Vital Signs: What’s causing a generational divide in happiness

CATHY WURZER: Thiss is Minnesota Now on MPR News. I'm Cathy Wurzer. It's time for our segment Vital Signs. Every month, we'll be talking about topics that are important to your health, take a deep dive into medical news or what's on the top of mind at your doctor's office.

Joining us right now is Dr. Jon Hallberg a family medicine physician at Mill City Clinic in Minneapolis and a professor at the University of Minnesota Medical School. Thanks for coming back.

JON HALLBERG: Oh, my pleasure, Cathy. Thank you.

CATHY WURZER: Let's talk about the lingering effects of this cyber attack that involved mammoth Minnetonka-based UnitedHealth Group. This is a system that's complicated for folks-- but it's a system that many hospitals and medical clinics use to submit claims, right?

JON HALLBERG: It's that and more. And I know that like in my clinic, we very quickly became aware of this when we were sending in prescriptions. And we do this electronically. There was a time when we would have a prescription pad.

CATHY WURZER: Yes.

JON HALLBERG: I'd get ink stains on my hand from filling these out. And I can't tell you how happy I am that we don't have to do it that way anymore. But when you rely on something electronic, you order the prescription, you send it in, you assume that the pharmacy that you're sending it to got it. And we pretty quickly realized that our pharmacies were not getting the prescriptions.

And, of course, people are showing up at the pharmacies to pick up their prescriptions, and their refills, or their new medications to treat acute conditions and chronic conditions. And, oh, my gosh, all of a sudden, it was just not chaos, but it was creating a ton of frustration and anxiety on behalf of the patients, and also our nursing staff who are fielding the phone calls, then, of angry patients. And it took a while to figure out why exactly this was going on.

CATHY WURZER: I was talking to the head of the Minnesota Hospital Association who said that this is also causing ripple effects when it comes to financial problems for hospitals and clinics.

JON HALLBERG: Oh yeah, I think especially small clinics. Some places are not able to make payroll because they're not getting reimbursed for the work that they're doing. And so you can imagine just the lower level small clinics, you've got massive systems dealing with this-- pretty much every clinic that's submitting things electronically using a certain system to get their prescriptions sent in, that was affected. So it had a really unforeseen, massive effect on patients, and health care providers, and the systems in which they work.

CATHY WURZER: I wonder what this says for the vulnerability of our health care system to cyber attacks.

JON HALLBERG: Well, this is certainly a test of that security or a test of that system. But what an example of how interconnected everything is. This is affecting everything from independent practices to massive systems, and we're all kind of buying into the same system. It's really tough.

CATHY WURZER: Hey, let's talk about a new report that was out. It's called the Global Happiness Ranking. And it looks at things like social supports, life expectancy, that kind of thing. And evidently, the US saw a big drop, going from 15th to 23rd.

And it looks like there are some generational divides in this study. It's pretty interesting stuff. What did you make of it?

JON HALLBERG: It's interesting-- so let's start with the positive, and that is that people over 60 in the United States seem to be relatively happy. So they actually made the top 10, and I think for a variety of reasons. Obviously, not ignoring social determinants of health, but let's say that people at 60, you're done raising your kids, generally speaking.

You've got some money that you've saved. Life is different. And, in fact, it's funny-- this past couple of weeks with my patients in clinic, a lot of my patients are over 60-- a lot of them are over 65-- and they've been reading books like Live Life in Crescendo-- Your Most Important Work Is Always Ahead of You by Stephen Covey.

Another one that was mentioned was Learning to Love Midlife-- 12 Reasons Why Life Only Gets Better with Age. And so it's interesting-- there's this certain security, amount of happiness in that group. But if we go to the other side, people who are younger, I'm hearing this all the time-- the political divide, climate change, housing affordability-- gone is sort of the starter home. I had a teacher the other day who works for one of the big school districts who is paying more for daycare than her home mortgage.

CATHY WURZER: What?

JON HALLBERG: Yeah.

CATHY WURZER: Wow.

JON HALLBERG: So how all of that erodes a sense of happiness and well-being and creates a huge amount of stress. And again, to stress just the social determinants of health for so many people-- just cost of groceries, can you afford a car, can I get to my job or my appointment. That is heavy, heavy stuff and absolutely will erode a sense of happiness.

And I think that the countries that have strong social support generally, they're happier. And I think a lot of times, we feel like we're kind of left to fend for ourselves. And it's really tough.

CATHY WURZER: I wonder what role the pandemic played in this too.

JON HALLBERG: Oh, I think a huge.

CATHY WURZER: Yeah.

JON HALLBERG: A huge, huge role. Yeah, a lot of folks are questioning everything. And it just--

CATHY WURZER: Still questioning everything.

JON HALLBERG: Still questioning everything. And people probably know, when you go to a medical appointment, generally speaking, we all have questionnaires to fill out ahead of time. And usually, it's a depression screening.

