartment, due to the fact that he was not a very good reader. He really couldn’t read very well,” Sheila Harmon said, estimating he could read about as well as a sixth-grader.
But “he was a genius at everything else,” she said.
Starting when he was a child, he could repair television sets and other electronic devices without having received any training. He would employ these skills as a handyman for the rest of his life — painting houses, washing cars and fixing appliances.
But his alcoholism stalled his progress. His drinking had roots in emotional trauma, Sheila Harmon said. She traces it back to the day when Harvey, then 14, saw his big brother Ivory, 17, die of a gunshot wound to the neck in their stairwell after a dispute over a television.
It was Harvey who answered the door for the shooter, she said. When Ivory walked out, her family heard a quick “pow, pow” just outside the apartment. Harvey and his brother David, then 12, rushed to see what happened.
“The next thing I know, they carried him down the stairs. Squeeky had his legs, and David had his arms,” she said. “I think he hasn’t been in his right mind since it happened.”
“It took a toll on his life and made him feel he was responsible for it,” she added.
Harvey Harmon stayed with his mother until he was in his early 30s, then moved in with David Harmon until 2009, when David Harmon suffered a severe stroke that left him in a nursing home.
After that, Harvey Harmon stayed on the streets, but he didn’t stay idle. Not content to get by on charity, he tried to make cash however he could. It wasn’t enough to get him his own apartment, but it was enough to support his drinking habit.
In the last years of his life, respite from street living for Harvey Harmon often came in the shelter of the New Life Baptist Church.
There he ate many of his meals, took showers, shaved and socialized with friends. The church’s work for the homeless is overseen by Glines House, a woman affectionately called “Mama” for the care she has provided people in need over the last 15 years.
A few days after he died, New Life’s regulars informed her of the news. She said they grieved together that morning.
“All we did was talk about what a nice guy he was, how he never hurt anybody and ‘Oh, man, we’re gonna miss him,’” House recalled. “He was a very caring person. I never had any problem out of him. He was a very courteous, humble person.”
She said he was outgoing. At meals the church hosted, other homeless people would ask him to join them. She knew he told jokes, but she never heard them.
"They would sit at his table with him, and the guys would just crack up” over one of his jokes. “And I come out, and the guys would say, ‘Mama, you don’t want to hear it.’”
Although he had genuine friends who enjoyed his company, he would still retreat in drunkenness, away from others. It was a habit that would contribute to his demise.
“Most of the time he was drinking, he was by himself. He would stay in abandoned buildings. Anywhere he could lay his head,” House said. “If you’re intoxicated and you go to sleep, that’s it. I’m sure that’s what happened to him.”
She said she once tried to get him to stop drinking, with little luck. “I asked him, ‘Aren’t you tired of this?’ and he said, ‘Yeah, Mama. I’m going to clean up,’” she recalled.
She said she told him, “‘We can send you to a place and get you some treatment. We could help you,’ and he said, ‘Yeah, we’ll talk about it.’”
But he never brought up the subject again.
“You can’t force someone. They’ve got to want to [get sober],” House said.
The last time she saw Harvey Harmon, just a few days before his death, she said he arrived at the church asking for a change of clothes. He had urinated on himself again — a result of his heavy drinking. “I bought him some Depends,” she said, thinking then that “when he comes in, I’m gonna give him them.”
She fed him one of his last meals: roast chicken, gravy, rice and salad, with banana pudding for dessert. “The last thing I remember him saying is ‘Mama, this food sure is good,’” she said.
She never got a chance to give him the adult diapers.
“Man, I didn’t get a chance to see him again,” she said she remembered thinking when she heard the news.
For his biological mother, Elizabeth Harmon, his death hasn’t sunk in, Sheila Harmon said. His mother is 80 and suffers from dementia, and she doesn’t understand that he is gone, believing her boy has recovered.
With her mother unable to take charge and her father having died in 2007, Sheila Harmon said she feels responsible for looking after her large extended family.
“What my father left to me is the legacy to keep the family together,” she said. “I’m, like, what they call the peacemaker in the family.”
A blood lab technician, she said she wished she could have afforded an apartment large enough to keep her whole family under one roof — a place Harvey Harmon could have called home.
“If I could own something … he would be in a home with me, even if I had to give him the basement. I wish I could come across a big windfall of money and see him taken care for. And then I turned around and see that one of my family members is missing.”
With his body lying in the morgue, Sheila Harmon worries about the fate of Harvey Harmon’s remains. She wants to keep her brother's ashes. “He was not a John Doe,” she said. “We would probably just keep it and put it on the mantel.”
Even though she doesn't have the money to pay for cremation, she might not need to. After 60 days, Cook County cremates all its unclaimed dead — a policy that started in February 2014.
The office keeps the ashes for two years, and family members can pick up the remains with no fee.
“Harvey Harmon — remains are still in the [medical examiner]’s cooler but are scheduled for cremation later this week,” Frank Shuftan, a spokesman for the county medical examiner’s office, said in an email Monday. Harvey Harmon's ashes will join those of at least 169 other people the county is holding.
Sheila Harmon takes solace that her brother, at least, had a memorial.
Roseland Christian Ministries — where he would regularly eat breakfast Sundays at 9 a.m. — held the service on Jan. 30, at no charge. About 60 people came out — friends, family and regular members of the church.
The Rev. Joseph Huizenga, who delivered the eulogy, said the event gave an opportunity for the residents of Roseland to come together.
Having services conducted without a body underscores how poverty affects a person, even after death.
“Seriously, this month I’ve done three [memorials] where there is not a body. That’s the difference between middle class and poor, because you can’t get the money to bury a body,” Huizenga said.
"How a culture treats their dead says something about them.”