9.2 Health

Given that the United States spends more on health care than most (if not all) industrialized nations in the world, one could reasonably expect the American people to be some of the healthiest citizens in the world. How is it then that modern Americans are significantly less healthy than other societies and, may even be expected to live shorter lives than previous generations? In previous chapters, westernized ideals of control, choice, short-term time orientation, and capitalism were explored as influencing how young people are enculturated in the United States.

In this chapter, aspects of western culture will be viewed through the lens of their impact on our physical health including our perceptions of health, desire to be health and access to health education and resources. In this chapter we will explore the impact of American culture on four aspects of health in United States society:

• American diet
• Sleep hygiene
• Socio-economic status
• Ethnic and racial disparity

The history of United States Department of Agriculture (USDA) nutrition guides includes over 100 years of American nutrition advice. The guides have been updated over time to adopt new scientific findings and new public health marketing techniques. The current guidelines are the Dietary Guidelines for Americans 2015 – 2020. What the government promotes as a healthy diet has not only changed over the course of generations but is often heavily influenced be societal values at that time.

These guidelines have been criticized over time as not accurately representing scientific information about optimal nutrition, and as being overly influenced by profit, personal interest, and the agricultural industries the USDA promotes. The introduction of the USDA’s food guide pyramid in 1992 attempted to express the recommended servings of each food group into the American diet.

MyPlate is the current nutrition guide published by the United States Department of Agriculture, consisting of a diagram of a plate and glass divided into five food groups. It replaced the USDA’s MyPyramid diagram in 2011, ending 19 years of food pyramid iconography (USDA, 2019).

Diet is the sum of food consumed by an organism or group, and should not be confused with dieting, which refers to food restriction with the goal of weight control. Numerous studies have attempted to identify contributing factors for poor health habits in the United States that have contributed to rising rates of obesity and diseases related to obesity. These studies have resulted in numerous hypotheses as to what those key factors are. A common theme is that of too much food, too little exercise, and a sedentary schedule; however, these themes are increasingly viewed as overly simplistic and lacking in awareness to the complex approaches that are needed to improve healthy living for all Americans. For example, while dieting, people tend to consume more low-fat or fat-free products, even though those items can be just as damaging to the body as the items with fat. Currently, less than 20% of all Americans meet the recommended minimum dietary guidelines for optimal health (“Health Diet”, n.d).

Other factors not directly related to caloric intake and activity levels are also believed to contribute to lowered physical fitness and higher body-mass index (BMI) rates. These include careers that involve long hours of sitting, decreased ability to delay gratification, and heavy marketing to promote unhealthy foods. Genetics are also believed to be a factor that contributes to higher BMI. In a 2018 study, researchers stated that the presence of the human gene APOA2 could result in a higher BMI in individuals. Also, the probability of obesity can even start before birth due to things that the mother does such as smoking and gaining a lot of weight.

Among the complex factors impacting eating habits in American culture are two key enculturated trends:

• Consumer culture
• Mixed media messaging

Consumer culture focuses on the spending of the customer’s money on material goods to attain a lifestyle in a capitalist economy. Over the years, people of different age groups are employed by marketing companies to help understand the beliefs, attitudes, values, and past behaviors of the targeted consumers. As consumers grow increasingly removed from food production, the role of product creation, advertising, and publicity become the primary vehicles for information about food. With processed food as the dominant category, marketers have almost infinite possibilities in developing their products for mass appeal.

Today’s American citizens are inundated with marketed messages that food choices should be fast, bring us pleasure, and meet our emotional needs over physiological needs. Of the food advertised to children on television, 73% is fast or convenience foods (“Consumer Culture”, 2019). Additionally, Americans are often enculturated to pursue personal satisfaction while also adhering to unrealistic standards of fitness and attractiveness. Our consumer culture promotes these conflicting standards with mixed messaging in various media formats.

Mixed messaging can refer to any communication that is contradictory, inconsistent, or unclear, especially in its motive or intent. Media advertisements, athletic and entertainer role-models, and character storylines are often embedded (subtly, or at times, overtly) with the message that Americans “deserve” to feel good but must also look good in the process.

With 1 out of 3 adults and 1 out of 6 children in the United States categorized as excessively overweight by the Centers for Disease Control (CDC) it is imperative to examine the factors affecting this damaging trend (Obesity, 2019). We will talk in Chapter 10 about the cultural relationship Americans have with diet and appearance, which contributes to the formation of eating disorders, further damaging overall health and well-being.

