Economic Stress—How Bad Is It Really?

Before the financial collapse, Dr. Jonathan Whiteson says his patients made predictable small talk. "It used to be, 'How are the children? Where did you go on vacation?'" he recalls.
"Now," he says, "they come in with a [newspaper] tucked under their arm and say, 'Did you see this?'" Usually they're pointing to a story about the market's dismal fortunes or the fallout of yet another Ponzi scheme.

Whiteson, director of cardiac and pulmonary wellness and rehabilitation at New York University's Langone Medical Center, says the change in tone has been accompanied by complaints about ailments small and large, including chest pain, gastrointestinal distress and muscle aches.

That's unsurprising given that scientific research has long demonstrated a link between poor health outcomes and declining employment and gross domestic product. Since the recession began in December 2007, the economy has shed 5.1 million jobs and the unemployment rate has reached 8.5 percent. Meanwhile, U.S. GDP decreased at an annual rate of 6.3 percent in the fourth quarter of 2008.

And since the economy began quickly unraveling last fall, there have been numerous reports about how this dynamic is playing out in the current recession: Americans are sleeping less, seeing doctors less frequently and slowing prescription drug refills.
But some reports may be exaggerating how bad the recession has been for Americans' health.

By the numbers
To be fair, various polls and surveys have accurately tracked some of the effects. In March, the National Sleep Foundation reported that more than a quarter of 1,000 survey participants were sleeping less because of the economy.

The recession has also forced Americans to skimp on health care. In a February telephone poll of 1,200 adults conducted by the nonprofit Kaiser Family Foundation, 53 percent of respondents said they cut back on health care costs by avoiding doctor's visits, skipping dental check-ups and not filling prescriptions, among other strategies.

The American Hospital Association, a national trade organization, recently reported that total visits to 650 hospitals across the country were down in the fourth quarter of 2008 compared to the previous year, with nearly 3 percent fewer visits to the emergency room and 2 percent fewer patient surgeries. The sample is not nationally representative, but is still considered a leading indicator of hospital performance.

Despite such research, it remains challenging to gauge what is happening across the nation. That's because the government rarely collects data about health outcomes in real-time. The Centers for Disease Control and Prevention, for example, surveys the public about contraceptive use once over a several-year period and those figures aren't released until a year or two later. As such, it often requires rigorous statistical and epidemiological analysis to link a single negative health outcome to the economy.

Even some major insurers are reluctant to discuss the situation. UnitedHealth Group and Aetna declined to comment on how the recession might be reducing the frequency of treatments and procedures, citing insufficient data on usage trends in the past six months.

Perception vs. reality
The dearth of statistics may explain why some are turning to individual providers for answers about what's happening to patients nationwide.

At his clinic, Dr. Whiteson has noticed that patients more frequently complain of shortness of breath, fatigue, dizziness and palpitations. They seem to be experiencing sexual dysfunction more often and report drinking more frequently.

But extrapolating such observations beyond one practice can be deceiving. Craig Wolf, president and CEO of the Wine and Spirits Wholesalers of America, Inc., says that per capita alcohol consumption has remained flat for the past 30 years—even in the past six months.

Even during deep recessions of the '70s and '80s, Americans annually drank about 2.7 gallons of alcohol per capita, a figure that has never decreased more than a half-gallon in the decades since.
Other potentially misleading anecdotes have popped up recently. A report by the Associated Press found that some regional and state health clinics and hospitals had seen a significant increase in the number of local abortions and vasectomies since last year. Last month the Washington Times reported that dentists nationwide had noticed an uptick in the number of teeth grinding cases since 2007.

But as it turns out, neither trend could be confirmed by outside sources. Planned Parenthood and the American Dental Association both lacked national data to verify the anecdotal reports.
"It's reasonable and it's plausible," says Dr. Matthew Messina, a consumer adviser for the ADA, "but it still is an urban myth."
Ted Joyce, a professor of economics at Baruch College at the City University of New York, says that there's little evidence that abortions follow business cycles. Verifying this would require comparing monthly unemployment data to monthly abortion rates, which is not collected by nonprofit organizations or the government. Looking at the raw data—abortions stayed level at 1.6 million annually throughout the '80s—doesn't help establish a pattern, either.

Skeptics might want to consult research pioneered by Dr. Harvey Brenner, a professor of public health at the University of North Texas Health Science Center and at John Hopkins University's Bloomberg School of Public Health, which has shown a correlation between economic downturns and a rise in suicides and cardiovascular mortality.

This has been proven in "sharp and complete statistical studies," says Brenner, which "all lead to a fairly strong case that major disturbances to peoples' economic lives make a real difference in life expectancy."

That's partly because high-stress events elicit an immunological response from the body, leaving it vulnerable to everything from the common cold to a heart attack. Couple the stress response with the cutback in preventive care prompted by the floundering economy, and personal health suffers.

But even Dr. Whiteson, who is certain the economy is negatively affecting his patients' health, is struggling to separate persistent symptoms from ones temporarily brought on by stress.

"It's becoming an increasing challenge to work out what's real and what's not real," he says