Health & Wellness Advice

A review and commentary with implications for public health, Pt. 2 by Dr. David G. Schawartz, M.D.


“WHERE TO INVADE NEXT, Documentary by Michael Moore" Part 2

Continued from last month, the next country that Michael Moore invades is Germany. He still could find a thriving middle class there. He visited a pencil factory that actually had windows. I learned from other sources that law requires a minimum number of windows in factories. Employees work 30 hrs per week and get paid for 40. None of the workers he interviewed had a second job. They have universal health care and no college debt. Any German can get an Rx from a doctor for a 3 wk stay in a spa, because in the long run it saves money in health care by managing stress. One of the attendees at the spa said, "It’s just common sense that if you take care of your neighbor, everyone benefits." My comment — When you have a single payer health care system, it benefits the taxpayers in the long run to provide primary preventive services because of better health outcomes and lower health care costs. With private insurers in an ever-changing market, there are fewer incentives to cover prevention, because the insurers providing the benefits may not be the ones that benefit from the better health outcomes. Also, regarding universal health coverage, I recently noticed an article in JAMA, Jan 24, 2017, quoting an editorial from 100 years ago in JAMA, Jan 27, 1917. It begins, "The United States is practically the only large industrial nation which has not adopted compulsory health insurance."

It is the law in Germany that in companies such as Mercedes, VW, etc., supervisory boards must have 50% of the representatives as workers. The management takes ideas from workers because they are intelligent, and a manager says, "and that’s the key to our success." The VW workers urged the government to prosecute VW official because of cheating. They knew it would help the company in the long run. It is against German law for any company to contact an employee while on vacation. Many companies have also adopted a rule not to email an employee while not at work. Here again, the labor movement had its beginnings in the U.S.A. May Day, now celebrated in many countries, symbolizing the rights of workers, started in Chicago in 1886.

The Germans openly confront their ugly past regarding World War II. Every day in schools all across Germany, the children have a lesson about what their predecessors did in the holocaust. The idea is that if you recognize your dark side and make amends for it, you can become a better person. It is not like, "Way back then it happened, and we’re not responsible for it." No, it is, "That is a part of our national identity, and we have to own it." Street stones mark the names of Jewish people who lived in the nearby houses before they were taken away. Other signs on lampposts remind people of anti-Semitic rules during that time. The German intention is to be sure that this never happens again.

Michael Moore asks, how much have we confronted the demons of our past regarding the genocide of native peoples, slavery of African Americans, (and I would add the Vietnam holocaust with millions of civilians slaughtered, and the genocide of the Philippines in the Spanish American War)? If we don’t confront our past, we are more likely to repeat it. Slavery exists currently in prisons in the U.S., with many major corporations benefiting from free labor in the prisons, by mostly black men.

Then, on to Portugal he flies. Michael Moore met with Dr. Nuno Capas, Minister of health. Portugal had been losing its war on drugs until drugs were legalized 15 years ago. Fewer people are using drugs now, and there is less drug-related crime. Dr. Nuno said you can’t just decriminalize it or legalize it, you also need other things like free treatment programs as a part of universal health care. Public Health alert - What would happen to our deadly epidemic of opiate addiction if we had those free treatment services abundantly available? Currently there are long waiting lists here and treatment is prohibitively expensive to many people. The police had a message to the U.S. "As long as you have capital punishment, you cannot preserve human dignity." My comment - Whenever we deliberately, premeditatedly kill someone, (except in an emergency to immediately save others lives), we diminish the value we place on anyone’s life, including our own.

Speaking of punishment, Moore finds next in Norway, a prison system that aims to "create good neighbors." The purpose is rehabilitation, and only that. Tom Eberhardt, the warden, says the only punishment the criminals have is that they are away from family and friends. They train them to go back to their communities to show kindness and love. He says, "This is not strange because it is in your constitution, ‘No cruel or unusual punishment.’ You wrote that. This is the way to take care of each other." The guards do not have guns, they sing in the prison, and they teach the prisoners music. In a maximum-security facility with convicted murderers, Moore talked to prisoners who had never been stabbed, beaten up, or raped in the shower. Each had his private shower. Each prisoner has a key to his own cell. Prisoners can vote, and candidates campaign, televised, inside the maximum-security prisons.

