When Healthy Kids Think They Are Sick

I had a happy and healthy American childhood, but perhaps I was an exception. According to a new report by UNICEF on children in developed countries, the US and UK rank last and second to last in the "well-being" of their children. (The Netherlands and Sweden were first and second.) The report looked at a variety of factors, from rates of teen pregnancy to infant mortality to poverty. But perhaps the most convincing evidence, at least for some observers, was the fact that American and British children are most likely to describe their own health as "fair" or "poor". In other words, kids in the US and UK think they are sicker than kids in any other developed country.

I'd take this data with a hefty grain of salt. Self-reports of sickness are notoiously unreliable. Take the public health statistics of India. Kerala, the southern most state in India, has the longest life expectancy of any Indian state by a significant margin. But Kerala also has, by a very high margin, the highest rate of people who consider themselves sick. At the other extreme, Indian states with low longevity and woeful medical care, such as Bihar, have the lowest rates of self-reported sickness. Why do healthy people consider themselves sicker? Because they are used to a higher standard of well-being, and thus are more sensitive to negative changes in their health. On the other hand, people living in states with terrible public health tend to turn a blind eye to non-fatal illnesses. If it doesn't kill you, then it probably isn't worth complaining about, or even paying too much attention to. As the Nobel-prize winning economist Amartya Sen observes, "If we insist on relying on self reported morbidity as the measure, we would have to conclude that the United States is the least healthy in this comparison, followed by Kerala, with ill provided Bihar enjoying the highest level of health, in this charmed internal comparison."

What accounts for this discrepancy? I think a big part of the answer is sensory adaptation. Instead of detecting everything that's out there, we only focus on changes in our environment. Constants are efficiently ignored. This means that a healthy person will notice every deviation away from the feeling of healthiness, but will never notice the fact that they are actually healthy. So the healthier you are, the more likely you are to notice minor illnesses. As Ben Franklin put it, "We are not so sensible of the greatest Health as of the least Sickness."

That said, even if we discount subjective reports of health and happiness, the report is full of depressing facts about growing up in America. There is no good reason why the richest country in the history of the world has more than 20 percent of its children living in poverty.