# The cost of stress

In related news:
http://rawstory.com/08/afp/2009/05/29/us-army-base-shuts-down-after-rise-in-suicides/ [Broken]
seems unlikely they'd be all that concerned about suicide, seeing as it's just above the "national record". but fragging it seems gets the attention of the brass.

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Moonbear
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http://www.webmd.com/balance/guide/effects-of-stress-on-your-body

Given that we tax alcohol, tobacco, and now even fat, based on the logic that the use of these products have a financial cost to society, it is interesting to note that stress is probably the single greatest cause of health problems, after genetics and aging.

Do insurance companies have the right to test for stress hormones and adjust insurance rates accordingly? Also, is it possible to somehow tax people who choose highly stressful lifestyles, or who engage in highly stressful activities?
I'd rather get the workman's comp for the work-related stress-induced health conditions. :tongue:

On a more serious note, I'm not sure how they came up with numbers suggesting that such a high percentage of office visits are ailments related to stress. That sounds like enormous hand-waving.

And, stress hormones generally are a lousy way to measure physiological responses to stress. It's something that researchers have debated for a very long time. Under chronic stress, there's an adaptation of stress hormone responses, and after a short time of being elevated, they return to baseline. Yet, the person experiencing the stressor would still self-report as being stressed. And, one of the real difficulties in studies of things like PTSD is that exposure to the stressor itself doesn't determine susceptibility to develop health problems as a result of the experience. In all likelihood, but as yet lacking solid evidence in the literature (a lot of other things have been ruled out), it still boils down to genetics in terms of susceptibility to stress. Two people can work at the same job under the same conditions, and one will complain of constantly being under stress and another will take it all in stride and not perceive it as particularly stressful at all.

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It goes back to my earlier post. Car insurance companies discriminate based on age which is theoretically illegal except that they discriminate 'against' younger people as opposed to older people and younger people do not have the lobby to protect them that older people do. They discriminate based on sex but 'against' males as opposed to females and males do not have a protective lobby. They discriminate based on where you live which on the surface seems fine and does not actually target a protected demographic except that blacks and hispanics are the ones prodominantly effected and they have quite a lobby so they can fight it even though they are not directly targeted.
Based on your logic, any risk-based assesment of insurance costs or taxes are discrimination. How is charging more for insurance for any person with a history of health problems not discrimination?

Smoking and drinking impact all demographics. They may effect minorities more so but I think any one would be hard pressed to show discriminatory levels of disproportion in statistics for medical purposes. They are also choices and while one can theoretically choose where one lives it is a choice with far less freedom than whether or not one smokes or drinks.
So then addiction is a myth?

Stress is certainly a multi-demographic issue aswell. The thing is that rich folk in high stress jobs probably pay for premium insurance to begin with and wouldn't even notice much if their payments were a bit higher, just as they probably have premium car insurance would not likely notice a difference there either. The pressure would come from poorer people who work in warehouses and such places where there is high stress and less income and they are less likely to be able to afford medical insurance to begin with. And then there are the union jobs and the unions have quite a voice.

Medical insurance providers instituting such a policy would suffer great political backlash and I'm sure they know it.
Well, since by yours and MB's statements, since it seems that we can't properly distribute the burden of the number one cause of health problems, instead we should just target the easy pickings - the poor, the under-represented, and those who suffer from deadly addictions or other problems - and impose excessive taxes and fees on them to make up the difference?

Based on your logic, any risk-based assesment of insurance costs or taxes are discrimination. How is charging more for insurance for any person with a history of health problems not discrimination?
There is a difference between discrimination and illegal discrimination. My point is that courts decide what is illegal discrimination and only those who have representation and choose to sue for discrimination will be protected.

Ivan said:
So then addiction is a myth?
No. But one chooses to smoke and chooses to drink while one does not choose where one is born or how rich the family they are born to will be. Most poor people live all or most of their lives in or near the same area where they grew up.
As I mentioned the primary target for lobbiests regarding alcohol and tobacco are going to be the companies that sell them. Not so much medical insurance companies. And on that front making sure that the poor have medical coverage to begin with is likely a greater concern than the policies of the insurance companies though the policies are probably treated as a part of the larger concern.

