The Road to Real Health
Several factors make American life particularly stressful. We are among the most competitive of wealthy capitalist countries and have the widest gap between rich and poor. Fewer people are on top; more are on the bottom. Studies clearly show that, whether you’re a person or a baboon, the lower your status, the higher your stress levels are. As Richard Wilkinson and Kate Pickett point out in their book, The Spirit Level (2009), members of more economically egalitarian societies, such as Sweden and Japan, lead less stressful, healthier lives—an improvement that holds true for every segment of the population, including the wealthy.
Stress is also the result of insecurity. As the American social safety net has been gutted in recent years, as more of us have lost health and pension benefits, and job protections have declined, life in America has become riskier than it used to be. Life here is certainly far more insecure than in other rich countries, where strong social safety nets remain in place. Danes, for example, can be fired as easily as Americans, but then they receive generous unemployment benefits, job training, and government jobs, if they are unable to find a position in the private sector.
Insecurity leads to increased anxiety levels. American rates of anxiety are double or triple those in western European countries. Such mental illness negatively impacts physical health even further. The health department in the United Kingdom suggests that “there is no health without mental health.” Europeans say their social safety net gives them a feeling of peace of mind. It’s certainly good for their health.
Finally, stress is also the result of time pressures and overwork, which are far more common in the United States than in other rich countries. Dr. Sarah Speck, a prominent Seattle cardiologist, has gone so far as to call stress from overwork in the United States, “the new tobacco.” More breaks from a stressful workplace are seen by Europeans as yet another way to improve health. It’s unlikely that we will be able to quickly change the levels of hierarchy and inequality in the United States or to suddenly strengthen our safety net—although we should. But policies offering shorter work time and longer vacations—clear stress reducers—could be enacted more easily and quickly. At present, there are several waiting in committee in Congress, including the Paid Vacation Act of 2009 and a major work-sharing bill.
Nic Marks, a psychologist with the New Economic Foundation in London, calls social relationships “the bedrock of good health.”Other population health experts agree. In fact, connecting with others may be the single most important thing we can do to be healthier. It’s widely understood in the field of public health that social connection strengthens immune systems and improves physical well-being. On the other hand, one of the worst things you can do to your health is to be lonesome. Yet despite all of our “social networking,” America is an increasingly lonely country. More and more people, especially older Americans, live alone, far more than in other rich countries.
A recent study by Harvard political scientist Robert Putnam found that the average American has only two close friends he or she can turn to. A quarter of us have none at all. Loneliness quickly turns into depression. As with anxiety, Americans are two to three times as likely to suffer from depression as western Europeans. Depression further weakens immune systems and lowers physical health outcomes. We respond not by changing the conditions that give rise to depression but by prescribing drugs; Americans consume two-thirds of the world’s antidepressants each year, a depressing thought indeed. “I’m always amazed at your huge pharmaceutical supermarkets,” says Nic Marks. “We have nothing like that in the UK.”
A Safe Environment
Other studies show extremely high rates of accidents in the American workplace compared to other nations. Preventable death rates in the United States, including deaths from automobile accidents, are the highest among industrialized countries. Moreover, on average, Americans breathe in air pollutants such as sulfur and nitrous oxides at double the levels of western Europeans. The European Union also has stricter controls on the release of toxic chemicals into the environment. Recent actions in Congress to ban toxins in children’s toys are a step in the right direction. Before then, many toys, particularly those imported from China, contained toxins that had been outlawed in Europe for years.
Finally—and this is no small matter—every other industrialized country guarantees its workers paid time off from work when they are sick. Only the United States does not: Half of American workers—86 percent of restaurant workers—get no paid sick days. In contrast, many other countries allow up to a month of leave. These countries know that without paid time off, workers will come to work sick, as many Americans do. Sick workers pass you your hamburger or garden burger and you get sick. They get their coworkers sick. They stay sick longer and often require more expensive treatment for their illnesses.
