"The environment" (God, I hate that word) also includes our lives at work, and in an important column last week in the NYTimes (excerpted below the fold) Paul Krugman discusses a carefully designed study that compared the health of Americans versus the health of Britons. The study finds that despite spending twice as much money, on average, as the Brits, Americans are far sicker.
Malcolm Gladwell, the gifted writer for the New Yorker, discusses the column and solicits comments on his fairly-new blog, and makes the crucial point:
Krugman argues that this is evidence of how much more stressful living in America is than living in England. I think that’s absolutely right. I would simply add that it is one more nail in the coffin of the notion that good health is something that can be purchased through fancy, high-tech drugs and doctors and hospitals. I know the idea that health care is just another consumer good is pretty popular at the moment. But its very hard to read the JAMA study, see what our $5274 actually buys us–and still believe in that notion. Our health is in reality a function of the broader society in which we live–the pressures and conditions and environments in which we find ourselves.
As one of the comments on Gladwell’s post points out, Americans consider themselves lucky to get paid for two or three weeks a year of vacation; in Britain, it’s five or six weeks. This is no small difference; and, I strongly suspect, a big reason why Americans lives are so much more stressful and so much less healthy than the Brits, even though Americans smoke less and drink less.
A solution? My fantasy is that a well-liked candidate runs for President on a platform of providing a month of paid vacation per working American per year. When I mention this people give me the sort of tolerant looks that one turns on crazy people, but why is this deranged? That we should have a tenth or so of our time for ourselves? And not for money? Man, don’t even mention it. That’s crazy…
Our Sick Society
By PAUL KRUGMAN
Published: May 5, 2006
Is being an American bad for your health? That’s the apparent implication of a study just published in The Journal of the American Medical Association.
It’s not news that something is very wrong with the state of America’s health. International comparisons show that the United States has achieved a sort of inverse miracle: we spend much more per person on health care than any other nation, yet we have lower life expectancy and higher infant mortality than Canada, Japan and most of Europe.
But it isn’t clear exactly what causes this stunningly poor performance. How much of America’s poor health is the result of our failure, unique among wealthy nations, to guarantee health insurance to all? How much is the result of racial and class divisions?
How much is the result of other aspects of the American way of life?
The new study, ”Disease and Disadvantage in the United States and in England,” doesn’t resolve all of these questions.
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Comparing us with the English isn’t a choice designed to highlight American problems: Britain spends only about 40 percent as much per person on health care as the United States, and its health care system is generally considered inferior to those of neighboring countries, especially France. Moreover, England isn’t noted either for healthy eating or for a healthy lifestyle.
Nonetheless, the study concludes that ”Americans are much sicker than the English.” For example, middle-age Americans are twice as likely to suffer from diabetes as their English counterparts. That’s a striking finding in itself.
What’s even more striking is that being American seems to damage your health regardless of your race and social class.
That’s not to say that class is irrelevant. (The researchers excluded racial effects by restricting the study to non-Hispanic whites.)
In fact, there’s a strong correlation within each country between wealth and health. But Americans are so much sicker that the richest third of Americans is in worse health than the poorest third of the English.
So what’s going on? Lack of health insurance is surely a factor in the poor health of lower-income Americans, who are often uninsured, while everyone in England receives health care from the government. But almost all upper-income Americans have insurance.
What about bad habits, which the study calls ”behavioral risk factors”? The stereotypes are true: the English are much more likely to be heavy drinkers, and Americans much more likely to be obese. But a statistical analysis suggests that bad habits are only a fraction of the story.
In the end, the study’s authors seem baffled by the poor health of even relatively well-off Americans. But let me suggest a couple of possible explanations.
One is that having health insurance doesn’t ensure good health care. For example, a New York Times report on diabetes pointed out that insurance companies are generally unwilling to pay for care that might head off the disease, even though they are willing to pay for the extreme measures, like amputations, that become necessary when prevention fails. It’s possible that Britain’s National Health Service, in spite of its limited budget, actually provides better all-around medical care than our system because it takes a broader, longer-term view than private insurance companies.
The other possibility is that Americans work too hard and experience too much stress. Full-time American workers work, on average, about 46 weeks per year; full-time British, French and German workers work only 41 weeks a year.
I’ve pointed out in the past that our workaholic economy is actually more destructive of the ”family values” we claim to honor than the European economies in which regulations and union power have led to shorter working hours.
Maybe overwork, together with the stress of living in an economy with a minimal social safety net, damages our health as well as our families.
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Kit Stolz 