Expensive shrinks cost Massachusetts billions in lost productivity

The Milken Institute reported on Tuesday that the US economy took a hit of more than $1 trillion in 2003, all from lost workdays and lower productivity due to chronic disease. Click here to get the details, including a map showing which states suffered the most, as well as state-by-state data on cases of cancer, diabetes, heart disease, hypertension, strokes, pulmonary conditions, and "mental disorders."

That last category seems to be responsible for the odd geographic pattern of the "State Chronic Disease Index." Massachusetts ranks 40th (or 11th worst), between South Carolina and Alabama, even though other surveys have tagged it as one of the healthiest states. (See, for example, the United Health Foundation.) The explanation seems to be emotional: According to the Milken study, 17.5 percent of the population in Massachusetts suffered from "mental disorders," a figured exceeded only by Oregon (18.0 percent) and well above the national average of 10.7 percent. But there’s reason to wonder whether this ranking was skewed by more accurate (or more aggressive) diagnoses of mental conditions here, and perhaps less stigma associated with those conditions than in other states (all data in the study were reported by patients themselves). Still, even these caveats don’t seem to account for the fact that the mental disorder rate in Massachusetts was more than twice that in similarly stressed-out New York (8.5 percent), or why first-place Oregon is right next to last-place Washington state (5.1 percent).

By the way, Massachusetts also seems to lose points because the treatment of mental health is costlier here ($1,928 per person per year) than in any state but Alaska. For a chart of how we rank on mental health criteria, click here: Download mental_disorders_by_state_in_2003_selfreported.xls

The Milken report doesn’t have much to say about the accompanying mental health data. The authors do point to the relatively high rate of cancer in Massachusetts (4.1 percent of the population, versus 3.7 percent nationally) as one reason for our low ranking on their index, but the difference isn’t nearly as great as it is for mental disorders. And the state is relatively low in the rates of diabetes (4.6 percent vs. 4.9 percent), heart disease (6.3 percent vs. 6.8 percent), and hypertension (12.3 percent vs. 13.0 percent).

Given the wide regional variations in the mental health data, perhaps they should not have been treated separately, or not included in the study at all. People see mental health professionals for enough reasons already; there’s no need to lay a statewide guilt trip over lost productivity.