Natural selection also has a social dimension which has a profound, and mostly unrecognized impact on health status. In a sense, it isn't really "natural" selection because the factors are socially determined, and not distributed by merit. Whether it is in career ladders, little league soccer, reality TV, small business survival, college admissions, and even dating, it is understood that personal qualities, effort and social standing create a pecking order of big winners, smaller winners, smaller losers, and bigger losers. People will compete and the "fittest" will have the most success (i.e. will survive).
Over the last 25 years what is known as the "social gradient" has been described by careful population research. This means that your position on the socioeconomic scale or social hierarchy will have a profound effect on your health. This is true even if we control for lifestyle(e.g smoking, obesity) and access to health care. People at the highest level of education, income, and social standing have the highest degree of health status. Those a notch lower have a little bit poorer health status, and so on down to the lowest levels of society, in which people have by far the poorest health status.
It can be argued that social determination of your health is inherently unfair. However, most people are apathetic because it seems so hopeless, as a practical matter to contemplate eliminating poverty or substandard housing. We know how to do these things in principle, but have had little success with real people in real communities.
This is certainly in the mainstream of progressive ideology, but that point of view seems to be an endangered species in 2010.
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