And even if people say they aren't depressed, they'll often have a little caveat with that. They'll say, I'm not depressed, but. And they'll say, I am so stressed, or I've never been more worried about the condition of the world.

I can't talk to my family members because they're on one side of the political spectrum. Yeah, there's rifts. I've been doing this for 28 years, and I just feel like lately since the pandemic, I'm hearing kinds of stresses and strains I haven't heard before.

CATHY WURZER: What kind of effect does it have on a body when you're under so much stress and anxiety?

JON HALLBERG: Oh, I talk about it all the time. This is simplistic, but I think of a rat and a maze. And if a rat, every turn that rat takes, you get a big piece of cheese, life is good. But if every turn you take you get zapped, how can that not have a physiologic effect on that body, and that brain, and neurochemistry?

And I think that, of course, life is that maze. And if you're getting negative, reinforcement negative feedback all the time, everything's a challenge, it's going to change things. And it has a profound physiologic effect on the body. And it can include and go to overwhelming anxiety, depression, of course, loneliness ties into all of this, and just all of that.

CATHY WURZER: I'm glad you brought up loneliness because, of course, the US Surgeon General declared, fairly recently, a loneliness epidemic-- about a year ago, actually, he did. I wonder if anything has improved along those lines-- because we are so connected, though, via our devices, but not necessarily person to person.

JON HALLBERG: Yeah. When you say that, I always go back to the Pixar movie Wall-E, the sort of dystopian future of people on sort of La-Z-Boys that float, and slurping on liquid protein, and connecting with one another through basically tablets.

And there's a scene in that movie where two people pull up side by side, and they don't realize that they're actually physically side by side. They're looking at each other on these screens. And I think that there's more talk about loneliness.

So I think that has been a conversation changer. That comes up all the time now. But what's the solution to that? It's sort of like, yep, we're talking about it. Now what? How are we going to fix that? How are we going to help people?

CATHY WURZER: Somehow, you just got to reach out, I think, and really work to make social ties with individuals.

JON HALLBERG: Yeah. And I think realizing, OK, if we're all acknowledging this now, then who in our lives can we think about, and turn to, and offer help, and a hand of kindness? I'm hoping that happens.

CATHY WURZER: Well, since you mentioned the Pixar movie, let me ask you about some pop culture. Do doctors watch TV medical dramas?

JON HALLBERG: I think some do. And I think, certainly, younger folks do.

CATHY WURZER: Maybe just to laugh at them, I don't know.

JON HALLBERG: Well, it's interesting-- I've talked to medical students over the years about this. And, boy, a number of years ago, I was in Washington, DC for a conference, and I polled the assembled medical students-- and, man, they loved House. And I was really surprised by that, because, really? This sarcastic, mean-spirited--

CATHY WURZER: Yeah.

JON HALLBERG: But I think that the undertone of that we are so careful with how we interact with people, we're so politically correct that he was like the opposite-- a little bit like Curb Your Enthusiasm with Larry David. Just everything that you may be thinking that you could never ever say, he says. And Dr. House, Gregory House, did the same thing in that show.

CATHY WURZER: Did you ever watch Northern Exposure? I mention this because it's out on Prime Video.

JON HALLBERG: Oh, yes, I did. And in fact, I had to go back, because I was thinking, I know that I was a medical student when that came out. I watched it with great anticipation. And it aired on July 12, 1990.

So I had just finished my second year of medical school. And Joel Fleischman recently graduated from Columbia Medical School, skipping the fact that he probably needs to do residency before he becomes a doctor in rural Alaska. But set in Sicily, Alaska-- was actually filmed in Roslyn, Washington.

I always felt like that little town was sort of like Grand Marais, this quirky, artsy kind of place. And, oh, I love that show.

CATHY WURZER: Did you start watching it again?

JON HALLBERG: Well, I haven't. I'm very interested, as a family physician, in how family medicine and, previously, general practice is portrayed in the arts, and pop culture in particular. And this is part of my, I don't know, 12, 15 television series and films that sort of do this-- that portray primary care.

And though his training has nothing to do with what we actually have to go through, the humanity in the show is really something. And I really, really love that. And so, yes, I'm watching it again and loving the music. And, Cathy, there's a DJ, Chris in the morning--

CATHY WURZER: What?

JON HALLBERG: Yeah. It's Alaska kind of public radio station. And he reads Dostoyevsky, and then he'll kind of turn to some music. And it's really a lovely, sweet series.

CATHY WURZER: See, I never got into it. I maybe watched a couple of episodes. But now that you say there's a DJ in it, oh, wow.

JON HALLBERG: Now's your chance.

CATHY WURZER: This is my chance. It's always a pleasure. I'm so happy you came into studio.

JON HALLBERG: My pleasure. Thank you so much.

CATHY WURZER: Dr. Jon Hallberg is a family medicine physician at Mill City Clinic in Minneapolis and a professor at the University of Minnesota Medical School. By the way, Friday, check out our podcast, and you'll find an extended version of this conversation.