Look­ing at the links be­tween the job mar­ket and life spans

A strong job mar­ket might help pro­long life spans—just look at Ja­pan

Modern Healthcare - - News -

You may have seen an As­so­ci­ated Press story last week about longevity in Ja­pan. The lead of the story was that Ja­panese women are ex­pected to live 86½ years, top­ping the world’s longevity rat­ings for the 25th con­sec­u­tive year. The fig­ures come cour­tesy of the nation’s health min­istry and show that both Ja­panese women and men ex­tended their av­er­age life ex­pectancy in 2009 to new records—86.44 years for women and 79.59 years for men.

Ja­pan has long been known for the ex­tended life ex­pectancy of its peo­ple. A min­istry of­fi­cial at­trib­uted the im­prove­ment to re­duced mor­tal­ity from can­cer, car­dio­vas­cu­lar dis­or­ders, stroke and pneu­mo­nia. Health of­fi­cials also cite the coun­try’s healthy diet (think fish, rice and veg­eta­bles) and high liv­ing stan­dards as con­tribut­ing fac­tors.

The re­ally in­ter­est­ing find­ing is re­ported lower in the story. Ja­panese men saw their av­er­age life ex­pectancy slip to fifth from fourth in the global rank­ings. The min­istry of­fi­cial noted an in­creas­ing num­ber of sui­cides among older men. Sui­cide, crime and al­co­holism have be­come grow­ing prob­lems be­cause of low in­comes and un­sta­ble em­ploy­ment.

These find­ings do not bode well for the U.S. Ja­pan plunged into a se­vere eco­nomic down­turn in the 1990s from which it has never fully re­cov­ered. The worst eco­nomic down­turn in U.S. his­tory since the Great De­pres­sion be­gan in De­cem­ber 2007. While most econ­o­mists say the Great Re­ces­sion has tech­ni­cally ended, un­em­ploy­ment re­mains high.

For all the good done by the fed­eral stim­u­lus pack­age, mil­lions re­main out of work. The of­fi­cial un­em­ploy­ment rate, not count­ing those who have given up look­ing for work, is about 9.5%. Worse yet, 46% of the un­em­ployed have been with­out work for six months or more—the high­est per­cent­age since the govern­ment started com­pil­ing such statis­tics in the late 1940s.

Mean­while, a Rock­e­feller Foun­da­tion re­port has found that 1 in 5 Amer­i­cans has seen a de­cline of 25% or more in house­hold in­come and the down­turns are hurt­ing peo­ple more than they used to. The re­port said that in 1985, 12.2% of Amer­i­cans suf­fered a fi­nan­cial loss bad enough to make them eco­nom­i­cally in­se­cure. Dur­ing this re­ces­sion, the fig­ure stands at 25%. The pain shows no sign of abat­ing soon. Like Ja­pan, the U.S. binged on eco­nomic spec­u­la­tion and now is pay­ing the price. Ex­perts say this na­tional ver­sion of a cor­po­rate work­out could last years longer. The po­lit­i­cally roiled pub­lic sec­tor is feck­less, and the pri­vate sec­tor prefers to sit on cash and boost prof­itabil­ity by not hir­ing work­ers.

This is a recipe for so­cial in­sta­bil­ity and di­min­ished pub­lic health. We told you ear­lier this year (Feb. 22, p. 22) about an At­lantic Monthly ar­ti­cle pre­dict­ing dystopian con­se­quences from the Great Re­ces­sion. That story noted that each re­ces­sion since 1980 has re­treated more slowly than its pre­de­ces­sor. These down­turns take a par­tic­u­lar toll on males, who stake much of their self-worth on their jobs. They suf­fer crip­pling dis­ori­en­ta­tion, ag­gres­sion and of­ten turn to do­mes­tic vi­o­lence and sub­stance abuse. And we know from other stud­ies that when peo­ple feel they have lost con­trol over their lives, they suf­fer from phys­i­cal as well as psy­cho­log­i­cal stress.

Hos­pi­tal ex­ec­u­tives can ex­pect con­tin­ued op­er­a­tional and fi­nan­cial pres­sures from the unin­sured and un­der­in­sured seek­ing treat­ment. State Med­i­caid bud­gets will be strained for the fore­see­able fu­ture. Hos­pi­tal billing de­part­ments and emer­gency rooms will be sim­i­larly taxed. The health re­form law will help, but its main im­pact won’t be felt un­til 2014. High-risk in­surance pools and other in­terim pro­vi­sions can of­fer only limited help.

The un­der­ly­ing em­ploy­ment prob­lems at the root of this cri­sis may take years to fix. Just look at Ja­pan.

NEIL MCLAUGH­LIN

Man­ag­ing Edi­tor

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