Ivan said:
Well, since by yours and MB's statements, since it seems that we can't properly distribute the burden of the number one cause of health problems, instead we should just target the easy pickings - the poor, the under-represented, and those who suffer from deadly addictions or other problems - and impose excessive taxes and fees on them to make up the difference?
I did not mean to make any value judgement or take any stance in this regard. I only meant to paint a picture of the concerns of the groups involved. I actually very much support the idea of socialized medicine.

Moonbear
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Well, since by yours and MB's statements, since it seems that we can't properly distribute the burden of the number one cause of health problems...
I'm not convinced it IS the number one cause of health problems. That WebMD article has no references to back up those claims, and while it's usually a reasonable source of basic information on medical issues, it does get things wrong from time to time...especially when the person writing the article hasn't bothered to cite any sources. Do you have a source to back up that claim beyond the WebMD site?

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I'm not convinced it IS the number one cause of health problems. That WebMD article has no references to back up those claims, and while it's usually a reasonable source of basic information on medical issues, it does get things wrong from time to time...especially when the person writing the article hasn't bothered to cite any sources. Do you have a source to back up that claim beyond the WebMD site?
Yes, I'm quite sure there have been other recent reports about this. A recent report heard is what made me think of this in the first place. I will dig some up. However, note that the $300 Billion number is attributed to an OSHA report. And that only applies to the workplace. Also, surely you would agree that it is a signficant factor no matter the language. Last edited: Staff Emeritus Science Advisor Gold Member No. But one chooses to smoke and chooses to drink while one does not choose where one is born or how rich the family they are born to will be. Most poor people live all or most of their lives in or near the same area where they grew up. Again you seem to be suggesting that addiction is a choice. As I mentioned the primary target for lobbiests regarding alcohol and tobacco are going to be the companies that sell them. Not so much medical insurance companies. And on that front making sure that the poor have medical coverage to begin with is likely a greater concern than the policies of the insurance companies though the policies are probably treated as a part of the larger concern. My point is in regards to taxes and insurance costs to the individual. From my point of view, tobacco and alcohol taxes in particular unfairly target the poor and people with addictions. I think it was Whoopie Goldberg who was saying that a pack of cigarettes cost something like$10 in New York now. Almost all of that cost goes to taxes. At that rate, we can expect a black market for cigarettes that will only follow suit with the violence and crime associated with illegal drugs. But that is another discussion.

I did not mean to make any value judgement or take any stance in this regard. I only meant to paint a picture of the concerns of the groups involved. I actually very much support the idea of socialized medicine.
Yes, this is not intended to be personal. I am trying to demonstrate the problem with a risk-based system. If we are going to charge and tax according to risk, then it must apply to ALL siginficant risks. I don't see how else the system can be fair and equitable. Based on the link in the op and other reports that I have heard about, stress is the elephant in the room.

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Again you seem to be suggesting that addiction is a choice.
I am suggesting that addiction is a consequence of choice and that there is far more freedom in those choices than the choice of where one lives.
I do not make much money. I live in a poor neighbourhood. I smoke and I drink.
I'll tell you right now that between choosing to quit smoking and choosing to live in a nicer neighbourhood the later would be the more difficult to accomplish.

