Archive for April 6, 2009

Stressed out? Overworked? Maybe it’s Affluenza

John de Graaf, executive director of Take Back Your Time – – will speak next Monday, April 13 at the University of Iowa about Time and Sustainability. More about his upcoming Iowa City presentation is in the Tuesday, April 7, edition of  The Gazette. In the meantime, de Graaf – a filmmaker and co-author of “Affluenza: The All-Consuming Epidemic” sent me the following on his observations about health care, which I thought were worth sharing:



By John de Graaf


There’s a problem with today’s health care debate.  It’s way too focused on health care.  How to fix the health care delivery system.  How to insure everybody.  And it’s true that the American health care system is on life-support.  Priced at nearly $8,000 a year per American, and soon to be 20% of our GDP, it’s more expensive by 40-60% than health care systems in any other industrial country and totals nearly half the health care budget of the entire world.  Yet it leaves 47 million Americans uncovered by health insurance and it produces results that are arguably the worst in any of the wealthy nations of the world. 


According to the CIA, Americans rank 46th in life expectancy, a bit above Albania.  After age 50, they are nearly twice as likely as western Europeans to suffer chronic illnesses like heart disease, hypertension and Type 2 diabetes.  Even in the hospital, US patients face unusual dangers.  More than 100,000 of them die each year from “healthcare” itself–errors or infections during treatment.  So the system is broken.  But fixing it will require a far more holistic approach than has been discussed in the health care debate.




Let’s consider American health as a house.  Health care is the roof, the final protection against illness.  In our case, it’s an expensive roof, gold plated yet with 47 million holes. 

In some ways—vaccinations, for example—it’s a preventive system, but mostly it’s sickness care.  


In other industrial countries, the roof is a simpler affair, asphalt shingles on a fiberglass mat but with hardly any leaks.  Their health care systems rely more on prevention; less on high tech treatment.  Yet the people in the house below live longer, healthier lives.  That’s because in those other countries, the foundation and the walls of the house are stronger, with fewer cracks to let in the cold.




Let’s start with the foundation.  That’s the head start toward health that children in most other rich countries receive.  There’s a stronger focus on pre-natal care, for example.  In part because of this, infant mortality in all other industrial countries is lower than in the United States, which ranks 42nd in the world, again according to the CIA.  Moreover, fewer mothers die in childbirth in those countries.  Here, the US ranks a comparatively poor 40th in the world  Maternal mortality rates for poor and African-American mothers are particularly high.  Every other rich country does better. 


Moreover, in every country in the world except, believe it or not, the United States, Liberia, Swaziland and Papua New Guinea, mothers are guaranteed paid time off from work to take care of newborns.  In most rich countries, fathers also receive paid time off to bond with young children.  In many cases, such “family leave” extends for up to a year or more.  In the US, by contrast, parents often return to work when children are only a few weeks old. 


Paid family leave, and the parental bonding it ensures, pays off in terms of children’s health—fewer childhood illnesses, fewer problems with attention-deficit disorder, less obesity, easier socialization, better readiness to learn.  Most countries find that such a taxpayer investment in early childhood results in lower health and other costs as children grow up.  In Canada, where paid parental leave—the government pays 55% of the stay-at-home parent’s salary—was recently increased from six months to a year, health care costs for children have dropped, leading to interest in extending the leave to 18 months.


A 2007 UNICEF study ranked the United States 20th out of 21 rich nations regarding children’s welfare.  The foundation of our “health house” is weak.  The rich enjoy a house with a marble floor, and our middle class, a wooden one.  Poor Americans, far less likely to be insured, have a dirt floor, with rain leaking through the holes in the roof and puddling up in the corners.




If Democrats talk almost exclusively about universal health care as the solution to our health problems, Republicans tend to focus on wall number one—lifestyle choices.  It’s a matter of personal responsibility, they say.  Americans should simply stop smoking, eat properly, avoid over-eating, and excessive alcohol consumption, exercise regularly and sleep enough.  And, the conservatives argue, they don’t need government to do this.  Of course, this is sensible advice.  Citizens of other rich countries generally exercise and sleep more than we do.  And they don’t eat as much so they are less likely to be obese.


But it isn’t all a matter of personal responsibility.  Policy changes would help here as well.  Our tax system subsidizes producers of sugars and fats and our marketing system relentlessly advertises fast, unhealthy foods.  At the same time, Americans tend to work longer hours than people in other rich countries.  Europeans, for example, work 300-350 fewer hours each year on average.  Laws guarantee them sufficient time off, including a minimum of four weeks of paid vacation a year, and shorter weekly working hours.  This leaves them more time to select foods carefully, eat more slowly—and, as a result, eat less—while exercising and sleeping more.  Laws reducing work time have the effect of making them healthier.




It’s no secret in the field of public health that stress is a killer.  Sudden bursts of adrenaline worked to protect our early human ancestors against attack by savage beasts.  But continued adrenaline response to the chronic stress of modern life leads to heart problems, obesity, hypertension and weakened immune systems.  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 on top; more on the bottom.  Studies clearly show that whether it’s humans or baboons, the lower your status, the higher your stress levels.  More economically egalitarian societies, like Sweden or Japan, for example, are clearly less stressful and more healthy.


