Economic Stress—How Bad Is It Really?

Before the financial collapse, Dr. Jonathan Whiteson says his patients made predictable small talk. "It used to be, 'How are the children? Where did you go on vacation?'" he recalls.

"Now," he says, "they come in with a [newspaper] tucked under their arm and say, 'Did you see this?'" Usually they're pointing to a story about the market's dismal fortunes or the fallout of yet another Ponzi scheme.

Whiteson, director of cardiac and pulmonary wellness and rehabilitation at New York University's Langone Medical Center, says the change in tone has been accompanied by complaints about ailments small and large, including chest pain, gastrointestinal distress and muscle aches.

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That's unsurprising given that scientific research has long demonstrated a link between poor health outcomes and declining employment and gross domestic product. Since the recession began in December 2007, the economy has shed 5.1 million jobs and the unemployment rate has reached 8.5 percent. Meanwhile, U.S. GDP decreased at an annual rate of 6.3 percent in the fourth quarter of 2008.

And since the economy began quickly unraveling last fall, there have been numerous reports about how this dynamic is playing out in the current recession: Americans are sleeping less, seeing doctors less frequently and slowing prescription drug refills.

But some reports may be exaggerating how bad the recession has been for Americans' health.

By the numbers

To be fair, various polls and surveys have accurately tracked some of the effects. In March, the National Sleep Foundation reported that more than a quarter of 1,000 survey participants were sleeping less because of the economy.

The recession has also forced Americans to skimp on health care. In a February telephone poll of 1,200 adults conducted by the nonprofit Kaiser Family Foundation, 53 percent of respondents said they cut back on health care costs by avoiding doctor's visits, skipping dental check-ups and not filling prescriptions, among other strategies.

The American Hospital Association, a national trade organization, recently reported that total visits to 650 hospitals across the country were down in the fourth quarter of 2008 compared to the previous year, with nearly 3 percent fewer visits to the emergency room and 2 percent fewer patient surgeries. The sample is not nationally representative, but is still considered a leading indicator of hospital performance.

Despite such research, it remains challenging to gauge what is happening across the nation. That's because the government rarely collects data about health outcomes in real-time. The Centers for Disease Control and Prevention, for example, surveys the public about contraceptive use once over a several-year period and those figures aren't released until a year or two later. As such, it often requires rigorous statistical and epidemiological analysis to link a single negative health outcome to the economy.

Even some major insurers are reluctant to discuss the situation. UnitedHealth Group and Aetna declined to comment on how the recession might be reducing the frequency of treatments and procedures, citing insufficient data on usage trends in the past six months.