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It's no secret that the poor, uninsured, obese, heavy drinkers and smokers of the world tend to have the most health problems. However, cultural factors may be as important as these well-known health risks, according to a study that appeared last year in the Journal of the American Medical Association (Vol. 295, No. 17, pages 2037-2045). Simply living in America may be as risky as a diet of doughnuts and beer, researchers suggest.

In fact, study author epidemiologist Sir Michael Marmot, PhD, of University College London Medical School and his colleagues found that despite the fact that Americans spend 2.5 times more on health care, we are far sicker than the British in rates of diabetes, high blood pressure, heart disease, heart attack, stroke, lung disease and cancer. Unsurprisingly, the team also found that Americans are less healthy the farther down they are on the socioeconomic ladder. However, in absolute terms the richest, "healthiest" Americans are as sick as the poorest Brits, Marmot says.

"Why are rich people in [America] unhealthy too?" he asks. "That's the real puzzle."

Just as intriguingly, "the usual suspects" don't fully explain these differences-accounting for less than half of them, the team found. For instance, the British drink a little more alcohol than we do. And though Americans are more obese on average, the difference between American and British body mass indices doesn't account for all of the difference in chronic illness.

Marmot believes the psychic smog that's making Americans sick could be composed of two factors. One is that Americans' long work hours leave us more stressed and less healthy. The other is that Americans may feel friendless and isolated due to social stressors created by our country's widening income gap. In turn, that societal divisiveness may be bad for our health-not just poor people's health, but everyone's, he speculates.

Nomads on a treadmill

Currently Marmot can only guess why Americans are less healthy than physical measures suggest they should be. But psychologists have identified some intriguing possibilities.

In the realm of work stress, Marmot is right: We do work longer hours than people from other countries, observes cognitive psychologist Alan Hedge, PhD, a professor in Cornell University's department of design and environmental analysis.

International Labor Organization statistics show, for example, that we're more than twice as likely as Europeans to work 50 hours a week or more. Relatedly, downsizing and outsourcing have led to longer hours and more job insecurity for many Americans, and poorer Americans often work two jobs-a trend that is nearly unheard of in Britain, Hedge notes.

As a possible consequence of such factors, many Americans are obsessed with money, no matter how much or little they make, Hedge observes.

"We're almost like a nomadic society on this treadmill, hoping that we'll either strike it rich with the lottery, or that if we work hard enough, somehow we'll become Google millionaires," he comments.

The way America deals with social building blocks such as health care, education and pensions compounds the problem, Hedge believes.

In England, for example, a university education costs about $3,000 a year, and everyone has access to adequate health insurance. British citizens must retire at age 65, with many companies encouraging earlier retirement, and they receive both a government and employer pension.

"And it's not linked to stock-market performance-your 401K doesn't evaporate because of the dirty dealings of an Enron!" he says.

By contrast, many Americans angst over how they can possibly make enough to cover insurance and other basics, while saving enough for retirement. In 2005, for instance, the average cost of a year at a private American college or university was $21,235, with some private institutions costing double that amount, statistics show.

Isolation nation

Americans facing job insecurity and financial instability may lack sufficient social supports to help them through tough times, other observers say. While findings on our degree of isolation are mixed, a study in the June 2006 American Sociological Review (Vol. 71, No. 3, pages 353-375), by University of Arizona sociologist Miller McPherson, PhD, and colleagues, for instance, reports that Americans' network of confidantes dropped from about three to two people between 1985 and 2005. Meanwhile, a 2001 study by York University psychologist Ami Rokach, PhD, in Social Behavior and Personality (Vol. 29, No. 5, pages 477-489) found that North Americans scored higher than their Spanish counterparts on five factors related to the experience of loneliness, including feelings of social inadequacy and alienation, interpersonal isolation, and self-alienation.

Indeed, Americans with two jobs, for example, may not have the time to meet up with friends, says Hedge. Our tendency to pick up and move for new jobs, leaving friends and family behind, could also be a factor, undergirded by a culture that favors the individual over the group, adds psychologist, social observer and best-selling author Mary Pipher, PhD, whose most recent book is "Writing to Change the World" (Riverhead, 2006).

"We no longer live in a culture where we know most of the people we encounter," she says.

Indeed, the British and other Europeans place far more emphasis on social bonding than we do, Hedge says. Take the British pub: "The fact that you have a local place where neighbors go every night just to communicate-that seems to be completely different from the American approach where people vanish into their house at night and lock themselves in," he says. In fact, many studies show that compared with Americans, Europeans would rather forego more income for more leisure time, Marmot adds.

Is it possible such differences could affect a nation's health? Maybe, says Sheldon Cohen, PhD, professor of psychology at Carnegie Mellon University. In a 2005 study in Health Psychology (Vol. 24, No. 3, pages 297-306), for example, Cohen and colleagues found that first-year college students with smaller social networks and greater reported loneliness had a poorer immune response to flu vaccine than other students.

In related findings, people with the greatest number of social roles and domains of social connection are less likely to smoke and drink in the face of social pressure than those with less diverse networks, according to another forthcoming study by Cohen's team, also to appear in Health Psychology.

"We think the high-integration people may in fact be responding to social norms," Cohen says, "but to the larger norms of their network as a whole-to stay healthy and take care of yourself so you can take care of other people." By contrast, those low in social integration "may use smoking and drinking as a way of lubricating social interactions," he notes.

Passing the bucks?

Parents, both rich and poor, may be bequeathing this culture of stress to their children, adds Marin County, Calif., psychologist Madeline Levine, PhD, author of "The Price of Privilege: How Parental Pressure and Material Advantage Are Creating a Generation of Disconnected and Unhappy Kids" (HarperCollins, 2006).

Levine wrote her book after observing more and more well-off young people entering her office with depression, anxiety, loneliness and self-destructive behaviors, such as cutting, eating disorders and substance abuse. The epidemic, she thinks, results from messages from parents and teachers that tell children to excel and seek material success, even at the expense of healthy prosocial development-a phenomenon she calls "the culture of affluence." This trend isn't limited to wealthy families, she adds, but to any parents who tend to value material goods over relationships and competition over cooperation.

To begin to break up this consumeristic malaise that's poisoning Americans and their children, Levine teaches parents first to spend substantive, nonstressed time with their kids, and then to help them build relationships and become giving members of society-views she's sharing with sell-out crowds around the country.

"Research shows that a child's first community is their home," Levine says. "If they grow up believing they have a contribution to make, they'll have an easier time raising a family and being part of a community. I tell parents that if at the end of the day your kid doesn't have coping skills, it doesn't matter where he gets into school."


Tori DeAngelis is a writer in Syracuse, N.Y.