Stress is also the result of insecurity.  As the American social safety net has been gutted in recent years (with more of us losing health and pension benefits, for example) and job protections have been reduced, life in America is riskier than it used to be.  It is 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 they receive generous unemployment benefits, job training and government jobs if they are unable to find a position in the private sector.  Insecurity also leads to anxiety, a mental illness.  American rates of anxiety are double or triple those in western European countries.  Mental illness negatively impacts physical health even further.  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 US than in other rich countries.  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 US, or that our safety net will be suddenly strengthened.  But policies offering shorter work time and longer vacations, clear stress reducers, could be enacted more easily and quickly, and they should be.




It’s another clear understanding in the field of public health that social connection strengthens immune systems and improves physical well-being.  In fact, connecting with others may be the most important single thing we can do to be healthier.  On the other hand, one of the worst things you can do for your health is to be lonesome.  Yet America is an increasingly lonely country.  More and more people, and especially older Americans,  live alone, far more than in other rich countries.  A recent study 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. 


A National Institutes of Health study comparing frequency of chronic illness in the United States and the United Kingdom found that Americans are nearly twice as likely to suffer from heart disease, diabetes and hypertension in old age.  Such diseases account of a huge part of our healthcare costs. The study controlled for age, race, income and gender differences and found, surprisingly, that poor Britons are as healthy as rich Americans. The study didn’t find that eating fish and chips makes you healthier. The major reasons for the difference were all related to the fact that the British had more security and more free time, which they used to exercise more, but especially to socialize more.  Here again, public policies giving workers more time off the job would improve health, in this case, by allowing Americans more time to spend with family and friends.  Clearly, this would also strengthen families and communities.




Americans, according to the UNICEF study of children’s welfare, rank at the bottom in child safety, with the highest rates of accidents among children.  Part of this is due to time pressure on American parents which leaves them less able to supervise their children.  Other studies show extremely high rates of accidents in the workplace compared to other nations.  Preventable death rates in the US, including deaths from automobile accidents, are the highest among industrial countries.  Moreover, on average, Americans breathe in air pollution at double the levels of western Europe.  The European Union also has stricter controls on the release of  toxic chemicals into the environment. 


Finally, and this is no small matter, every other industrial country guarantees its workers paid time off from work when they are sick; only the US does not—half of American workers get no paid sick days.  In many other countries, as much as a month of leave is allowed.  These countries know that without paid time off, workers will come to work sick, as many American workers do.  They will get others sick and stay sick longer, often requiring more expensive treatment for their illnesses.  This is not rocket science.  Most Americans get this immediately.  That is why more than 80% of them favor a law that would guarantee paid sick days for workers.




To achieve better health outcomes, Americans must begin to see health as a holistic matter, like the house I describe.  Right now that house has a foundation that is part marble, part rotting wood and part dirt.  It has four walls that are a mixture of teak, balsa wood and bamboo, all of them in sorry shape.  And finally, 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, taking the profit and costly complexity from the system and expanding a program like Medicare to cover everyone, potentially at less cost.  Such a system must rely more on preventive methods rather than high tech cures. 


But fixing the roof is only a first step.  If we also pay attention to the foundation and the walls, we can assure better outcomes and probably, at lower cost, as is the case in other rich nations.  We can:


Strengthen the foundation by improving pre-natal 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.


Strengthen the wall of lifestyle by encouraging consumption of whole grains and vegetables, teaching children the value of eating healthy foods, eliminating subsidies to the purveyors of sugars and fats, and especially, reducing working hours to give Americans more time for exercise, sleep and healthy eating. 


Strengthen the wall of stress relief by re-instituting tax policies that narrow the gap between rich and poor, re-building our social safety net and adopting policies like paid vacation time (the US is the only industrial nation without a law guaranteeing paid vacations) that can assure Americans periodic relief from the stress of our hyper-competitive and long-hour workplaces.  We must also provide more resources for the early identification and treatment of mental illnesses such as anxiety and depression.


Strengthen the wall of connection by  reducing working time and by stimulating, through programs like national service, greater volunteer involvement with our neighbors and communities.


Strengthen the wall of safety by improving OSHA and other protections for workers, building more pedestrian and bicycle friendly cities, and regaining the environmental zeal of the early 1970s, which led to much cleaner water and air for all Americans.  Pass the Healthy Families Act, guaranteeing seven paid sick days to American workers.


Most of these changes are taken for granted in other nations.  All of them will make the United States healthier, and almost certainly at less cost than our current system.  Improving our health outcomes is less a matter of better science and more money than of political will and an 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.  But the cost of poor health will be far greater than the price tag for such reforms.  If there is one thing more than any other which 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 thousands of dollars more expensive in the United States than in Canada, for example, and countries with strong social safety nets are among the most competitive in the world.


We can do better.  We owe it to ourselves and our children to make these changes without delay.



John de Graaf is a documentary filmmaker, Executive Director of Take Back Your Time ( and co-author of Affluenza: The All-Consuming Epidemic.

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