This is not rocket science. Most Americans get this immediately. That is why more than 80 percent of them favor a law that would guarantee paid sick days for workers and why cities like San Francisco and Milwaukee have passed paid sick leave bills. Senator Edward Kennedy’s last piece of legislation, still waiting to be passed, would help alleviate this problem. It’s called the Healthy Families Act and would offer seven paid sick days a year for full-time American workers. But sadly, the recent health care reform legislation ignored this reality.
What Can We Do to Improve our Health?
To achieve better health outcomes, Americans must begin to see health as a holistic matter, like the house I will describe. Right now, the house has a foundation and four walls that are in sorry shape. It has a gilded roof with millions of holes. It is not enough to talk of making the roof all gold and eliminating the holes, though we do need to eliminate the holes. We need to eliminate the gold as well. We need to take the profit and costly complexity out of the system and expand a program like Medicare to cover everyone, potentially at less cost. But such a system must rely more on preventive methods than high tech cures. What is clear is that universal health care is only a first step. We can:
- Strengthen health care in the early years by improving prenatal care and providing at least three months or more of paid leave to all parents of babies or very young children. Make the Family and Medical Leave Act a paid provision and extend it to all workers. Change the rules that subsidize sweeteners and other foods that are unhealthy for children. Restrict advertising of junk foods aimed at children.
- Improve our lifestyle by encouraging consumption of whole grains and vegetables. Teach children the value of eating healthy foods. Reduce working hours to give Americans more time for exercise, sleep, and healthy eating.
- Reduce stress by reinstituting tax policies that narrow the gap between rich and poor. Rebuild our social safety net and adopt policies like the Paid Vacation Act of 2009 to assure Americans periodic relief from the stress of our hyper-competitive and long-hour workplaces. Provide more resources for the early identification and treatment of mental illnesses, such as anxiety and depression. Deal with root causes, instead of merely treating symptoms.
- Strengthen connections by reducing work time and encouraging greater volunteer involvement with our neighbors and communities. Promote national service programs. Design communities that have smaller homes and more public gathering space from coffeehouses to car-free shopping districts.
- Improve safety by improving the Occupational Safety and Health Administration (OSHA) and other worker protections. Build higher density cities that are more pedestrian and bicycle friendly. Regain the environmental zeal of the early 1970s, which led to much cleaner water and air for all Americans. Pass the Healthy Families Act guaranteeing paid sick days to American workers.
Putting the Science of Happiness into Practice
News from the 5th International Conference on Gross National Happiness: How nations are applying the science of well-being to the decisions they make.
Most of these changes are taken for granted in other nations. All of them will make the United States healthier and will almost certainly cost less than our current system. Improving our health outcomes is less a matter of better science and more money than of stronger political will and the ability to see the connections between things.
Many business leaders (though certainly not all!) will object to these ideas on the grounds that they will cost too much and make us less competitive in the world economy. Yet enlightened business leaders and business schools see the value of such changes, even for the bottom line. A 2009 Harvard business school study showed that workers in a large Boston firm who put in shorter hours were more productive than longer-hour workers. Another found that companies that reduced work hours and shared jobs did far better after recessions than those that eliminated parts of their work forces. In their book, Raising The Global Floor (2009), Jody Heymann and Alison Earle show conclusively that countries that adopt more generous worker and health care policies are no less competitive and often have lower unemployment rates than those, like the United States, that practice a harsher form of capitalism.
The cost of poor health is and will continue to be far greater than the price tag for such reforms. If there is one thing more than any other that makes it harder for American businesses to compete, it’s the escalating cost of health care. Health care payments make the cost of producing an automobile, for example, far more expensive in the United States than in Canada.
We can do better. We owe it to ourselves and our children to make these changes without delay.
Click here for citations.
- A Second Opinion on Health Care: Primary care physician Ken Fabert traveled to New Zealand to experience another possible way of providing health care to America's uninsured.
- Photo Essay: Humanity: A celebration of friendship, family, love, and laughter.
- Equality and the Good Life: An interview with epidemiologist Richard Wilkinson, whose research shows that what the healthiest and happiest societies have in common is not that they have more, but that what they have is more equitably shared.
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