Are Americans Working Health Care into the Ground?

We Americans are proud of our work ethic. We work longer hours, and more productively, than any other nation. Our industriousness has long been cited as a source of strength of our economy—but it just might be a source of some of our health care woes as well. 

According to a just-released study from Wake Forest University, professional flexibility is an important contributor to better health. Employees at all levels who have, or feel they have, more job flexibility (e.g. the ability to work from home, choose their hours, etc.) engage in healthier behavior than those that don’t. The study found that employees with flexible schedules exercised more, attended more employer-sponsored health classes, were more likely to describe themselves as living a healthy lifestyle, and reported getting more sleep. When the researchers checked in a year later, they found that as job flexibility improved, so did healthy habits: more flexibility meant more sleep, more health classes, and a healthier lifestyle.

This study deserves attention. Changing behavior is the single most powerful way to prevent health problems. As experts from the Robert Wood Johnson Foundation noted in a Health Affairs article earlier this year, “behavioral issues represent the greatest single domain of influence on the health of the U.S. population,” with 40 percent of early deaths in the U.S. due to behavioral patterns. Anything that promotes health behavior needs to be seriously considered as a strategy for making America healthier—and by extension, health care costs lower. 

Obviously, somehow ensuring that everyone in America had more flexible hours wouldn’t cut early deaths by 40 percent. And there’s no guarantee that more flexible hours will translate into better sleep, more exercise, or more education on a national scale. Any movement for universal job flexibility would have to be coupled with a concerted effort to translate free time into healthy time.

But this study gets us thinking about behavior as more than just the usual spate of no-nos like smoking or eating poorly. Work is behavior. Work is relevant to health—more so even, than the Wake Forest University study suggests. There’s an argument to be made that more job flexibility can translate into a shift away from medication in two big arenas: childhood disorders and depression.

More flexible work schedules allow parents to spend more time with
their children. This may seem like a fuzzy nicety, but parenting is making a scientific comeback
as an important means of addressing childhood disorders like ADHD. Both
the American Psychological Association and American Academy of Child
and Adolescent Psychiatry recommend qualitative, talk-based treatments
before turning to drugs.  These recommendations are based on a growing
body of evidence that interactive, family-based therapies may take
work, but they get results. For example, studies find that up to three
quarters of children who suffer from depression, anxiety or
obsessive-compulsive disorder find relief of their symptoms with the
help of cognitive behavioral therapy (CBT), where children learn
lessons with therapists that parents reinforce at home. And parents are
vital to CBT’s success—their involvement has been proven to make the therapy more effective than child-centered approaches. 

Again, freeing up parents’ time is no guarantee that they’d be better
parents. But imagine if our family and medical leave laws covered
quality time with kids that have disorders. Currently, employees get
unpaid leave for attending to sick children; but it’s possible to
envision a policy where properly authorized parents can take leave, or
fudge their schedule, to be able to participate in CBT with their
children or help them focus, etc. The more accommodating work hours are
to parental interventions, the less we rely on medication as the
exclusive antidote for childhood disorders. The ADHD drug market is
predicted to be $4.3 billion by 2012, with 90 percent of sales being in
the U.S. Make a dent in this market—not eliminate it, just help shift
to a less exclusively medicinal model of treatment—and the savings
would be gigantic.

We could also cut spending on antidepressants, the drug of choice for the over-worked and the stressed around the world. A study of Finnish workers in October found that those with job burnout are far more likely to receive antidepressants for mental health problems. An August British study
showed that people in high-stress jobs run twice the risk of suffering
serious depression or anxiety as those in lower-stress occupations. In
the U.S., job flexibility has been shown to help reduce postpartum depression among employed women.

This all seems painfully obvious. But in the U.S. our approach to the
stress-depression relationship is usually to try to treat the
depression—rather than reducing the stress. Increased job flexibility
wouldn’t by any means eliminate depression. Nevertheless,
antidepressants the most prescribed drugs in the U.S.: we have a lot to save if we prioritize avoiding burnout.

It’s worth keeping in mind that the U.S. spends far more per capita on
pharmaceuticals than any other nation—not only because we pay higher
prices, but because we pop more pills.

But this isn’t just about saving money. The other benefit, of course,
is better health. Sweden is one of the healthiest countries in the
world, and its strong benefit system allows for a flexible hours.
Sweden boasts the greatest percentage of people who work from home at
least one day a week in the world (51 percent). By contrast, in 2006, only 21 percent of Americans did some or all of their work at home over the course of the entire year. Sweden’s focus on flexibility stems from what Foreign Policy calls
“holistic social care—everything from happier professional lives to
better street lights that encourage evening walks” is thought to
produce “healthier citizens and ultimately lower medical bills.” 

Belgium, also one of the world’s healthiest,
prohibits night work except in fields where it is essential, such as in
the hotel, event, or health care business. Belgium also allows
employees to take advantage of a “time credit” scheme that allows
workers to stop working or reduce their working hours for any reason,
without losing their social security entitlements, for up to one year.

Are these examples—or even the Wake Forest research—guarantees that job
flexibility would immediately improve our national health and cut
costs? Not necessarily. But the undeniable link between job flexibility
and good health suggests that we need to think about the multiple
dimensions of “health care” or caring for our health. It’s not just
about medicine.

To improve healthy behavior we have to look at all behavior—including
work. And when looking abroad, “socialized medicine” isn’t the only
thing we should be examining—we should also be reflecting on this
holistic approach to health.

That means thinking about changing our family leave policies,
instituting more alternative work schedules, and truly bringing the
U.S. into the digital age so we can encourage more telecommuting. This
isn’t a cure-all. But it’s a start.

13 thoughts on “Are Americans Working Health Care into the Ground?

  1. Mega-Thanks Niko for posting this.
    I’ve dedicated much of my professional life to the premise that work satisfaction is the most understudied-underestimated source of health in our times.
    Work is central to health which of course even Freud knew over 100 years ago.
    I was the only physician on a government team (in NIOSH) on this and related matters. I’d be happy to send this work to you, Maggie and HealthBeat Blog readers.
    Dr. Rick Lippin
    PS- My Rx – Do meaningful work until the day you die.

  2. PS- Niko – I think you meant title to be “Are Americans Working Health Into the Ground?” Your original title is another essay by you or Maggie? No?
    Rick Lippin

  3. Hi Rick,
    Thanks for your comments–please do send along your thoughts on work satisfaction and health. Very interesting stuff, and a prime example of how we take a tunnel-vision approach to health in the U.S. and fail to think about the web of behavior, circumstances, and conditions that affect health far more than does medical care.
    FYI, there’s also a new University of Texas study that I was eager to include in my post but didn’t quite fit that says creative work , or work that gives workers control over their daily activities, adds years to your life. You can read more about it here:
    More evidence that work matters for health (seems so intuitive when you put it like that, and yet…)
    As for the post title, I was hoping to suggest that we are packing on unnecessary health care costs by our work habits(e.g. child medication, antidepressants). But you’re right, the post ended up being more about health than the actual savings we could get for the health care system–sometimes the posts don’t lead exactly where I think they will!

  4. The Century Foundation is an extreme left wing organization. Its utterances are presumptively garbage, in the absence of extraordinary evidence. You have no data for your garbage claims, let alone extraordinary evidence.

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