The U.S. has one of the highest recidivism rates in the world, nearly 80% within 5 years. In Norway, it is 20%. The longest possible prison term in Norway is 21 years. Public health alert - Norway has one of the lowest murder rates in the world. Again, the elimination of capital punishment was an American idea long ago. Michigan, Michael Moore’s home state, was the first English-speaking state in the world to eliminate the death penalty.

The next invasion is in Tunisia. In the revolution of 2011, where the Arab Spring began, the women took to the streets in multitudes. They were determined to have rights equal to men. The conservative Islamist party in parliament strongly opposed it, but when the will of the people obviously demanded it, the Islamist party agreed to step down and to abide by the ruling. Rached Ghannoueli, the head of the Islamist party said, "It was indeed a difficult decision. We made this moral choice because power isn’t everything. Prayer comes before power. So does avoiding conflict and bloodshed…I personally tell my wife to cover her head, but the state should not do that. The state should not tell women how to dress, or to interfere with their lives." Regarding homosexuality, he said, "What happens in the home is not a state affair, it’s private. Regardless of a religious person’s opinion, the government should only focus on public matters."

My comment - In this country some of us are terrified that the Muslims in this country will take over with Sharia law, and would do well to hear what Rached Ghannoueli had to say. When we think we are so big and powerful, it is easy to not care to learn about other countries unless a terrorist attack occurs, and then paranoia can result, and we don’t know why people hate us. Ignorance is not bliss. A Tunisian reporter involved in the revolution said, "I know a lot about your country. I wear your clothes, I eat your food, etc., but you are not curious about my country. Come visit us, see how we live, you might learn something." Public health alert - What we don’t know can hurt us.

So in the 2014 Tunisian constitution, Article 46 says, "The state shall guarantee equality of opportunity between men and women in the bearing of all responsibilities and in all fields. The state shall strive to achieve equal representation for women and men in elected assemblies. The state shall take all necessary measures in order to eradicate violence against women." The women in Tunisia have access to all aspects of health care.

Public health alert - When women have equal access to employment and health care, and other equal rights, they are safer and in better heath, and it follows that their children and families are in better health and safer. The old saying goes, "When Mama is not happy, noooobody is happy."

The Tunisian constitution accomplished what was strongly promoted in the USA as the Equal Rights Amendment in the 1970’s, and it still lies moldering in the "lost and found," yet to be retrieved.

Next he traveled to Iceland, where he found another example of the beneficial economical and political effect of women’s actions. Much of this started with the women’s strike in 1975. Ninety % of women did not work that day. No banks, schools, or buses operated that day. Five years after that, Iceland was the first country in the world to democratically elect a woman president, Vigdis Fimbogadotter. After that, dozens of other countries followed suit with women heads of state.

In the 2008 financial crisis, 85% of the economy was wiped out in weeks. All banks failed except for one that was entirely owned by women. Women make less risky investments than men. Icelanders took to the streets, and what followed was that 70 bankers and hedge fund managers were sent to prison. Since 2003 no banker in the U.S. without a Muslim name went to prison.

The special prosecutor who got them convicted was Olfur Thor Huksson. He got advice from Bill Black in the U.S., the attorney who had prosecuted the Savings and Loan Crisis decades ago. This is another example of an idea that came from the U.S.A. After the Icelandic financial crisis, much of the financial decision-making was turned over to women. Since then, their economy has recovered completely.

Michael Moore played golf with 3 Icelandic women CEO’s, who described their current financial regulations. The board of directors of a company has to be at least 40% women and at least 40% men, no more than 60% of either. Halla Tomasdottir says, "Once you have 3 women on the board, it changes the whole dynamic. One is a token, 2 is a minority, but 3 changes things, what is discussed, how the dialog takes place. "Women ask about all the stakeholders, not just the bottom line." They said that here we say "we," and in the States you say "me."

In the interview with Iceland’s first woman president, she said, "Women look for collaboration. They want to save humanity and the children." When Moore asked the 3 CEO’s what advice they would have for us, and then one, after pondering the question seriously for a while, responded sadly, "I wouldn’t want to live in the States if you paid me. The society and the way you treat people, the way you treat your neighbors, I would never want to be your neighbor, never, ever! Because you don’t treat your fellow Americans the way you should."

In the end, Michael Moore recognized that all these main concepts, the rights of workers and of women, educational excellence, no cruel and unusual punishment, promoting the general welfare, jailing of bankers, etc., all were originally American ideas, and that, "We don’t need to invade other countries to get these ideas, we just need to go to the American "Lost and Found."

