Long Term Unemployment and Mental Health

“Injustice anywhere is a threat to justice everywhere.” 

*Martin Luther King Jr.

In the news: Unemployment Benefits Cut

The current unemployment rate in the United States is 6.7% (December 2013), a rate that is down from the height of the Great Recession.  Unemployment benefits have been in the news because Congress failed to renew an aid program for the jobless. Roughly 1.3 million Americans lost their insurance benefits last month. States vary on the number of weeks an unemployed person receives benefits.

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Source: http://www.washingtonpost.com/blogs/wonkblog/wp/2013/12/20/unemployment-benefits-for-1-3-million-workers-expire-next-week-heres-what-you-should-know/

Long Term Unemployment

Most economists define chronic unemployment to be a period of unemployment lasting longer than six months. It is important to note when calculating most unemployment statistics, those that are underemployed or not actively searching for a job are not counted. In November 2013, the chronically unemployed made up 37% of total unemployed people. While the overall unemployment rate is lowering over time, the rate of the chronically unemployed remains stagnant.

For those that experience long periods of unemployment, it is more challenging to get a job. The reasons for this could be an outdated skill set or a possible employer’s bias to hire someone currently unemployed. The long-time unemployed tend to be people who worked in manufacturing or construction and are older. Many companies do not look at the resumes of the long-term unemployed.

Source: http://www.motherjones.com/politics/2013/12/longterm-unemployment-recession-charts

Long-term Unemployment and Mental Health

People that are unemployed understand the stress associated with joblessness. The process of looking for a job, in many cases, is much harder than the jobs itself. No income, high levels of uncertainty, and limited health insurance is terrifying. WBEZ (Chicago Public Media) had a segment about the emotional expense of unemployment. This conversation went beyond the financial toll of unemployment to the impact of mental health. Chronic unemployment is associated with higher rates of depression and suicide.

In 2011 the CDC found that suicide rates rise when the economy is bad. The federal government statistics on suicide released in May 2013 showed a 28% increase in suicides for 35-64 year olds between 1999 and 2000. The unemployment rate peaked in 2009. Researchers find that those who are looking for work are about twice as likely to end their lives as those who have jobs.  As economic stress increases, the incidence of anxiety disorders increase. To add to the pain of losing a job, most people quickly lose health insurance. Without health insurance, it is expensive to see a doctor or mental health provider. The Affordable Care Act might help people obtain health insurance in the future. It is important to point out that unemployment and suicide are not causal but rather correlated factors.

Back to that funding cut

Long term unemployment is a serious problem and not just for the economy. Long-term joblessness is a serious risk factor for suicide and depression. Much of the national discussion about unemployment benefits are centered on time limits - the number of weeks of unemployment benefits available for the newly unemployed. However, placing time limits on unemployment benefits is hurting the group of people who have the hardest time finding employment - the long-term unemployed. In many cases, unemployment benefits are not handouts, they are lifelines. The link between unemployment and mental health must be discussed and not stigmatized. I urge Congress to renew spending for unemployment programs. In honor of Martin Luther King Jr., if you see injustice somewhere do something. Contact your Representatives and Senators and let them know how you feel.

Water = Life

Early on Thursday, residents of Charleston, West Virginia began to notice a licorice smell in the air because of a chemical spill in the Elk River. Since then, nearly 300,000 people have been unable to use their tap water for fear of being exposed 4-methylcyclohexane methanol, a chemical used to process coal that can cause skin and eye irritation, nausea and vomiting.  Though experts say that the chemical isn’t lethal, they admit to not knowing much about the chemical and it’s effects on people’s health.  

Thankfully, the National Guard and other emergency aid agencies have been able to distribute bottled water to residents of the affected counties.  However, there has been some worry about price gouging to the point that the State Attorney General encouraged citizens to report anything they noticed.  Many West Virginia residents are frustrated with the situation as well as the company that spilled the chemical and rightly so. Citizens in West Virginia are undoubtedly suffering because of this chemical spill.  Not only those who have been exposed to the toxin and gotten sick because of it, but also the wage workers in the counties that have been shut down.  Many people in the service industry (like waiters) are out of work until restaurants, hotels, and stores open again.  These tend to be the people who can least afford to go without wages.