Sleep hygiene is the recommended behavioral and environmental practice that is intended to promote better quality sleep. Sleep hygiene recommendations include establishing a regular sleep schedule, using naps (with care), avoiding physical or mental exercise too close to bedtime, limiting worry, limiting exposure to light in the hours before sleep, getting out of bed if sleep does not come, not using bed for anything but sleep and sex, avoiding alcohol, nicotine, caffeine, and other stimulants in the hours before bedtime, and having a peaceful, comfortable and dark sleep environment.

One set of recommendations relates to the timing of sleep. For adults, getting less than 7–8 hours of sleep is associated with a number of physical and mental health deficits. A top sleep hygiene recommendation is allowing enough time for sleep. There is also focus on the importance of waking up each around the same time every morning and generally having a regular sleep schedule

Human sleep needs vary by age and among individuals. Sleep is considered to be adequate when there is no daytime sleepiness or dysfunction. Researchers have found that sleeping 7–8 hours each night correlates with longevity and cardiac health in humans, though many underlying factors may be involved in the causality behind this relationship.

Research also suggests that sleep patterns vary significantly across cultures (“Sleep”, 2019). Sleep deprivation, also known as insufficient sleep or sleeplessness, is the condition of not having enough sleep. According to the Centers for Disease Control and Prevention (CDC), 79% of Americans are currently getting less than the recommended 7-hour minimum of quality sleep per night. The United States experiences some of the highest rates of sleep deprivation and sleep disorder rates in the industrialized world; it is worth examining aspects of American culture that contribute to this trend.

Researchers examining health trends in the United States have highlighted our time-sensitive culture, emphasis on technology, and general attitudes toward sleep as contributing factors to our sleep hygiene. In 2000, the average American worked 1,978 hours per year, 500 hours more than the average German but 100 hours less than the average Czechoslovakian (“Sleep”, 2019). Overall the United States labor force is one of the most productive in the world, largely due to its workers working more than those in any other post-industrial country (excluding South Korea). Americans generally hold working and being productive in high regard. Being busy and working extensively is a source of pride for many and, as they say in America, “time is money.” Additionally, while there is little dispute that technology has enhanced our daily lives, studies show it is also negatively impacting our sleep habits. The increased stimulation of our devices can make it more difficult to unwind at the end of the night, while the unique light put off by these devices also block key sleep hormones. According to the National Sleep Foundation (2019), children (ages 6-17) who slept in the same room as an electronic device reduced the amount of quality sleep by one-hour each night.

Overall health is correlated with the quantity and quality of our sleep. Studies have shown that those who engaged in protective habits (e.g., getting 7–8 hours of sleep regularly, not smoking or drinking excessively, exercising) had fewer illnesses, felt better, and were less likely to die over a 9–12-year follow-up period (Belloc & Breslow 1972; Breslow & Enstrom 1980). For college students, health behaviors can even influence academic performance. Poor sleep quality and quantity are related to weaker learning capacity and academic performance (Curcio, Ferrara, & De Gennaro, 2006). Overall, people with sleep less are more likely to be obese, report higher levels of stress, and/or report symptoms of a mood disorder than those who obtain optimal levels of sleep each night (CDC, 2014).

Socioeconomic status (SES) is an economic and social combined total measure of a person’s economic and social position in relation to others, based on income, education, and occupation; however, SES is more commonly used to depict an economic difference in society as a whole. Socioeconomic status is typically broken into three levels (high, middle, and low) to describe the three places a family or an individual may fall in relation to others. Recently, there has been increasing interest from researchers on the subject of economic inequality and its relation to the health of populations.

Socioeconomic status is an important source of health inequity, as there is a very robust positive correlation between socioeconomic status and health. Socioeconomic status in the United States is related to health outcomes. Individuals higher in the social hierarchy, typically, enjoy better health than do those lower in the hierarchy. Low income and education levels have been shown to be strong predictors of a range of physical and mental health problems. These health problems may be due to environmental conditions in living and workspaces, increased levels of stress, lack of access to healthcare, food scarcity or poor nutrition. This correlation suggests that it is not only the poor who tend to be sick when everyone else is healthy, but that there is a continual gradient, from the top to the bottom of the socio-economic ladder, relating status to health.

Education in higher socioeconomic families is typically stressed as more important, both within the household, as well as the local community. In poorer areas, where food, shelter and safety are priority, education often takes a backseat – becomes less of a priority. American youth are particularly at risk for many health and social problems in the United States. Overall, lower socioeconomic status has been linked to chronic stress, heart disease, ulcers, type 2 diabetes, rheumatoid arthritis, certain types of cancer, and premature aging.

