My First Full-Time Paycheck
Get a Grip!

The Asthma Crisis and Mental Health

By Jonathan B. Wight

PBS NewsHour ran a story last night on the discovery that stress—particularly induced by childhood trauma—is behind some or much of the meteoric rise in asthma cases in youth in America.

“Why Stress May Be Fueling the Childhood Asthma Epidemic”
looks at the astounding increase in asthma rates in Detroit, Michigan, which far exceeds neighboring regions that presumably are subject to the same natural environment conditions. What distinguishes Detroit?—its violent crime and murder rates, leaving young kids bereft and feeling under attack.

This is a reminder of a finding that Fiedler and Wight made way back in 1989, that treating mental illness provides a cost-effective way of reducing physical health treatments (The Medical Offset Effect and Public Health Policy, New York: Praeger, 1989). In their pathbreaking (okay, a little self-hype here) analysis, Fiedler and Wight demonstrate in case studies of several hundred thousand patients in two states that there was an important payback for mental health prevention.

The “offset effect” is the lowering of physical health expenditures induced by a patient receiving timely and appropriate mental health interventions. If anyone is looking for it, this is another bit of evidence that a national health care system that covers everyone makes more sense financially than the hodgepodge of coverage we have today. We always end up paying, but not in ways that are efficient or desirable.


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