The Benefits of Clean Water

We in the United States often take water for granted.  Most of us have never experienced a drought, a disaster that cuts off water, or a chemical spill like the one in the Elk River.  Getting the water we need has always been a simple matter of turning on a faucet, so we don’t always appreciate how important water is for life.  We need water …

1.) to live - water plays an essential part in the work our cells do to keep us alive which is why people can generally only survive 3 days without water.

2.) for sanitation purposes - without an adequate water supply, sanitation suffers and disease spreads.

3.) for personal hygiene - think about it - showers, hand washing and brushing your teeth all require water.

When people don’t drink enough water, the health consequences are myriad - from headaches, constipation, and kidney stones to dehydration (which means you don’t have enough fluid to get blood to your organs).  If you have to drink unclear water you could suffer non-fatal issues like those in West Virginia or you could contract a water borne illness like dysentery and hepatitis A.

Who Doesn’t Have Access to Clean Water

It is estimated that currently 1 billion people worldwide do not have access to clean water and that each year 3.4 million people die because of it (Water Facts - Water.org).  Most of the people without access to clean water live in Africa and the Middle East which not only compromises their health, but also keeps them from rising out of poverty.  This is especially true in Africa, where many people (mostly women) have to walk 3 hours both ways to collect unclean water for their families.  “The United Nations estimates that Sub-Saharan Africa alone loses 40 billion hours per year collecting water; that's the same as a whole year's worth of labor by France's entire workforce!” (Poverty In Africa Begins With A Lack of Clean Water)

What Can We Take From the West Virginia Water Crisis

As with most things, we can use this disaster to do something positive.  Below are some ideas on how to do so.

1.) Finally get your 3 day  to 2 week supply of water that FEMA recommends in case of emergencies

2.) Start conserving water by turning off the faucet while brushing your teeth, not throwing away water, shortening your showers, etc

3.) Donate to organizations that help people around the world without access to clean water.  The Water Project is a good one.

Happy New Year! (And an ObamaCare update!)

Happy New Year! Welcome to 2014, a year that is sure to bring many new twists and turns to the Affordable Care Act. Most people agree that the rollout of ObamaCare (starting October 1, 2013) was flawed. But it is a new year so let’s reflect on ObamaCare in 2013 and anticipate ObamaCare in 2014.

Here is a quick summary

The Affordable Care Act (ACA) was signed into law on March 23, 2010 and it still remains the law (although some people think it is has been repealed). 

During the writing of the law and the constitutionality hearings regarding the law, some things got messy. For example, some states opted out of expanding Medicaid and states had the option to run their own “Health Insurance Exchanges” or let the federal government take control of the insurance enrollment process. Sometime in 2010, Republicans started calling the ACA ObamaCare with a negative connotation.

Flash forward to 2012, Obama embraced the the term and the ACA is now called ObamaCare. I just wanted to clear that up. Affordable Care Act = ACA = ObamaCare.

October 1, the “Health Insurance Exchanges” opened and the previously uninsured started shopping for an insurance policy. Or that was the plan. In reality, major technology glitches for the federally run insurance exchanges and most state run insurance exchanges prevented people from signing up for insurance.

New things that started January 1, 2014

Parts of ObamaCare that went into effect on January 1:

1. The start of coverage for people who signed up for ObamaCare. For those individuals (nearly 2 million)  who signed up for insurance and paid their first premium between October 1 and December 24, coverage started on January 1, 2014. For those individuals who live in states that expanded Medicaid, coverage also started January 1.
2. Coverage for people with pre-existing conditions. Starting in 2014, insurance companies cannot deny coverage for individuals with preexisting conditions.
3. The individual mandate. The individual mandate is the part of the law that requires individuals get health insurance or pay a fine. In 2014 the fine for not being insured is $95 or 1% of income, whichever amount is higher. The fine will raise each year. The White House has issued several hardship exemptions for those who insurance is deemed too expensive or who experience unique situations. A huge group of people who will fall into this category are those in the states that did not expand Medicaid. In those states, people ‘make too much money’ to qualify for Medicaid but not enough money to qualify for tax credits to purchase insurance on the insurance exchange marketplace, can file a hardship exemption.
4. Minimum insurance benefits. From now on, insurance policies have to cover preventative services and other health services defined in the law. Which is why some insurance policies were cancelled.

