We’re # 1? Nope – #38 and dropping

What does overall life expectancy have to do with upstream distressors?  This BBC article does a good job at listing many of the ills that result from US style westernized culture.

Risk factors

Source: University of Washington

Unsurprisingly, many of the risk factors tend to be behaviors which involve  self-medicating and self-soothing for perceived stress, anxiety and depression.  Some are related to living in poor quality neighborhoods lacking accessible and affordable fresh whole foods and green natural spaces to walk, sit, play and socialize.  Some are results of poor work and school environments, where long periods of enforced near immobility induce ill health.

All of the listed risk factors are malleable, modifiable and can be replaced with healthier choices.  But some of those alternatives needs must be supported by national, state and local policies and funding.  Fat chance of that happening in Tea Partier America.

Scientific American must have been channeling along the same lines in its Myths piece.

Myth #3 speaks to the notion that access to healthcare is a primary determinant of health.  Not so.

Access to health care is only one of several factors that play an important role in determining how healthy people are. Several studies suggest that easily being able to obtain medical care does not play as big a role as education, lifestyle, income and modern housing, along with sanitation (pdf) and vaccinationin determining why some folks are healthier than others.

Where the availability of health care makes the biggest difference to the health of any group is when people have regular access to general or primary care clinicians, who are able to take care of most of the medical problems people face most of the time. Good nursing care is particularly important for people with multiple chronic conditions.

When People Aren’t De-Stressed

There was an extraordinary commenting discussion about suicide as reader responses to a NYTimes column by the physician and writer, Danielle Ofri. In her essay, she laments the death by suicide of a patient and expresses frustration about the seeming non-suicidality of him making the death an unexpected shock.

Two weeks ago, I called one of my patients to reschedule an appointment. A family member answered and told me that my patient had been found dead in his apartment, most likely a suicide. This robust and healthy 54-year-old had screened “negative” for depression at every visit, despite having risk factors: being unemployed, living alone, caring for an ill relative.

Here she makes a clinical error: screening for depression and suicidality are two distinct entities.  Once does not necessarily presage the other. In terms of perceived burdensomeness, thwarted belongingness, isolation, hopelessness, helplessness and worthlessness, this gentleman was existing in a stew of toxic risk factors.

Maslow’s hierarchy of needs is old, but useful, in my view.  This person exhibited unmet basic needs – financial burdens, caregiver burdens, physical burdens, social isolation burdens.  The question becomes, where art thy neighbor?  Who is thy neighbor?

Maslow's Hierarchy of Needs. Resized, renamed,...

Image via Wikipedia

One of the risk factors for suicidality is that physicians increasingly treat rather than care for patients.  Because the care is missing, patients aren’t supported around anything other than medications, surgery and medical procedures.  One thing Dr. Ofri could have addressed is linking the patient to a home health nursing agency or to a social worker who could help him access caregiver support, perhaps home delivered meals and financial and job search supports.

The bottom line is that it appears that no one was this man’s neighbor, or brother, or fellow citizen.

Now to the commentary:

Readers addressed a wide variety of insightful and thoughtful aspects around suicide and suicidality.  The right to end terminal suffering – psych ache – is addressed quite compellingly.