Ivan said:
My point is in regards to taxes and insurance costs to the individual. From my point of view, tobacco and alcohol taxes in particular unfairly target the poor and people with addictions. I think it was Whoopie Goldberg who was saying that a pack of cigarettes cost something like $10 in New York now. Almost all of that cost goes to taxes. At that rate, we can expect a black market for cigarettes that will only follow suit with the violence and crime associated with illegal drugs. But that is another discussion. As far as taxes are concerned I would agree. I do not support "sin taxes". But probably more so for other reasons than you do. Ivan said: Yes, this is not intended to be personal. I am trying to demonstrate the problem with a risk-based system. If we are going to charge and tax according to risk, then it must apply to ALL siginficant risks. I don't see how else the system can be fair and equitable. Based on the link in the op and other reports that I have heard about, stress is the elephant in the room. I understand. When it comes to a private company though I can not argue with informed risk assessment. Its certainly not fair. Its not supposed to be. That is why I prefer socialized medicine. Staff Emeritus Science Advisor Gold Member I am suggesting that addiction is a consequence of choice and that there is far more freedom in those choices than the choice of where one lives. I do not make much money. I live in a poor neighbourhood. I smoke and I drink. I'll tell you right now that between choosing to quit smoking and choosing to live in a nicer neighbourhood the later would be the more difficult to accomplish. It is undeniable that many people struggle desperately with addiction. I don't know how many people smoke or drink by choice as opposed to those who can't help themselves, but the fact is that addiction destroys lives every day. That is a tougher road to follow than is moving. You know that by smoking you are killing yourself, so why don't you quit? Isn't that a greater motivation to quit than is a tax? Just popping in to post a couple of links regarding the cost and causes of stress. Work-related stress is one of the biggest health and safety challenges that we face in Europe. Nearly one in four workers is affected by it, and studies suggest that between 50% and 60% of all lost working days are related to it. This represents a huge cost in terms of both human distress and impaired economic performance. http://osha.europa.eu/en/topics/stress Stress Having good mental health helps you make good decisions and deal with lifeÌs challenges at home, work and school. (APA, How Psychotherapy Helps People Recover from Depression, 1998) Learn more here. Two thirds of Americans say they are likely to seek help for stress. (APA Survey 2004) 45% of workers list job insecurity has a significant impact on work stress levels. (APA Survey 2004) 61% of workers list heavy workloads as a significant impact on work stress levels. (APA Survey 2004) Executives and managers tend to have the most stressful jobs, while self-employed workers are the least stressed. (APA Survey 2004) A majority of workers (52%) are more stressed because of work than home. (APA Survey 2004) 54% of workers are concerned about health problems caused by stress. (APA Survey 2004) One in four workers have taken a mental health day off from work to cope with stress. (APA Survey 2004) Learn more here. 62% of Americans say work has a significant impact on stress levels. (APA Survey 2004) 73% of Americans name money as the number one factor that affects their stress level. (APA Survey 2004) Fifty-four percent of Americans are concerned about the level of stress in their everyday lives. (APA Survey 2004) http://apahelpcenter.org/articles/topic.php?id=6 [Broken] Last edited by a moderator: Staff Emeritus Science Advisor Gold Member A related discussion is the so-called fat tax Alabama officials are warning state employees to shape up or pay more for health insurance. On Friday, the State Employees' Insurance Board announced a new plan beginning next year in which state employees will be required to receive medication screenings for several conditions, including body mass index. Those considered obese or who have high blood pressure, high cholesterol or high glucose will have to pay$25 a month more in health insurance beginning in January 2011, if they don't take steps to address their health problems.

The new rule will affect more than 37,000 people employed by the state. Alabama is the first state to issue a so-called fat tax. The state already charges smokers a $24 per month surcharge (which will increase to$25 next month)...
http://latimesblogs.latimes.com/booster_shots/2008/08/alabama-places.html

There has been discussion of taxing fatty foods. Also, I don't know if anyone has proposed a salt tax yet, but by the current logic, they should. From what I understand, sodium is one of the greatest offenders related to issues of heart disease and high blood pressure. Then we could talk about processed sugars and diabetes...

Note also that the current philosophy is to tax health sins to such a level that the sins are avoided.

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It is undeniable that many people struggle desperately with addiction. I don't know how many people smoke or drink by choice as opposed to those who can't help themselves, but the fact is that addiction destroys lives every day. That is a tougher road to follow than is moving. You know that by smoking you are killing yourself, so why don't you quit? Isn't that a greater motivation to quit than is a tax?
Alot of things I enjoy are bad for my health. Smoking is certainly the worst. There's alot that would go into the discussion on that point that is quite irrelevent to your thread though. My point is that I could do it more easily than moving to a nicer neighbourhood. If you think about it I am quite certain you will realize that for a poor person saying moving isn't so hard is about the same as saying that not smoking isn't so hard. Getting by in a poor neighbourhood is a struggle. People die daily because of where they live whether it be because of pollution, violence, or simply that people don't care. Do you know how many people die during the summer heat in L.A. because they have no air conditioning? Do know how many people live in homes that are death traps? that have abestos and black mold?
People are born into these places and only a small percentage escape. People are not born with a carton and a fifth in each hand.

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It is slow going getting original sources as there are so many quotes and websites. I will post relevant links as I find them.