What to wait for in 2014

1. A functioning website. Marketplace.gov as well as the insurance exchanges the state-run exchanges seem to be working. But, hey, anything could happen. A golden rule in my life is if the success of something is 110% dependent on functioning technology, be cautious. This isn’t pessimism, people, it is reality.
   
2. Enrolling enough people. The White House wants to enroll 7 million people by the end of March 2014. About 2 million have enrolled. Based on the interest people have in obtaining health insurance, I think this is a reachable goal. But it will take a lot of website functionality and work.
3. Payment of premiums. To get coverage with ObamaCare insurance options, the individual has to pay their premium. Many people that are signing up for ObamaCare insurance have never had insurance and a premium might be a new (and scary) concept. Not many people are discussing this point, so maybe I am worried over nothing. In full disclosure, I work at a Federally Qualified Health Center and am in this thing everyday with patients.
4. Formal proof of insurance from insurance companies. The process of signing up for insurance has a lot of moving parts - the human needs to correctly determine income and correctly fill out the online application for the insurance marketplace, the insurance marketplace has to do some sort of fancy identity check, the marketplace has to talk to the insurance company, and the insurance company has to contact the human. In 2014, we will hear both success stories and horror stories.
5. Will insurance = Health? We will have to wait much longer than 2014 to answer this but it is the huge question. Will Insurance improve health? Insurance alone certainly does not save money nationally or improve individual health. Obtaining an insurance policy is only a small part of overall well-being.

As you can see, 2013 was a big year for ObamaCare but 2014 will be even bigger.

The Media's Portrayal of Women's Bodies and Its Consequences

It’s New Year’s Eve which means the people across the world are making resolutions for next year.  One of the most popular resolutions is also the one that Emily and I find the most frustrating - lose weight.  Don’t get me wrong, losing weight can be a very healthy thing to do; however,  it isn’t always.  Losing weight should never be the goal (or resolution) - being healthy should.  So why do so many people, especially women, focus on the weight?

Media’s Portrayal of Women

It’s no surprise to anyone that models are thin, but, in fact, most runway models have BMIs low enough to qualify as anorexic.  Models have been getting thinner as well - “Twenty years ago, the average fashion model weighed 8 percent less than the average woman. Today, she weighs 23 percent less” (Most Models Meet Criteria for Anorexia).  When women turn on the TV or go to a movie, they are inundated with images of women who are much smaller than they are.  “You either look like Calista Flockhart in Ally McBeal and your weight is never mentioned, or you look like Nikki Blonsky [...] and your weight is the focus of the show (The Unwritten Weight Rules for Hollywood Actresses).  If an actress does approach a more average body size, she is generally attacked in the media - just ask Jennifer Love Hewitt who was bullied in the tabloids for pictures taken of her at the beach (one of which is below).  

Women everywhere are being told that being a healthy weight is fat.  We hear sayings like, “you can never be too rich or too thin” or Kate Moss’ “nothing tastes as good as skinny feels”, so it is no wonder healthy women are always trying to lose that last 5 pounds.  For more on the media’s representation of women, check out Mis-representation and America the Beautiful - both are great documentaries and are available on Netflix.  It’s also important to note that men aren’t immune to skewed images in the media either.  Check out the National Eating Disorder website for more info on the increase in muscularity in the media as well as other issues more specific to men with eating disorders.

The Consequences

You might be thinking, “but wait, isn’t there an obesity epidemic in this country?  This can’t be that big of a problem if there is”; however, there are many negative consequences to the unhealthy portrayals of women in the media and our resultant desire for the unattainable body.

