There is an old folk song some of whose lines say, “If living were a thing that money could buy, you know the rich would live and the poor would die.” Regrettably, there’s little “if” about it, according to research. On average, poor people live less healthy lives and are generally more than three times as likely to die prematurely as the rich in developed countries.
The reasons are many, ranging from less healthy diets with too much processed food through polluted cities to a lot more toxic stress. In recent years, however, researchers have added one more factor to this mix: It turns out that poor and socially disadvantaged people sleep much less well on average than the rich, which can take a major toll on their physical and mental health.
What constitutes good sleep? Most experts agree that for children between the ages of five and twelve, a night’s sleep of nine hours is necessary. The average person should sleep about seven hours a night around the age of 40, and about six-and-a-half hours a night between the ages of 55 and 60. On the other hand, a healthy 80-year-old should sleep about six hours a night. Of course, these are all averages: everyone needs a different amount of sleep.
Wendy Trocel, senior behavioural and social scientist at the Rand Corp., who co-wrote an Analysis of socio-economic disparities in sleep and health in 2020, says that “We used to think that sleep problems were limited to Type A professionals, and they certainly aren’t immune, but low-income individuals are actually at greatest risk.”
If living were a thing that money could buy, you know the rich would live and the poor would die.
The alarm bells about an epidemic of poor sleep among people have been ringing for years. For many, sleep issues such as insomnia have been worsened by the COVID-19 pandemic, with one meta-study in the USA reporting that nearly 40% of people had sleep problems during the first half of 2020.
Other studies show that poor sleep can also cause illness. For example, people who suffer from sleep apnea are more prone to cardiovascular disease and stroke, as well as increased inflammation, which may contribute to such illnesses as heart disease, cancer and arthritis.
In a first for Europe, Dusan Petrovic, of the University Centre of General Medicine and Public Health Lausanne, analysed data about more than 111,000 adults in Europe to find whether lack of sleep could partly explain why poor people have more heart disease. He found that short sleep explained 13.4% of the link between occupation and coronary heart disease in men.
In his study (Sleep Disorders, Stress, Psycho-Social and Cultural Aspects of Heart Disease, 2019) he also concludes that short sleep among women could be due to the weaker relationship between occupation and sleep duration compared to men. “Women with low socio-economic status often combine the physical and psychosocial strain of manual, poorly paid jobs with household responsibilities and stress, which negatively affects sleep and its health-restoring effects compared to men,” he says.
The problem is not limited to adults, though. One study among teenagers (Sleepless in Fairfax, 2014) has shown that each hour of lost sleep comes with a 23% increase in the risk of tobacco, alcohol or marijuana use and a 58% increase in suicide attempts.
People may even become more vulnerable to viruses and less likely to benefit from a vaccine, due to insufficient sleep, another study (Why sleep is important for health, 2014) by Michael Irwin suggests.
But here’s where the great sleep divide comes in. Over the years, researchers have repeatedly found evidence that people in poverty get less sleep than those with more money. In 2013, for instance, the USA’s CDC reported in its National Health Interview Survey, that 35.2% of people earning below the poverty level reported sleeping less than six hours in an average 24-hour period, compared with 27.7% of those earning more than four times the poverty level.
Here in Malta the situation is definitely not any better. The percentage of people aged 16 years and over with a less than primary education who were in good or very good health in 2019 was 61%, but that of people who had a tertiary level of education was much higher at 92.4%. On the other hand, those with a less than primary education who had bad or very bad health were 6.3%, whereas those with a tertiary level of education were just 0.6%.
Several economic, social and physical factors contribute to these differences and their related harm to health, school performance and productivity.
One reason for this difference is that excess weight can partially close off breathing during sleep. Girardin Jean-Louis, a sleep researcher at New York University, and his fellow researchers conducted sleep studies where they discovered that some people wake up as often as 200 times a night. This predicament can become a cruel trap, since poor sleep can affect people’s metabolism and even hormones that regulate appetite, leading to further unhealthy weight gain.
Stress is an additional impediment to sleep. Socially and financially disadvantaged people, not surprisingly, tend to have more of it. What with financial problems and a relative lack of control over one’s life, it is no wonder that for years they do not get sufficient rest. On average, poor people are more likely to work in jobs with little sense of control, work at more than one low-wage job at a time, and live in poverty even when employed.
There is little hope that issues such as poverty, income inequality and environmental injustice, will be solved anytime soon. They are profound and depressingly familiar, having bedevilled policy-makers for decades. But the link between socio-economic shortcomings and poor sleep is not beyond their wit.
Changes in laws and regulations could go far to improve sleep health. For example, improved noise ordinances, reduced light pollution, and more humane schedules for overnight shift work could all help reduce the sleep divide.
One relatively straightforward change, which scientists contend could help tens of millions of people to sleep better, is delaying school start times by as much as an hour. The science is solid. For their physical and mental health, teens need a lot more sleep than they’re getting. Yet, in Malta we persist in the maniacal practice of waking kids at six in the morning, and sometimes even earlier, to catch the school bus. Schools in other countries that have moved back their starting clocks have seen benefits, including more alert students, better academic outcomes, and fewer car accidents.
A paradigm shift is needed. Sleep has traditionally been seen as a purely individual responsibility: Don’t drink coffee at night; keep the room dark; don’t look at your phone in bed. Yet, we need to widen our perspective to reimagine sleep as a public health opportunity.
We all need to become more like sleeping babies.