reflect a similar relationship between socioeconomic status and disease incidence or death in the united states. disease composes a very significant portion of u.s. mortality; as of may 2017, 6 out of 7 of the leading causes of death in america are non-communicable diseases, including heart disease, cancer, lower respiratory diseases, and cerebrovascular diseases (stroke). indeed, these diseases have been seen to disproportionately affect the socioeconomically disadvantaged, albeit to different degrees and with differing magnitude. mortality rates associated with cardiovascular disease (cvd), including coronary heart disease (chd) and stroke, were assessed for individuals across areas of differing income and income inequality. the authors found that the mortality rates for each of the three respective diseases were greater by a factor of 1.36, 1.26, and 1.60, in areas of higher inequality compared to lower inequality areas of similar income. across areas of differing income and constant income inequality, the rate of death due to cvd, chd and stroke was increased by a factor of 1.27, 1.15, and 1.33 in the lower income areas. these trends across two measures of variation in socioeconomic status reflect the complexity and depth of the relationship between disease and economic standing. the authors are careful to state that while these patterns exist, they are not sufficiently described as related by cause and effect. while correlating, health and status have arisen in the u.s. from interrelated forces that may intricately accumulate or negate one another due to specific historical contexts. as this lack of cause and effect simplicity indicates, exactly where disease-related health inequality arises is murky, and multiple factors likely contribute. important to an examination of disease and health in the context of a complicated classification like socioeconomic status is the degree to which these measures are tied up with mechanisms that are dependent upon the individual, and those that are regionally variant. in the aforementioned 2006 study, the authors define individualized factors within three categories, "material (eg, income, possessions, environment), behavioural (eg, diet, smoking, exercise) and psychosocial (eg, perceived inequality, stress)", and provide two categories for external, regionally varying factors, "environmental influences (such as provision of and access to services) and psychosocial influences (such as social support)." the interactive and compounding nature of these forces can shape and be shaped by socioeconomic status, presenting a challenge to researchers to tease apart the intersecting factors of health and status. in the 2006 study, authors examined the specific drivers of the correlation between stroke occurrence and socioeconomic status. identifying more nuanced and interlocking factors, they cited risk behaviors, early life influences, and access to care as tied to socioeconomic status and thus health inequality. inequality in disease is intricately tangled up with stratification of social class and economic status in the united states. correlations, often disease-dependent, between health and socioeconomic attainment have been demonstrated in numerous studies for numerous diseases. the causes of these correlations are interlocking and often related to factors varying between regions and individuals, and design of future studies concerning inequality in disease require careful thought to the multifaceted driving mechanisms of social inequality. environment the neighbourhood and areas people live in, as well as their occupation, make up the environment in which they exist. people living in poverty stricken neighborhoods are at a greater risk for heart disease, possibly because the supermarkets in their area do not sell healthy foods and there is increased availability of stores selling alcohol and tobacco than in more affluent parts of town. people living in rural areas are also more susceptible to heart disease, as well. an agriculturally based diet rich in fat and cholesterol, combined with an isolated environment in which there is limited access to health care and ways to distribute information probably creates a pattern in which people living in rural environments have higher levels of heart disease. occupational cancer is one way in which the environment one works in can increase their rate of disease. employees exposed to smoke, asbestos, diesel fumes, paint, and chemicals in factories can develop cancer from their workplace. all of these jobs tend to be low-paying and typically held by low income individuals. the decreased amount of healthy food in stores located in low-income areas also contributes to the increased rates of diabetes for persons living in those neighborhoods. one of the best examples of this can be seen by observing the city of jacksonville, florida. food deserts in urban jacksonville in jacksonville, florida it is hard to find groceries stores around the area because it is surrounded by fats, sugar, and high in cholesterol markets. in duval county, there are 177,000 food insecure individuals such as children, families,senior citizens, and veterans that do not know when they will have a chance to have another meal again. nearly 60 percent of the food that is consumed in duval county is processed. to combat this, agencies helped distribute food and they averaged 12.3 million meals over eight counties in northern florida. in duval alone, 3.5 million meals were handed out to families. the image below shows all of the hunger-relief partner agencies located within jacksonville's food deserts that get food from feeding northeast florida. in all feeding northeast florida provided 4.2 million pounds of food to agencies in food deserts. these numbers were stats recorded in 2016. water pollution just like flint jacksonville had a water crisis and found 23 different chemicals in their water supply. it was so bad that jacksonville was labeled top 10 in worst water in the nation. they stood at number 10 because of the 23 different chemicals. the chemicals that were most found in the water in high volumes were trihalomethanes, which is