Opinion: Washington’s failure making us sick

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It’s ironic that a pandemic that has made us overly cautious about the physical health of our families has also had a more insidious impact on our stress. Many caregivers experience increased anxiety, depression, and burnout. While the pandemic may have pushed more people to the brink, none of the structural failures are new – caregivers have long faced inadequate family and sick leave and an uneven child care system and expensive.

Given the wealth of research linking chronic daily stress to long-term health, it begs the question: is our country’s failure to support caregivers making Americans sick? Is caregiver support a health problem?

As of this writing, Congress was debating President Joe Biden’s Build Back Better plan, which includes historic funding levels to create a paid family and medical leave program, expand access to child care, and reduce child care. child care costs, and make kindergarten universally available. Opposition to this bill has focused on its high price. But no one is talking about how much we could recoup in short-term and long-term health care costs.
The bill’s most expensive family support proposals – $ 400 billion for child care and universal preschool and between $ 225 billion and $ 550 billion for paid time off over the next decade – only account for about 10% of our annual health expenditure. In 2019, the United States spent $ 3.8 trillion on health care, far more than other developed countries.
According to data from the United States Centers for Disease Control and Prevention, more than 90% of health spending in the United States is spent on chronic and mental health conditions, and decades of research have linked stress related to lifestyle and the long-term risks of these problems, ranging from heart disease and obesity to depression and autoimmune disorders.
While nearly 3% – or about $ 110 billion – of our health care spending goes to preventive medicine, we have higher preventable disease death rates than countries that spend less. If we conceptualize health broadly and consider the role of stress, the missing piece is clear. Compared to other countries, we have significantly under-invested in policies that support families and caregivers, such as paid families, sick leave, and child care. For example, the United States is the last of the developed countries when it comes to spending on early childhood: countries like Norway, Denmark and Finland spend four times as much as we do per child per year. These policies directly affect exposure to stress and stress-related illnesses, particularly during times of change and vulnerability such as the transition to parenthood and the transition to adulthood.
Stress translates into health through pathways such as strain on the heart, weakened immune resistance, poor sleep, and even faster brain aging. Stress can take a disproportionate impact during major life transitions, such as the period after a baby is born, when hormones change and sleep is disturbed. Stress in adulthood also compromises health, and the stress of caring for sick, elderly or disabled family members has been linked to an increased susceptibility to disease.
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According to Dr. Allison Applebaum, a clinical psychologist who runs a Caregiver Support Clinic in New York City, “I have lost count of the number of caregivers in my clinic who have also become patients. Insomnia rates are skyrocketing among caregivers. chronic depression, chronic anxiety. ”As Applebaum told us,“ People are so busy balancing their jobs and caring for their loved ones that they don’t have time to take care of themselves. They often neglect their own medical screening and care.

The toll of caregiving without job or income security can lead to new health care costs for the caregivers themselves. Applebaum experienced this by taking care of his own aging father while working full time. As she says, “I took him to the emergency room and contracted a bacterial infection. I hadn’t slept and had a chance to rest or take care of myself, and ended up being hospitalized. My immune system I couldn’t fight it because I was so exhausted. ”

Those most at risk of ill health are also those who will benefit the most from supportive policies. Research has shown that people of color and low-wage workers start from a high baseline stress load due to socio-economic tensions and exposure to systemic racism. The stress of caregiving adds an extra layer, as these communities are also the least likely to be protected by current policies regarding paid sick leave or paid family and medical leave.
By not supporting caregivers with effective policies, we are missing out on the most promising opportunities to promote the health of adults and children. If we can reduce stress in critical windows in life – early childhood, transition to parenthood, caring for loved ones of all ages – we may be able to bend the arc of disease trajectories at the end of life.
It is essential to reframe supportive policies such as paid family and medical leave and accessible and affordable childcare services as forms of preventive medicine. From a health point of view alone, repairing healthcare support structures is profitable. We can potentially save billions of taxpayer dollars now spent on treating stress-related illnesses by devoting a fraction of that funding to supporting families during key health transitions.

As Applebaum says, “If I could have taken more paid time off to care for my father, I probably wouldn’t have been hospitalized for my own illness. A few extra weeks, or even a few extra days, of paid family leave could have avoided a hefty hospital bill.

When we assess the cost of new legislation, we have to look at the big picture. Investments in care today represent a down payment for tomorrow. We need to move away from policy silos into categories such as “social”, “economic” and “health care” and take a holistic view of our families, our health and our economy as we develop policies to support caregivers and promote the health of the nation.


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