My depiction of this story does not do justice to the impact of this movie. You need to watch it to get the emotional impact, the humor, and the dramatic and entertaining narration.

So, are these ideas really likely to take hold in this society any time soon? If governments pass laws to which the society or culture is not amenable, it is a hard sell. If more "general welfare" measures were taken, people with more individualistic values would try to "game the system," and try to get more than they were allotted. If workers were paid more for a shorter workweek as in Germany, would they here just take another job or 2 to acquire more things and bigger houses? German houses are very small compared to ours. Richard, the plumber on "Ask This Old House," after his visit to Germany, said that it was rare for him to see a business that did not have a roof top garden or solar panels. Our individualistic values are more materialistic, and they militate against collaboration and sharing, and distract attention from non-materialistic values such as emotional, mental, and spiritual life, survival for future generations. Even many low-income people vote against their own self-interest, to favor the wealthy, gambling on hopes that they too would become wealthy some day, a very unrealistic view, considering that the system is designed against upward mobility and continues to shrink the middle class, siphoning the benefits of increased productivity upward to the 1%. Our culture is heavily weighted into the individualistic, materialistic values that contrast with the collaborative, humanistic, socio-centric values demonstrated in this movie. The sensationalism in the media is also a reflection of people’s materialistic values, and that gives an advantage to a politician who is so obnoxious that he creates a sensation that gives him extra free media coverage. This allows him to get his point across and to have an advantage in winning elections, since many people mostly watch the sensational things and don’t listen much to thoughtful consideration of issues and good journalism. This is one of the reasons why excellence in journalism has decreased because few people pay attention to it. The militarism that hogs so much of the federal budget so we don’t have enough of the much needed human services also is a result of materialism, defending our "interests" abroad, (mostly financial), not mostly our safety. In fact it makes us less safe because of hording the resources, feeding terrorism, making us more fearful, isolated, and selfish.

This materialistic value system has been at odds with the socio-centric, collaborative humanistic value systems demonstrated in this movie. These 2 value systems have been in conflict in this country during the last century, and now more than ever they seem to be strikingly opposing each other almost equally. This balance now seems to be moving toward more social collaboration and away from materialistic values. Slowly, with fits and starts, we are moving that way, as it appears to me. The older value system puts up a fight as it is losing power and only temporarily appears to be dominant as it creates disturbances. Do not despair. Local communities in the U.S.A. have done more "promoting the general welfare" when the federal government has neglected its constitutional duty. Some localities have outlawed non-family corporate farm ownership, and have taxed surcharges on corporations that pay their CEO’s more than 100 times the salaries of workers. One has established a community for the homeless, with micro houses, communal kitchens and gardens, etc. One taxed itself to fund quality full day preschool for all 4 year olds.

These 2 contrasting value systems are now sharply polarized, with each camp rigidly opposed to the other, and often not listening to each other. These countries Moore visited were not without conflict also, but they have mechanisms in place for compromise, coalition building, communication among a variety of factions in parliamentary democracies. In our country the duopoly of the 2 major parties makes it hard for 3rd parties, and the system is designed for "winner take all." This limits fresh ideas and creativity, and it rigidly pits one camp against the other, in a box. No room to think outside the box. The aim is to beat up the other party and to eliminate it if possible. The districts are gerrymandered for safe seats, all majority one party or another. This win/lose scenario is consistent with the violent movies and video games and preoccupation with guns. If we put more mechanisms in place for cross-party communication, we could make transitions more smoothly, and each side would not have to be so obsessed with fear of the other party and its ideology.

We have to recognize that materialism and capitalism are what brought many people out of poverty in the first place, but running on unlimited, they can create disaster. We need to achieve the right balance, and that requires listening to the other side.

If we move more toward socio-centrism, this would be a great boon to public health, as seen in the movie. This could lead to less isolation, depression, violence, addictions, environmental diseases, and poor nutrition, very likely resulting in less diabetes, cardiovascular disease, and cancer. As Kilo and Larson said, we may achieve better public health by spending more dollars on education, jobs, environmental quality, etc., (and I would add, correcting economic inequalities), than on medical care. We often forget that Darwin considered love to have survival benefit. To love is to be fitter to survive. Will we love enough to preserve our planet’s environment so that future generations of the human species will survive?

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Wishing you all a long, healthy and happy life!

Dr. David G. Schwartz, M.D.

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