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The Truth Business Leaders Need to Face

April 26, 2024

A silent disruption of population health and human potential is causing a decline in economic growth and increased poverty worldwide. The number of citizens losing trust in leaders from public-private partnerships that ruled and mandated public health and climate policies and are responsible for eroding human capital is rising.

Recovery via improved investments is urgently needed. Creating healthy generations and rebuilding a flourishing economy both require trusted independent business leaders from small and medium enterprises (SMEs) who uphold finding truth and not doing harm as bedrock principles. 


Human Capital is the Key Driver of Economic Growth and Poverty Reduction

Every business leader and politician knows that absence and poor mental health drain business. 


The true problem business leaders need to face is the increase in unexpected deaths at all ages, a rise in frequent and long-term sick leave, and more people experiencing lifelong disabilities. Together, they lead to a considerable loss in productivity and high costs, a rise in bankruptcy of small and medium enterprises, and an increasing number of people in poverty. 


Analysis of a Covid-19 Policy Score Card in the US shows a negative health effect for about 10% of the population and 30% of the civilian labor force. Business analysts are warning that this alarming negative trend is expected to continue over the next several years.


Moreover, those under 25 years of age, who will make up 90% of the prime-age workforce in 2050, experienced at critical moments in the lifecycle a derailing of developments by lockdowns and school closures. This amounted to a hidden but massive loss of unmet potential with a decline in lifetime earnings as high as $21 trillion globally. 


The economic loss by the disastrous Covid-19 pandemic response and unneeded climate measures will exceed far beyond the $16 trillion virus. Soon, human capital will be the number one topic in risk management for business owners and investors for years to come.


Skyrocketing Sickness Hits the Heart of Business

Sickness hasn’t been this prevalent in decades. Independent investigators and insurance companies all point to similar observations, noticing a sharp decline in general health and well-being and an increase in sudden unexpected deaths of people in the workforce since 2021. According to Randstad 1.27 million employees miss work every day. The absenteeism rate rose to 6% in Q3 2023.


The growing number of people not able to work because of long-term illness is reflected in the economic data of many countries. Moreover, mental health problems among the youth have almost doubled. 


Insurance companies in various EU countries, the UK, and the US have started to sound the alarm bell over the risk of recession and an increasing number of businesses that face bankruptcy due to high costs of human capital and poor performance.


Switzerland

Switzerland had a previous low sick leave rate of 2.4 days per year. This has changed. In the Swiss economy, absence from work due to mental illness has reached a record level and is 20% higher as compared to the previous year. Never have absences due to mental illness, burnout, post-traumatic stress syndrome, fatigue syndrome, or Long Covid syndrome been this high, with young people affected disproportionately. In the 18-24 age group, seven out of 10 people who are unable to work suffer from mental illness. This is four times higher than 25 years ago. These data reflect a structural trend.


A survey by AXA Insurance among SME found that almost two-thirds are confronted with absenteeism due to mental health issues. Workplace absenteeism weighs heavily on the activities of companies. 


Extended employee absences can have detrimental consequences for the company’s operation. Among the most frequent repercussions are overtime and increased workload from the remaining staff (54%), costs related to recruiting additional personnel (38%), loss of production or failures in services (37%), and costs related to continuous salary payments.


Germany

Germany’s true economic disease, recession, includes rising sickness and declining productivity. In 2023 each employee had 19.4 days of sickness leave, almost equal to one month per employee and two times higher than in 2010. The highest increase was observed in 2022 and 2023. Filling open vacancies has become a headache for each business owner.

Source: tagesschau 20.00 uhr 26.01.2024


recent study of the Kielerinstituts fur Weltwirtschaft observed that the increasing number of sick days cost the German economy between €27 billion and €42 billion per year. The number of sick days per employee increased from 8.5 days in 2020 to 11.3 in 2022 to 19.4 in 2023. The highest percentage of sick leaves is caused by respiratory diseases, followed by mental diseases (3.6 days/employee), and muscle disease and back pain (2.8 days/employee). In 2023 corona declined from 50% in 2022 to 34% of sick days. 


According to AOK, absences due to mental illness have increased 48% since 2022, and this type of sick leave is associated with much longer periods of absence. In the study, a significant proportion in Germany complained that they were overburdened and stressed at work, with 78% complaining of exhaustion, anger, and annoyance, and 66% complaining of listlessness.


