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This article is a guest post written by University of Illinois Professors Teresa J. Krassa and Michael A. Krassa. Their areas of academic study are nursing and political science, respectively.
Around the world, health correlates with happiness. The two are inextricably linked in numerous ways and through various channels, but in the end the relationship is a very strong one. Given the connection between health and happiness—that the two cause each other, in effect—the student of politics draws an immediate connection to the institution that might thus be responsible for variations in both health and happiness across the world: the nature and quality of a country's health care system. The simple fact is that the happiest countries, as well as the healthiest ones, tend to be those with some form of universal health insurance covering all citizens. It does not appear to matter what form universal access to care comes from—it could be a single payer system as in Canada, "socialized medicine" as in the UK, or the various forms and mixtures of guaranteed private or public insurance that characterizes most countries in Western Europe. What seems to matter is the simple question of whether all citizens have access to affordable, high quality medical care.
Let us first consider a life expectancy and health across nations. While life expectancy is obviously an indicator of a healthier populace, it is also used as a measure of the quality of healthcare in a given country, as low-quality health care obviously results in shorter lives. The first graph (below) shows that, in general, longer life expectancies correlate with greater levels of life satisfaction (indeed, the full statistical relationship is actually stronger than this simple exercise illustrates). Similarly, and more tellingly, the average number of "healthy years" of life we can expect (perhaps a better way of thinking about longevity) is even more strongly correlated with satisfaction, as the second graph shows.
The scholarly research clearly indicates that happiness promotes longer lives (e.g. Frey, 2011), better health, and faster recovery from surgery or illness (e.g. ABC News, 2016). We also know (as several earlier pieces in this column have discussed) that a generous social safety net helps promote happiness by freeing citizens from not only actual economic hardship, but also by protecting them from the worst kind of worry over financial disaster should they might become ill, pregnant, unemployed, retire, change jobs, or start businesses.
Providing some level of insurance obviously relieves worry and tension, both about healthcare and finances, which in turn promotes health and lengthens lives. Where this safety net originates may or may not be important, but one thing is clear: whether it is provided by government, family, church, private insurance, or even one’s community, its presence frees people to pursue longer, happier, and more productive lives. Since this century is characterized by transience (weakening community ties), high divorce rates and nuclear (not extended) families (i.e. weakening family ties, and weak ties (at best) among neighbors), it may be obvious that, while not the only way, government offers the most obvious and common way of providing some kind of safety net to all citizens.
As far as health statistics go, it is important to note that the U.S. fares poorly, largely because it is the only developed nation not offer universal coverage to all citizens. The simple fact is that all nations that have some form of universal care rate relatively highly in happiness, life expectancy, and health. The relatively poor performance of the US on these measures is at least partially attributable to the absence of universal health care. The reasons for this are well understood.
American life expectancy has for decades been declining for poor and working-class men (Lowry, 2016), and even more dramatically for all but the richest women (Ehrenfruend, 2015). There are many causes for this, related to social changes, the economic decline and associated insecurity of the working and middle classes, and the nature of the healthcare system. In the US, all of those forces work against improving health and extending life. Economic insecurity (Woolf, et al., 2015) and declining real wages increase both a person’s level of worry and the chances of being uninsured or poorly insured. Moreover, across most of this time frame we’ve seen both the affordability (Riffkin, 2015) and comprehensiveness (Kaiser Family Foundation, 2013) of insurance decline, resulting in more Americans having difficulty accessing health care even if they have some health insurance, thus increasing both psychological and physical problems.
Healthcare affects life expectancy in America in several ways. One is that having quality healthcare includes regular check-ups and physicals, affordable prescriptions, care for chronic conditions, and emergency care—all things obviously likely to affect one's health and longevity. But it also is worth noting that while access to such care is directly important, both lack of access and access that puts family finances in jeopardy dramatically affect both health and life expectancy indirectly by increasing tension, creating stressful uncertainty over one's life and future, and straining interpersonal and family relations. We know that worry and stress (Lu, 2014) decrease life expectancy and health (Goodman, 2012).
Regardless of whether it is achieved via the free market, regulated markets, government plans, or other means, it is clear that universal health coverage that is high quality and provides a mechanism against bankrupting a family who uses it is will increase well-being (Institute of Medicine, 2012), worker productivity (O’Brien, 2003), job performance (Way, et al, 2011), and life expectancy (Kronick, 2009).
It seems uncontroversial to suggest that we consider these facts in our public debate over the fate of the healthcare system.
Data Sources and References
Data for life expectancy and number of healthy years used in this article are from the UN World Development Indicators (WDI) and use the most recent year given for each nation.Data for life satisfaction come from the 2015 World Happiness Report.
ABC News, “Positive Thinking, Faster Recovery.” ABC News Archive, July 24, 2016. http://abcnews.go.com/Health/story?id=117317
Sirry M Alang, et al. “Disability, Health Insurance, and Psychological Distress among US Adults: An Application of the Stress Process.” Society and Mental Health 4:3 (May 23, 2014). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352711/
Max Ehrenfreund, “The stunning—and expanding—gap in life expectancy between the rich and the poor.” The Washington Post, September 18, 2015. https://www.washingtonpost.com/news/wonk/wp/2015/09/18/the-government-i…
Bruno S. Frey, “Happy People Live Longer” Science 331, 542 (2011). https://www.bsfrey.ch/articles/C_521_2011.pdf
Brenda Goodman, “Even mild anxiety may shorten a person’s life.” WebMD Archives, July 31, 2012. http://www.webmd.com/mental-health/news/20120731/mild-anxiety-may-short…
Institute of Medicine, “Family Well Being and Health Insurance Coverage.” Health Insurance is a Family Matter, Washington, DC: Institute of Medicine Committee on the Consequences of Uninsurance, National Academies Press, 2012. https://www.ncbi.nlm.nih.gov/books/NBK221008/
Kaiser Family Foundation, “Kaiser Health Tracking Poll: September 2013.” Kaiser Foundation, Sept 28, 2013. http://www.kff.org/health-reform/poll-finding/kaiser-health-tracking-po…
Richard Kronick, “Health insurance coverage and mortality revisited.” Health Services Research 44(4): 1211-1231, 2009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739025/
Rich Lowry, “The Working Class Meltdown.” The National Review, April 26, 2016. http://www.nationalreview.com/article/434544/white-working-class-mortal…
Stacy Lu, “How chronic stress is harming our DNA.” American Psychological Association 45:9, p. 28. (October 2014). http://www.apa.org/monitor/2014/10/chronic-stress.aspx
Ellen O’Brien, “Employers’ benefits from workers’ health insurance.” Milbank Quarterly, 2003.
Jonathan Potts. “Happy People are Healthier, Carnegie Mellon Psychologist Says.” Carnegie Mellon News Archive (Nov. 6, 2006). https://www.cmu.edu/news/archive/2006/november/nov.-6-happy-is-healthie…
Rebecca Riffkin, “Cost still a barriers between Americans and medical care.” Gallup, 2014. http://www.gallup.com/poll/179774/cost-barrier-americans-medical-care.a…
Sean Way, et al., “The impact of health insurance on employee job anxiety, withdrawal behaviors, and task performance.” Cornell University School of Hotel Administration, Jan 1, 2011. http://scholarship.sha.cornell.edu/chrpubs/165/
Steven Woolf, et al., “How are income and wealth linked to health and longevity?” Virginia Commonwealth University and The Urban Institute Center on Health and Society, 2015. http://www.urban.org/sites/default/files/publication/49116/2000178-How-…