Social class in the United States is a controversial issue, having many competing definitions, models, and even disagreements over its very existence. Many Americans believe that in the country there are just three classes: the American rich; the American middle class; the American poor. Most definitions of the social classes in the United States entirely ignore the existence of parallel Black, Hispanic and minorities communities. SES differences in health have long been associated by many Americans as related to poor impulse control, unhealthy habits, and an overall lack of motivation (Braveman, et al, 2010). One difficulty with this oversimplification is that these attitudes reduce poverty (and related problems associated with lower SES) as a problem with the individual rather than a reflection of complex societal components that contribute to poor health and lower life expectancy. The assumption that individual choices and internal control are enough to overcome the impact of poverty further adds to the difficulty impoverished people have in overcoming economic hardships. Educational, economic, and health care inequity within lower SES groups have each been shown to correlate with poor health must be addressed in order to create meaningful change in the health of Americans (Braveman, et al, 2010). Given the ranking of the United States across global indicators, we might do well to address poor health of Americans as a social problem and not a personal problem.

The United States is a racially diverse country. Race and ethnicity in the United States is a complex topic both because the United States has a racially and ethnically diverse population and because of a history of racism involving slavery and segregation that persists to present day. At the federal level, race and ethnicity have been categorized separately. Race refers to a classification of humans into groups based on physical traits, ancestry, genetics or social relations, while ethnicity refers to a category of people who identify with each other based on similarities such as common ancestry, language, history, society, culture or nation. Race and health refers to how being identified with a specific race influences health.

Race and ethnicity often remain undifferentiated in health research. Differences in health status, health outcomes, life expectancy, and many other indicators of health in different racial and ethnic groups are well documented. Some individuals in certain racial groups receive less care, have less access to resources, and live shorter lives in general. Epidemiological data indicates that racial groups are unequally affected by diseases, in terms or morbidity and mortality. These health differences between racial groups create racial health disparities.

Health disparities are defined as preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. Health disparities are intrinsically related to the historical and current unequal distribution of social, political, economic and environmental resources (“Health Equity”, 2019). The relation between race and health has been studied from a multidisciplinary perspective, paying attention to how racism influences health disparities and how environmental factors and physiological factors respond to each other and to genetics.

Current evidence supports the notion that these racially centered disparities continue to exist and are a significant social health issue. A current report from the Centers for Disease Control (CDC, 2019) found that 700 women died from preventable complications of pregnancy in the United States, a rate higher than any other developed country, but the rate of death was higher for Black and Native American women. The death rate for Black mothers was over 3 times higher than for white mothers and the rate for Native American mothers was over 2 times higher than for white mothers. A majority of these deaths are largely preventable and some relate to implicit racial bias that is unrelated to social status, income or education.

Minority populations have increased exposure to environmental hazards that include lack of neighborhood resources, structural and community factors as well as residential segregation that result in a cycle of disease and stress (Gee, 2004). Racial segregation is another environmental factor that occurs through the discriminatory action of those organizations and working individuals within the real estate industry, whether in the housing markets or rentals. Even though residential segregation is noted in all minority groups, blacks tend to be segregated regardless of income level when compared to Latinos and Asians. Thus, segregation results in minorities clustering in poor neighborhoods that have limited employment, medical care, and educational resources, which is associated with high rates of criminal behavior (Williams, 2005). In addition, segregation affects the health of individual residents because the environment is not conducive to physical exercise due to unsafe neighborhoods that lack recreational facilities and have nonexistent recreational space.

Racial and ethnic discrimination adds an additional element to the environment that individuals have to interact with daily. Individuals that report discrimination have been shown to have an increased risk of hypertension in addition to other physiological stress-related affects (Mujahid, 2011). The high magnitude of environmental, structural, socioeconomic stressors leads to further compromise on the psychological and physical being, which leads to poor health and disease (Gee, 2004).

Subjective well-being (SWB) is the scientific term for happiness and life satisfaction —thinking and feeling that your life is going well, rather than badly. Levels of subjective well-being are influenced by both internal factors, such as personality and outlook, and external factors, such as the society in which they live. Some of the major determinants of SWB are a person’s inborn temperament, the quality of their social relationships, the societies they live in, and their ability to meet their basic needs. Although there are additional forms of SWB, the three in the table below have been studied extensively. The table also shows that the causes of the different types of happiness can be somewhat different.

There are different causes of happiness, and that these causes are not identical for the various types of SWB and high SWB is achieved by combining several different important elements (Diener & Biswas-Diener, 2008). People who promise to know the key to happiness are oversimplifying.