Remarkably, many young people between the ages of 18-29 years are more frequently sick than they used to be. One would expect this generation to be more resilient and with stronger immune systems. Some suggest they might stay home while still being fit enough to work. Unfortunately, a rise of mental health problems in Generation Z is seen in all countries evaluated in this article. Risk management should pay more attention to the unprecedented rise in mental problems in this age group.


UK 

Although the UK has consistently been a strong performer internationally in terms of working-age participation, its post-pandemic rise in inactivity stands out. The UK is facing a recession due to unneeded pandemic and climate measures that eroded human capital. This is a hidden crisis that can no longer be ignored.


A recent report has found that workplace absences soared to the highest level in over a decade. It found stress to be a significant factor for both short- and long-term absence. 


A staggering 2.6% of total working hours were lost in the UK last year, amounting to 18.6 million days off work and costing the UK economy £14 billion annually. UK employees are two whole days more absent than they were before the pandemic, with an average of 7.8 days per employee per year. 


The number of people saying they are economically inactive due to long-term sickness is now 2.8 million (1.5 million women and 1.3 million men), an increase of more than 200,000 in the past year and 700,000 since the pandemic started in 2020. This is the number of working-age adults who are not at work or looking for jobs. Women are more likely to be in low-paid jobs and suffer the impact of austerity.


Analysis of trends in disabilities in Personal Independence Payments data by Phinance Technologies shows an upward trend for chronic and infectious diseases in most age groups. 



Source: Phinance Technologies



Moreover, the UK is facing significant problems in recruiting and retaining staff in the health and care sectors. Health reasons are increasingly a cause for staff to leave the NHS. The reported monthly sickness absence rate at NHS was 29% higher in 2022 than in 2019 (5.6% versus 4.3%). This equates to some 27 million days across 2022, which is on average 75,500 full-time equivalent staff, including 20,400 nurses and 2,900 doctors. 


Reasons for NHS sickness absence are most prominently mental health problems. Mental health problems cost the UK economy £118 billion annually. This equals 5% of GDP.

Reasons for sickness absences, average number of sick days per month 2019 and 2018


Also in other UK public sector groups, the sudden rise in sickness absence started in 2021.

Changes to sickness absence rates across specified UK public sector groups (2015 baseline 28/6/23)


High absence levels and poor retention are both causes of and caused by increased pressure on services. The NHS risks getting stuck in a vicious cycle while 7.6 million people are on the waiting list for diagnosis and treatments. The NHS is putting patients at risk by letting 335 staff including doctors do their jobs from abroad. 


Leaving people sick without diagnosis or with delayed diagnosis and treatments will result in higher healthcare expenditures and prevent employers and employees from engaging in other businesses, as they are stuck with high costs and are at risk for severe disease and even death.


Sickness absence rates are known to be related to season, infectious disease outbreaks, job satisfaction and employee engagement, workload over previous years, effort-reward imbalance, socioeconomic status, and gender. The latest report from the UK Health Security Agency shows that 70% of frontline healthcare workers refused the Covid-19 booster vaccine in 2023/2024.


In February 2024, hospitals experienced more pressure with three times more flu patients than last year. Primary care noticed a 9% increase in appointments in December 2023 as compared to pre-pandemic. Much of primary care is via e-health contact. 

A continued weakness in productivity at work seen by most economists is the biggest long-term challenge to living standards in Britain. As shown in a recent study of health and well-being in Irish companies, workplaces are becoming more stressful with mental absenteeism rising. 


Business is growing increasingly concerned about higher levels of inactivity and their economic impact on growth and inflation. Wages are rising because of skills shortages, which affect both employers and individuals. With more than 900,000 job vacancies and unemployment below 4%, the UK has a problem that won’t be solved without change.


The Netherlands

The Dutch insurance company Nationale Nederlanden calculated that in the year 2022, Dutch people were more frequently (1.5 times) and for more days sick (9 days/year) from work than ever before. From Q1 to Q4 2022, levels of sickness were increased compared to 2021 and 2020. 


In 2022, the costs for the Dutch economy were €27 billion, €9 billion more than one year earlier. For the first time, the mean sickness percentage crossed 5%; in 2020, sickness percentage reached 4.7%, in 2021 4.9%, and in 2022 5.6%. Sickness percentage increased faster for women, being 1-2% higher as compared to men. Women were more frequently ill and for more days. The highest percentage of women at work is found in the Dutch healthcare sector, which is also the sector with the highest sickness rate. Analysis showed that low autonomy and high-stress level/pressure contribute significantly to absence, accounting for 2.9 million days of sick leave with mental health problems annually and costing €1 billion/year.


