Access to Health Care Can Make You Healthy and Happy

Given the corona virus crisis I didn’t expect to wake up to happy news. And I mean that literally.  A study, The World Happiness Report 2020, conducted by the United Nations Sustainable Development Solutions Network, ranked 156 countries by how their citizens rated their state of happiness, i.e., how respondents measure their sense of personal well-being and the well-being of their society as a whole.

The top ten countries were Finland, Denmark, and Norway, Iceland, Netherlands, Sweden, New Zealand, Canada, and Austria.  Readers of this blog know where I’m going with this.  All of the top rated countries provide their citizens with social programs such as old age pensions, child and elder care, paid sick leave, guaranteed paid vacations for workers, and of course, universal health care.  These are all capitalist countries, but they recognize the importance of providing healthy living and working conditions and environments to their citizens. 

According to the study, Finland comes out on top due to “the country’s social safety net combined with personal freedom and good work-life balance.”[1]  It’s worth noting that many of these “happy” countries have decriminalized drug use, seeing addiction as a health/mental health problem rather than a legal problem.  Nonetheless, Finland and the other Scandinavian countries have crime rates less than half of the United States and as a result, they don’t spend billions of dollars to support a huge prison industry.[2] 

Those countries faring the worst were nations undergoing civil unrest, economic strife, government corruption, and a lack of personal freedom.  That last factor is probably why China ranked 93rd; despite individual Chinese citizens making economic gains, the Chinese communist government stifles individualism and civil liberties.  Russia scored 68th, which is probably due to economic hardships and government corruption.  India, with its abject poverty, poor sanitation, and overcrowded conditions ranked 140th.

That of course brings us to the United States which ranks 19th, down from 18th last year.  Given the size and diversity of our country, ranking 19th isn’t such a bad thing.  For example, the U.S. has a population greater than the top ten ranked countries combined.  Societal cohesion is one of the factors all of the top ten nations share, which is more difficult to achieve in a nation that is so large physically and in population that it has to be divided into separate states for governance.

Another contributing factor may be that many Americans have the same safety network as citizens in the top ten countries.  For example, millions of Americans have good health plans, retirement accounts, good employee benefits, such as paid sick and holiday leave, and have incomes that assure a comfortable lifestyle.  Conversely, millions of Americans are without those supports and the supports that society does provide, such as Medicaid, is not available to all citizens (18 states have still not expanded Medicaid eligibility).  And in many states, tax supported programs such as public education are not fully funded.  Thus the higher ranking may reflect the well-being of those that have, while at the same time the ranking is pulled down by the have nots.

In regard to societal cohesion, America has always been diverse, but in recent years there is a visible divide based on political ideology, economic status, and theology.  In regard to political ideology, conservatives emphasize individualism, whereas liberals emphasize individualism in the context of shared responsibility.  The problem is that as a country we’re having a hard time balancing these values.  Republicans in particular extol individualism as the answer to everything, i.e., your success in society is based on your personal efforts and nothing else.  For example, if you work for an employer that can’t offer benefits such as health care or a pension, that’s your problem, not my problem or the government’s problem.  Conversely, liberals want to change the structure of our society so that everyone has health care and a pension regardless of an employer’s situation and liberals believe the way to do that is through government actions as the people’s representative.  Unfortunately, Republicans and their conservative supporters have become ever more rigid in belief and support of their ideology.  For example, at the national level, Republicans have been unwilling to compromise on most legislation, taking a “our way or the highway” position on most issues.

Thanks to Republican economic policy, such as “trickle-down economics” and massive tax cuts for the rich, we have an economic divide never before experienced in the United States.  On the plus side, the upper middle class has grown during the past five decades.  According to the Pew Research Center, in 1971, 14% of households had an annual median income of $126,100.  Over the past half century that has grown to 20% of households with an annual median income of $207,400.  During the same period, middle-class annual household income grew from $58,100 to $86,6000.  However, the number of households in the middle-class shrunk from 61% in 1971 to 51% in 2019.  Worse, the highest earning 20% of U.S. households earned more than half (52%) of all U.S. income combined.[3]  So while some Americans faired better, increasingly more Americans are losing ground, particularly when inflation is taken into consideration.

This same divide has found its way into the nation’s religious institutions, particularly Christian churches.  In recent years, conservative Christians have tended to shape their religious values and beliefs to fit their conservative politics.  An example is the multiple times Jesus preaches against materialism and castigates the rich and condemns them to eternal damnation.  Despite that guidance, many conservative Christians adhere to the belief in the “prosperity gospel” which equates faithfulness with material prosperity.  Thus life’s rewards come as a result of individual actions rather than by supporting and engaging in activities for the common good of all.  Conversely, the common good is the underlying theme of liberal Christianity, with its emphasis on Jesus’ ministry to the poor, needy, downtrodden, ostracized, and working class.  Conservative Christians find comfort through a personal relationship with God, whereas liberal Christians find comfort by doing good works consistent with Jesus’ ministry.

We Americans place a lot of importance on our individualism and personal independence, i.e. the right to believe different things.  But it may come at a cost of personal well-being.  For example, the World Happiness Report found that:

“individuals with higher levels of interpersonal and institutional trust fare significantly better than others in several negative situations, including ill-health, unemployment, low incomes, discrimination, family breakdown, and fears about the safety of the streets. Living in a trusting social environment helps not only to support all individual lives directly, but also reduces the well-being costs of adversity. This provides the greatest gains to those in the most difficult circumstances, and thereby reduces well-being inequality.”[4]  

Contrast this statement with the messaging from the political right that government should not be trusted; something with even greater meaning under the Trump administration’s dysfunctional management of the COVID19 pandemic.  Thus good social supports not only improve the material lives of individuals it also improves their emotional well-being.  In fact, having strong social supports were found to improve virtually every variable of interest to both liberals and conservatives.  For example, nations with good social supports tend to have lower rates of discrimination, poverty, and ill health, issues that are of great concern to liberals.  However, social supports were also found to lower rates of divorce and crime, which are traditionally conservative issues.

This study created a lot of information and I plan to return to it from time-to-time, as it clearly supports that access to health care creates positive outcomes at many levels, including physical health, emotional security, and safety.  Obviously, the COVID19 pandemic will strain the governments, economies, and cultures of all nations.  However, having the kinds of social structures that contribute to “happy” societies will undoubtedly help people withstand and heal from the trauma.


[1] https://www.weforum.org/agenda/2019/03/finland-is-the-world-s-happiest-country-again/

[2] https://worldpopulationreview.com/countries/crime-rate-by-country/

[3] https://www.pewresearch.org/fact-tank/2020/02/07/6-facts-about-economic-inequality-in-the-u-s/

[4] World Happiness Report 2020.  P. 14, https://happiness-report.s3.amazonaws.com/2020/WHR20.pdf

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