For the hundreds of millions of people living where vital resources are scarce, hazards to health are not hard to find. For those of us fortunate enough to reside in resource-rich countries, however, the greatest health hazards are subtle -- and far more telling than the usual litany of hypertension, high cholesterol and the like.
The greatest hazards to our longevity relate to the quality of our daily lives. The less frequently we can end the day with some sense of peace and satisfaction, the sooner we die. There are segments of the population that lose 5-10 years of their lives on this basis. We have a robust science that identifies these segments. Much of this science relates to our life in the workplace.
For most of us, the workplace is the setting in which much of our adult life plays out. For all of us, there are challenges and rewards, times that are gratifying and times that are not. No one escapes difficult moments, days -- or even more.
Those who find little satisfaction, who feel misused, abused or insecure, face more than an assault on their sense of worth. They face an assault on their sense of well being. And they face an assault on their longevity. None of this is trivial.
This is magnified greatly whenever employment is threatened. Loss of income stability can quickly prove malignant. For example, life expectancy in Russia dropped a decade within 10 years of the fall of the Berlin Wall.
Even more dramatic is the health consequence of "downsizing." We have known about this since the Reagan-Thatcher era.
One lesson came from Finland. Scientists at the Finnish Institute of Occupational Health had been studying the health and welfare of the workforce when Finland suffered a severe economic downturn; unemployment surged to nearly 20 percent between 1991 and 1995.
Raiso, a city in southwestern Finland, watched its tax base erode, leaving no option other than downsizing its 1,000-person municipal workforce. In anticipation of job loss, the rate of absenteeism for medically certified sick leave escalated. This was particularly the fate of higher-income, older workers. Many found their next episode of backache or some other musculoskeletal disorder to be incapacitating.
Therefore, money saved in downsizing was partially offset by the cost of disability awards. That's the least of it. The Finnish investigators added the experience of the municipal employees of nine other cities to that in Raiso. Downsizing had a similar effect across the board.
However, when they analyzed the consequences for this larger population of over 25,000 workers, it became clear that there was a five-fold increase in the risk of death from heart attacks apparent in the first four years after major downsizing.
Downsizing is more than miserable, more than an assault on one's sense of well being. It's lethal, and it's particularly malicious when it comes to the aged worker.
The Finnish experience in the 1990s is impressive. However, this is neither a Finnish problem nor a problem of the 1990s. Similar studies have since appeared from many resource-advantaged countries and many industries.
The resource-advantaged world is in the midst of economic upheaval. We watch aghast as familiar institutions fall and sometimes are reborn.
Does anyone speak to the cost in human capital? There is a looming crisis in the health of the public. We need a "soft landing" for the displaced, redundant, downsized, unemployed, aged workforce more urgently than for the Dow Jones Industrial Average. We even know ways to soften the landing: shared jobs, reduced workdays, more rational health insurance, or help transitioning.
We need the priority.
Dr. Nortin Hadler is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and an attending rheumatologist at University of North Carolina Hospitals. He is the author of Worried Sick: A Prescription for Health in an Overtreated America and The Last Well Person.
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