Recent investigations of the Dutch Trade Union Movement FNV reflected misbehavior at the Ministry of Healthcare and several other organizations in healthcare with employees feeling shut out, censored, and unsafe.

Percentage of illnesses 2020-2021-2022 men, women, and total


As in many other countries, mental health has worsened in the Netherlands at all ages from 2021 onwards, with the highest increase in ages 18-24 years and more for females than men. The number of young people who need to use invalidity benefits increased by 13% in 2021 and this trend is not going to reverse soon, as there is an expected increase of 30% per year for years to come. 


In 2022 social security costs were €22.7 billion and are expected to rise to €1,8 billion in 2023. This is a skyrocketing increase as compared to 2022’s €93 million rise. The reason for this is still unclear.


Nearly half of the young people in the Netherlands are impacted negatively by the pandemic. The suicide rate of young people under the age of 30 in Amsterdam went up 40% in 2023. 





Mental unhealthiness


Unfortunately, Dutch healthcare, as well as the Dutch Employee Insurance Agency (UWV) which is responsible for the invalidity benefit system, is facing a shortage of well-qualified employees. This has resulted in increasing waiting lists, holding sick people in uncertainty and desperation. In the worst-case scenario, young people are pushed into lifetime invalidity benefits due to insufficient time for accurate medical assessments. 


As observed in a recent report by the ESB, the Netherlands is facing an ongoing trend in low productivity, far lower as compared to Switzerland, Denmark, and Sweden. The economic analysis thus far neglects to refer to the declining health status of the population. There is a rising number of people in poverty expected to reach 5.7% of the population in 2024. The authors of the report relate the decline in productivity to a transfer of high-productivity jobs to low-wage and low-productivity jobs and to more people starting to work as freelancers who are less productive as compared to large corporations. 


In January 2024, a 60% increase in bankruptcy of small and medium enterprises as compared to the same month in the previous year was observed. The rising trend in bankruptcy started in 2022. Almost 25% of the healthcare providers (who report continuous sickness absence > 8%) in long-term care (especially those for people with disabilities) expect negative financial results at the end of this year.

Will the Netherlands be the next country facing recession?


US

For the general US population aged 16-64, from 2/2021 to 1/2022 the absolute numbers of the increase in disabled individuals amounted to about 1.460 million. Of those, 1.366 million were in the civilian labor force, and only 9.4% were not in the labor force.

A declining trend in absence rate was observed from 2002-2019 for both men and women. Increases started in 2020 (3.6%) and in the consecutive year, 2021(8.6%), and the largest rise occurred in 2022 (28.6 %). This was higher than the 2019 rate and a 50% rise in lost work time rates. Again, absence rates are higher for women than for men.






Absence rates 25-64 years old deviations from 2002-2019 trend


Like in many other countries, mental health in the US is a rising problem. Over 21% of the adults in the US experience mental health problems. This is 50 million Americans. On average 6% of youth (12-17 years) with major depression do not receive mental health services, and 55% of adults aged 18 and older did not receive treatment. Healthcare workers are receiving confidential mental health treatments. 


In the US in 2021 and 2022, for the civilian labor workforce of 148 million, there was a 23% excess mortality relative to the expected baseline. In absolute numbers, this represents about 310,000 deaths. An estimated 1.36 million individuals aged 16-64 who are actively engaged in labor became disabled.


Even before the pandemic, 100 million people in the US who had a good paying job when they got ill now live with disability debt. Over 47% of persons with disabilities in the EU cannot pay their bills. The Human Rights report “Right to Work’ reveals the persistent gap in access to quality employment for persons with disabilities.


According to Edward Dowd, founder of Phinance Technologies, who posted on X the US Covid Policy Scorecard Human Cost for the year 2020: 458,000 all-cause excess deaths and zero excess disabilities from the trend. For the years 2021-2023 there are approximately 1.1 million all-cause excess deaths and 3.5 million excess disabilities from trend (population 16-64 years) and 28 million injuries with lost work time. 