In the past 20 years, many studies have looked at the relationship between
job stress and a variety of ailments. Mood and sleep disturbances, upset
stomach and headache, and disturbed relationships with family and friends
are examples of stress-related problems that are quick to develop and are
commonly seen in these studies. These early signs of job stress are usually
easy to recognize. But the effects of job stress on chronic diseases are more
difficult to see because chronic diseases take a long time to develop and can
be influenced by many factors other than stress. Nonetheless, evidence is
rapidly accumulating to suggest that stress plays an important role in
several types of chronic health problems—especially cardiovascular
disease, musculoskeletal disorders, and psychological disorders.
10
Health care expenditures are nearly 50% greater for workers who
report high levels of stress.
—Journal of Occupational and Environmental Medicine
http://www.cdc.gov/niosh/docs/99-101/pdfs/99-101.pdf

One that I have no been able to confirm
In the article Stress and Health: How Stress Affects Your Body, and How You Can Stay Healthier, Elizabeth Scott, M.S., writes “it’s been estimated that as many as 90% of doctor’s visits are symptoms that are at least partially stress-related!”

This is ultimately attributed to the CDC but I haven't found the original document.

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Alot of things I enjoy are bad for my health. Smoking is certainly the worst. There's alot that would go into the discussion on that point that is quite irrelevent to your thread though. My point is that I could do it more easily than moving to a nicer neighbourhood.
Maybe that is true for you. That doesn't make it true for everyone. What you are arguing is that addiction is always a choice.

While this is an article specific to crack, it addresses addiction more generally as well.\

...How Do People Get Addicted to Crack?
Need Help?

Contact Narcotics Anonymous
http://www.na.org/
U.S. - (818) 773-9999
Europe - 32-2-646-6012
Cocaine is a highly addictive substance. People who take it can become physically and psychologically dependant upon it to the point where they can't control their cravings. Researchers have found that cocaine-addicted monkeys will press a bar more than 12,000 times to get a single dose of it. As soon as they get it, they will start pressing the bar for more.

Crack and other addictive drugs chemically alter a part of the brain called the reward system. As mentioned previously, when people smoke crack, the drug traps the chemical dopamine in the spaces between nerve cells. Dopamine creates the feelings of pleasure we get from enjoyable activities such as eating and having sex. But in crack users, dopamine keeps stimulating those cells, creating a "high" -- a euphoric feeling that lasts anywhere from five to 15 minutes. But then the drug begins to wear off, leaving the person feeling let-down and depressed, resulting in a desire to smoke more crack in order to feel good again.

The brain responds to the dopamine overload of the crack high by either destroying some of it, making less of it or shutting down its receptors. The result is that, after taking the drug for a while, crack users become less sensitive to it and find that they must take more and more of it to achieve the desired effect. Eventually, they cannot stop taking the drug because their brains have been "rewired" -- they actually need it in order to function. How long does it take to become addicted? That varies from person to person, and an exact number is difficult to pin down, especially when physical addiction is paired with psychological addition...
http://health.howstuffworks.com/crack5.htm

Based on the level of dependence, the most common measure for determining the addictiveness of a drug, the substances ranked as follows, from most to least addictive:
1.Nicotine
2.Heroin
3.Cocaine
4.Alcohol
5.Caffeine
6.Marijuana

Yes you are reading that correctly! Nicotine is considered to be more addictive than heroin or cocaine. What do you call it when you impose exorbitant taxes on poor people who can't help themselves? Extortion?

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Maybe that is true for you. That doesn't make it true for everyone. What you are arguing is that addiction is always a choice.
I am arguing that addiction stems from choice. Once one is addicted the level of freedom of choice one has deminishes. But you make a choice to partake in the addictive substance.
And again my argument is also in regards to the level of choice compared to where one lives. Like I said you are born where you are born but you are not born with cigarettes in hand.

Ivan said:
Yes you are reading that correctly! Nicotine is considered to be more addictive than heroin or cocaine. What do you call it when you impose exorbitant taxes on poor people who can't help themselves? Extortion?
I've heard it before and I think that this is propaganda. I can not argue with the cause that the propaganda supports but it is still propaganda. The primary reasons why cigarettes are considered so addictive is availability. I can walk to the corner and get a pack of smokes for five bucks or I can even bum one from someone I am around. Its incredibly easy to get your hands on and that is what makes it so difficult to kick. But you don't see people spending all of their money, stealing, selling their belongings, selling their children, or preforming sexual favours behind dumpsters just to get a nicotine fix. I doubt you ever would see such a thing except when it comes to crack, meth, and heroin. THAT is serious addiction and saying nicotine addiction is worse only deminishes the incredible severity of hard drug addiction. Ask anyone who has ever done hard drugs whether or not they would have been able to quit if their drug of choice was available in every corner store for under ten dollars and I will bet that you will get an unequivocal "No".