What I find most troubling about the reactionary “useless eater” mentality (see May 24 blog) pushed by policy and opinion makers is the way Americans have internalized the belief that it’s their own fault if they become ill. In fact much of the US population seems more freaked out about getting sick than dying. I can’t say I blame them, as so many American workers have no sick leave and lose a day’s pay every time they are ill.

Americans also spend billions of dollars on alternative health care and vitamin supplements and other non-prescription remedies. And many are practically obsessed with healthy eating, only drinking bottled or filtered water, compulsive exercise routines and meditation, yoga and other stress reduction techniques to keep their massive job stress from making them sick (at present those who still have jobs do the work of 1.5 to 2 people on average).

The media compounds the problem by promoting a variety of cough and cold remedies and caffeine and mega B vitamin “boost” drinks to enable people to attend work when they have colds or even quite serious illnesses, such as bronchitis and influenza.

Medicating Kids

Parallel to this pressure for adults to be healthy, is immense pressure for children to be “normal.” While parents seem to be appropriately skeptical about taking unnecessary drugs themselves, they seem far too eager to and medicate children with behavior problems. As a child and adolescent psychiatrist, I am well aware that ADHD is a genuine disorder affecting 1-2% of children (but not childhood bipolar disorder – this is a diagnosis heavily marketed by drug companies and totally unsupported by developmental or epidemiological research).

At the same time I see absolutely no reason why American children should be three times as likely to be diagnosed and treated for ADHD than children in other parts of the world. In my work, I come across psychiatrists from all over the world. Based on their input, I can safely asserted that the eagerness of US doctors (at the behest of drug companies) to prescribe psychotropic medication for children is an international scandal that casts the standard of  American pediatric and psychiatric care in a very bad light.

Sending Sick Kids to School and Day Care

However I am even more concerned about the number of kids who have to go to school or day care when they’re sick because their working parents can’t afford to stay home and have nowhere else to send them. In doing so, they will also expose all their child’s classmates. Who, because their immune system is still forming, are very likely to develop the illness themselves and expose other children. Over the past decade, I have seen many children who suffer 12 or more serious (requiring antibiotics) throat, ear, sinus or chest infections a year.

This is a major public health problem, especially now that asthma (often triggered by chest infections), is reaching epidemic proportions among American children. Allowing children to suffer one respiratory infection after another can have permanent lifelong health consequences.

Take Home Message

Good health is elusive. In general we have a very limited ability to stay well by eating right, exercising and reducing stress. Epidemiological studies show that only 10% of illness is accounted for by lifestyle factors (including smoking).

The reality is that illness – both acute and chronic – is fundamental to the human condition. In my experience, people willing to allow themselves to be ill and take time off to get well recover faster and cope better with other life stresses better.

Obviously adults have the choice whether or not they want to work when there are sick. Parents with sick children must make that decision for them. They are also entrusted with that child’s future health and welfare. And I think they need to weigh that responsibility carefully in deciding to send a sick child to school or daycare.

To be continued, with a discussion of the role of socioeconomic status (at birth) and income inequality in determining adult health status and life expectancy.

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