1.) Dissatisfaction with body image starts young and can create disordered eating

“Studies have found that nearly half of females ages 6-8 have stated that they want to be slimmer” (Female Body Image and the Mass Media).  The quoted article goes on to say that most eating disorders start as normal dieting behaviors but a good predictor that someone will have a clinical eating disorder is that she had early body dissatisfaction and dieting behavior.  There are not definitive numbers on how many people suffer from eating disorders as many go untreated, but the estimate is between 3 and 10%.  A striking example of how media can cause eating disorders is Fiji.  Before TV was available on the island, only 3 percent of middle school girls surveyed on the island said they had induced vomiting to control their weight - after TV, that percentage rose to 15.  Before TV, 13% of girls were considered at risk for an eating disorder, after TV it rose to 29%.  (Study Finds TV Alters Fiji Girls' View of Body)  Moreover, eating disorders have the highest mortality rate of any mental illness and are associated with depression.

2.) Even women without eating disorders damage their health

Recently, a study came out showing that unregulated supplements, especially those that supposedly burn fat or calories, are causing liver damage.  Supplements account for almost 20% of drug related liver injuries, and, though many are treatable, some people need liver transplants or die from these injuries.  When the ideal body image is unattainable by healthy means, people will turn to unhealthy means.

Conclusion

Instead of making your New Year’s resolution to lose weight, focus on being healthy or feeling good.  Maybe resolve to work out the recommended amount of time a week, or eat more vegetables.  Maybe resolve to lower your blood pressure or cholesterol.  If those things mean that you also lose weight then great - if they don’t, then you didn’t need to lose weight in the first place.

*If you or someone you know is suffering from disordered eating, please seek the care of a medical professional.  To learn more, check out www.nationaleatingdisorders.org or www.anad.org.

The hidden costs of car-centricity

The costs of car-centricity

I am a huge fan of public transportation. I am lucky that I can choose where I live based on the availability of public transportation. In the United States, there are millions of people that do not have the option of public transportation. Many cities are built so that driving is essential for every errand. Stop and think for a second how much money cars cost - the purchase of cars, insurance policies, repairs, parking and the gas. Those are the costs to the individual and they are substantial. Now think about the costs of cars to society - increased obesity and respiratory conditions are among the largest costs. All of these costs could be reduced if we start to improve our cities to be less car-centric and more person-centric.

Car centricity and obesity

On the very basic level, obesity = calorie intake > calories burned. So, if you eat more than you burn, you gain weight. Walking burns calories, while driving doesn’t. Imagine that instead of driving to work, you walked 3 blocks to a bus stop. That would be 6 blocks of walking without even trying!  Researchers have found that the more we drive as a nation, the more obese we become. The map below shows the link between obesity and car commuting.

Obesity rates are highest in Appalachia and the Southeast United States. Image: Planetizen

The American Public Health Association (APHA) estimates that cost of obesity associated with inactivity for society is $142 billion dollars annually for the United States.

Car-centricity and respiratory conditions

Car exhaust exacerbates respiratory conditions and is linked to heart conditions. Children, the elderly, and low-income individuals are at a greater risk than the general public to develop car exhaust related illnesses. While children and the elderly are at special risk due to the structure of their lungs, low-income individuals are at a great risk because the neighborhoods in which they reside are more likely to contain massive highways. The costs associated respiratory conditions include health costs, like doctors appointments and ER visits, as well as premature death. The APHA estimates the cost of air pollution in the United States  from traffic to be $50-80 billion dollars annually.

How to decrease car-centricity

Unfortunately it is not possible for most Americans to take public transportation instead of driving.  Cities are built up around the use of cars and cars are very much part of the American culture. Emerging research suggests that younger Americans are driving less. I do not think that higher taxes on cars or toll ways are a good option. People have to get to work and should not be punished because for centuries American cities have been build around car use. However, mixed-use developments are a promising step in the right direction. Mixed-use development integrates commercial and residential areas into one building that emphasizes pedestrian functionality. Major investment in both city and regional trains is also imperative. On a smaller level, I encourage businesses to offer mass-transit passes to employees or organize ride-share programs.  Americans are interested in more public transportation options. However, our dependence on the car is structural and it will take time to modify the American culture, change human behavior, and re-design cities and regions with better mass transportation options.