How does ill health affect our ability to function and what difference does it make to us, not just as individuals, but to how we function as a society?
This is the question I have been pondering as new reports show that the global population continues to get sicker.
For instance, findings from the European Social Survey European Research Infrastructure Consortium report showed that women are much more likely to report depressive symptoms and severe headaches. Men were far more likely to report being overweight and rates of smoking and binge drinking are up across much of the continent.
Simply promoting healthy behaviours, say the authors, is not enough to create change since many of these problems can be linked, in part, to economic and social conditions.
Around the same time a US report looked at rates of ‘co-morbidity’ – people who have more than one chronic condition − especially as it relates to people with mental illness.
Their data showed that nearly 40% had one or more chronic medical conditions in their lifetimes; 18.4% of US adults had a mental illness in the past year, and 8.6% reported substance abuse/dependence during the same time. Once again social conditions played a role; 14.7%, for instance, were living in poverty.
What the future holds for the 50% of Americans suffering from multiple health challenges remains to be seen, said the researchers. Indeed.
This isn’t new information. Last year the Global Burden of Disease report − the largest analysis of trends in health around the world for the years 1990 to 2013 − found that only about 4% of people worldwide had no health problems. In contrast, a third − about 2.3 billion people − had more than five health problems.
The study which involved data from 188 countries and looked at more than 300 types of illnesses and injuries also confirmed what many of us have been saying for years – that although we are living longer, we are not necessarily living better.
A two-way street
All of these reports acknowledge the relationship between poor health and factors such as income and social conditions.
But my question is, what if we look at this relationship as a two-way street?
What if our social situations don’t simply feed into our health status? What if our level of health also directly contributes to how we perceive, construct and interact with society?
There is no question that, at a fundamental level, being ill changes who we are and how we interact and respond to events.
Patients with chronic conditions often have to adjust their hopes and aspirations, their lifestyles, and even sometimes their employment prospects. For this reason they may be in a state of grief and frustration that never gets diagnosed or addressed.
If the illness is protracted or has a poor prognosis they may develop deeper psychological distress, most commonly in the form of depression or anxiety.
Different conditions bring with them different levels of emotional symptoms. For instance, the proportion of patients with conditions such as diabetes or rheumatoid arthritis who have an ‘affective’, or emotional disorder is between 20% and 25%. Among patients admitted to hospital for acute care and among patients with cancer, rates of depression can exceed 30%, compared with a general rate in the community of about 4%-8%.4
Other evidence suggests that in an ageing population as rates of illness go up so do rates of emotional instability, a trend that is contrary to what we might normally expect – namely that as we get older we become more emotionally stable.
Add in the number of drugs we take to deal with multiple illnesses and we have an even more toxic emotional mix.
Functioning, but how well?
Many of us continue to ‘function’ from day to day with all these physical and emotional challenges. But how well we function is anyone’s guess.
When we are in pain or distress, when we are anxious or depressed or feeling isolated or helpless it alters our personalities, our emotions, our needs and therefore our decision making.
With big political decisions looming in many countries it’s worth at least asking the question: How might society’s general health status affect how we ‘read’ the media or understand the ‘facts’ and how this might translate into our political and economic choices?
No one has yet compared the progress of US presidential candidates to the health of the states that have got behind them. Nor have I seen any correlation of those who voted for Britain to leave the EU as it relates to their general levels of health. These might be interesting exercises.
As our society gets sicker it also begs the question of who really wants the job of governing such a population? Will it be someone who is a nurturer or an abuser? Someone who creates advantages or takes advantage?
Presented with the facts of an increasingly sick society we usually focus on how much it costs healthcare system. This is an important consideration, but there are other unexplored costs attached to a sick society too.
Perhaps we need to start accounting for these as well.
Pat Thomas, Editor
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