made up of four different cleaning by products such as chloroform. trihalomethanes are confirmed to be carcinogenic. throughout the five year testing period, unsafe levels of trihalomethanes were found during the 32 months of testing, and levels that are considered illegal by the epa were found in 12 of those months. in one of the testing periods the trihalomethanes were found at twice the epa legal limit. other chemicals such as lead and arsenic that can cause health problems to people, were also found in the drinking water. another way that water pollution is damaged is from nutrient overload. nutrient overload is caused by manure and fertilizers, storm water runoff, and wastewater treatment plants. this occurs in a lot of florida rivers and the rivers are contained with blue green algae that feed on all those nutrients. all the waste that is dumped into the rivers gets fed on by other plants and animals that release toxins in the area, which makes everything surrounded by it a deadly toxin as well. the toxins that are dumped into the rivers can cause discoloration in the rivers to make a dark blue and green color. by looking at the river most people can tell how dangerous and harmful it is to be around it. if the water were to somehow get into water companies people can receive serious harm from drinking and bathing with this water. education education level is a great predictor of socioeconomic status. on average, individuals with a bachelors, associates, and high school degrees will annually earn 64.5, 50, and 41 thousand dollars respectively. this means that the average bachelor's degree earner will receive approximately $1,000,000 more over their working life than an individual with only a high school degree. furthermore, as authors montez, hummer, and hayward explained, "in 2012, unemployment was 12.4 percent among adults who did not graduate high school, compared to 8.3 percent among adults with a high school diploma and 4.5 percent among college graduates." because the relationship between socioeconomic status and the prevalence of disease has already been well established, education is indirectly responsible for an increased prevalence of disease among the impoverished. more directly, educational attainment is a great predictor of how likely an individual is to engage in risky, possibly disease causing, behaviors. in terms of smoking, which directly correlates to an increased risk for diseases like lung cancer, education is an important determining factor in the likelihood of an individual to smoke. as of 2009–10, 35 percent of adults who did not graduate high school were smokers, compared to 30 percent of high school graduates and just 13 percent of college graduates. high school graduates also smoked more packs, on average, each year than smokers who had graduated from college. furthermore, individuals with a high school degree or less were 30% less likely to abstain from smoking for at least 3 months during their time as a regular smoker other studies have found that binge drinking is higher among those with college degrees, implying that binge drinking is a habitat developed by many during the college years. unhealthy dietary habits can also directly lead to diseases such as heart disease, hypertension, and type-2 diabetes. one of the leading causes of unhealthy eating habits is a lack of access to grocery stores, creating so called "food deserts." studies have found that immediate access to a grocery store (within 1.5 mile radius) was 1.4 times less likely in areas where only 27%, or less, of the population was college graduates. the negative effects of these food deserts are exacerbated by the fact that impoverished neighborhoods also had an oversupply of liquor store, fast food restaurants, and convenience stores. one significant risk for sexually active individuals is that of sexually transmitted diseases and infections. while studies have found that the correlation between education and carrying these is relatively low on average (and even less so for certain subsets such as black women), there is a strong correlation between education and other risky sexual behaviors. those with only a high school degree or less were significantly more likely to engage in risky practices such as early sexual initiation, sexual activity with those who use "shooting" street drugs such as heroin, and even prostitution. in addition, those with less education were also less likely to practice some safe sex practices such as condom use. studies have also found that adults with higher educational achievement were more likely to lead healthier lives. intake of key nutrients such as vitamins a and c, potassium, and calcium was positively correlated with education level. this is a critical statistic because those nutrients, such as vitamin c, are critical in helping the body fight diseases and infections. there was also a correlation between education and exercise habits. a 2010 study found that while 85% of college graduates stated they exercised in the last month, only 68% of high school graduates and 61% of non-high school graduates said the same. because exercise is so crucial to preventing diseases like hypertension and type 2 diabetes, this stark distinction between exercise habitats can have significant effects. by 2011, 15% of high school (or less) graduates had diabetes, compared to just 7% of college graduates. arguably the best way of seeing the true effects of education in the inequality of disease is to examine mortality levels, as heart disease, cancer, and lower respiratory diseases are the top three killers, respectively, of americans every year. by age 25, if an individual does not have at least a high school degree, they will die an average of 9 years earlier than an otherwise similar college graduate. a different national study found that individuals with only bachelor's degrees were 26% more likely to die in the next 5 years than individuals of the same age with professional degrees such as a master's. even more stark, americans without a high school degree were almost twice as likely to die than those with a professional degree in the study's 5 year follow-up period.