Some people experience all three elements of happiness and are very satisfied, enjoy life, and have only a few worries or other unpleasant emotions. Other unfortunate people are missing all three. For example, imagine an elderly person who is completely satisfied with her life—she has done most everything she ever wanted—but is not currently enjoying life that much because of the infirmities of age. There are others who show a different pattern who are having fun, but who are dissatisfied and believe they are wasting their lives.

Importantly, researchers have also studied the outcomes of SWB and have found that people you report being happier are more likely to be healthier and live longer, to have better social relationships, and to be more productive at work (Diener & Tay, 2012; Lyubomirsky, King, & Diener, 2005). In other words, people high in SWB seem to be healthier and function more effectively compared to people who are chronically stressed, depressed, or angry. Happiness does not just feel good in the moment, but it is good for people over time and for those around them.

Money and Happiness

A certain level of income is needed to meet our needs, and very poor people are frequently dissatisfied with life (Diener & Seligman, 2004); however, having more and more money has diminishing returns. This means that higher and higher incomes make less and less difference to happiness. Wealthy nations tend to have higher average life satisfaction than poor nations, but the United States has not experienced a rise in life satisfaction over the past decades, even as income has doubled. The goal is to find a level of income that you can live with and earn.

You should not let your aspirations continue to rise so that you always feel poor, no matter how much money you have. Research shows that materialistic people often tend to be less happy, and putting your emphasis on relationships and other areas of life besides just money is a wise strategy. Money can help life satisfaction, but when too many other valuable things are sacrificed to earn a lot of money—such as relationships or taking a less enjoyable job—the pursuit of money can harm happiness.

Self – Examination

Although it is beneficial generally to be happy and satisfied, this does not mean that people should be in a constant state of euphoria. In fact, it is appropriate and helpful sometimes to be sad or to worry. At times a bit of worry mixed with positive feelings makes people more creative. Most successful people in the workplace seem to be those who are mostly positive but sometimes a bit negative. You do not need to be happiness superstar in order to be a superstar in life. What is not helpful is to be chronically unhappy. If you feel mostly positive and satisfied, and yet occasionally worry and feel stressed, this is probably fine as long as you feel comfortable with this level of happiness. If you are a person who is chronically unhappy much of the time, changes are needed, which may include some professional support.

Many of the factors explored in American health also relate to global health such as:

• Access to health education and care
• Socioeconomic and racial disparities
• Food or housing scarcity

Health disparities are also due in part to cultural factors that involve practices based not only on sex, but also gender status. For example, in China, health disparities have distinguished medical treatment for men and women due to the cultural phenomenon of preference for male children. Additionally, a girl’s chances of survival are impacted by the presence of a male sibling. Girls do have the same chance of survival as boys if they are the oldest girl – they have a higher probability of being aborted or dying young if they have an older sister.

In India, SES and gender-based health inequities are apparent in early childhood. Many families provide better nutrition for boys in the interest of maximizing future productivity given that boys are generally seen as breadwinners. In addition, boys receive better care than girls and are hospitalized at a greater rate. The magnitude of these disparities increases with the severity of poverty in a given population.

Additionally, the cultural practice of female genital mutilation (FGM) is known to impact women’s health, though is difficult to know the worldwide extent of this practice. Female genital mutilation (FGM), also known as female genital cutting and female circumcision, is the ritual cutting or removal of some or all of the external female genitalia. While generally thought of as a Sub-Saharan African practice, it may have roots in the Middle East as well. The estimated 3 million girls who are subjected to FGM each year potentially suffer both immediate and lifelong negative effects. Long-term consequences include urinary tract infections, bacterial vaginosis, pain during intercourse, and difficulties in childbirth that include prolonged labor, vaginal tears, and excessive bleeding (“Female Genital Mutilation”, 2019).

Globally, the poorest countries in the world remain the least healthy (CDC, 2018). In 2015, the World Health Organization (WHO) identified the need for multiple countries to unify in targeting health disparity and basic rights/needs. The Sustainable Development Goals (SDGs) are a collection of 17 global goals set by the United Nations (UN) General Assembly in 2015 for the year 2030. According to the United Nations, the long-term target is to reach the communities farthest behind and most in need.

There are 169 targets for the 17 goals. Each target has between 1 and 3 indicators used to measure progress toward reaching the targets. There are many obstacles to realizing this global call to end human suffering, improve the environment, and ensure access to basic needs. Critics of SDG’s highlight the high cost of achieving even the initial target goals and suggest the plan is overly complex. Currently, world leaders continue to work with the United Nations in pursuit of global peace and prosperity to improve human health and well-being.