Rise in Disabilities Related to More Deaths

For the UK, Germany, and the Netherlands, excess deaths have been investigated by Phinance Technologies in the period 2020 to 2023 and others. Depending on the excess mortality methods used, the profile varies per age group.


Correlation analysis by Phinance Technologies showed quite a strong relation between the rise in disabilities and excess deaths for the US. An 84% rise in excess deaths was observed in the age group 25-44 years.


Dowd stated in an official roundtable in the US: ‘It is not possible to hide dead people.’ Dowd referred to One American CEO Scott Davidson, who revealed in a Chamber of Commerce meeting that he had seen 40% excess mortality for ages 25-64 years. More independent analysis in the US found an increase in sudden and unexpected deaths starting in 2021.


Governments in various countries have started to introduce new methodologies for modeling excess deaths. The ONS in the UK recently changed the methodology on excess death figures that modeled far fewer excess deaths in the past three years as compared to the previously used method. Even with these changes, there are still 11,000 excess deaths in 2023 and 43,500 in 2022 when Covid was only a minor player.


Moreover, the rising absence sickness, disabilities, and decline in productivity are another reflection on the decline in population health. 


The increase is observed in all ages in the year 2021 when Covid-19 vaccines were rolled out, with the strongest signals in deaths and disabilities in the 15-44 age group with malignant neoplasm in the UK. The UK saw an unusual spike in middle age death (35-39, 40-44 years) in the first half year of 2023. According to a Bloomberg Intelligence Report, members of the public have been increasingly dying from heart failure, strokes, blood clots, and various forms of rapidly emerging cancers. If sustained, this could impact the pricing of all pension and life insurance companies.


Although a direct correlation has not been proven yet, in the past year more peer-reviewed studies have shown a risk for an increase in infectious diseases upon repeated injections with Covid-19 mRNA vaccines and an increased risk for adverse reactions


new peer-reviewed study that involved 99 million people over 8 countries identified potential links to conditions in the brain, the heart, and the immune system. Analysis of VAERS data on all vaccine deaths from 1988 to 2021 demonstrated that Covid vaccine deaths in 1 year are equivalent to deaths of 94 other vaccines in 33 years. More medical doctors started to question the safety and effectiveness of the Covid-19 vaccines in public.


UK MPs say that medicine regulators failed to flag Covid vaccine serious side effects. They believe that the Medicines and Healthcare Products Regulatory Agency (MHRA) was aware of heart and clotting issues in February 2021 but did nothing to highlight problems for several months. In 2022 Dr Maryanne Demasi published an investigative report in the British Medical Journal called ‘From FDA to MHRA are drug regulators for hire?’ calling for an independent drug and vaccine safety board. Will there be an inquiry into Covid vaccine safety soon?


Lockdownslong-term wearing of facemaskscontinuous stress and anxiety, and Covid-19 vaccines may all have contributed to the degradation of the human immune system. An increased risk of opportunistic pathogenic bacteria taking over a precious balanced immune system results in a systemic invasive bacteremia that may cause chronic diseases, acute respiratory distress syndrome, and sudden deaths. 


The possibility that mRNA Covid-19 vaccines impair the immune system needs careful consideration per person. This is also why (repeated) vaccination could never be mandated or injected without informed consent. Moreover, a recent peer-reviewed article indicated that bivalent vaccines demonstrated moderate (29%) to negative efficacy. The association of increased risk with more prior vaccine doses was unexpected.


Recently, the FDA and CDC have confirmed that the Covid-19 vaccines do not prevent transmission of infection, so any mandates need to be stopped immediately and should be prevented forever. Mandates are unlawful under the Human Rights Act as was declared by the Supreme Court of Australia. Also in New Zealand, the Court of Appeal made a significant ruling that upheld a previous High Court Judgement that the Defence Force’s workplace Covid-19 vaccination mandates are unlawful. Moreover, the South Australian Employment Tribunal has ruled that employers are responsible for compensating employees who acquire vaccine injuries from work directives.


A Broken Society

Increasing uncertainties and pressure during the past four years have fueled fear and anger from various corners of society all over the world. The many protests from farmers to young doctors, supported by a growing number of citizens, are expressing how people feel. Being unheard of for well-based comments on unfeasible policies written behind desks and pushed into society as the only truth, low prices, effort-reward imbalances, and rising costs of food and energy are the main motivations for people to stand up for autonomy and freedom.


The whole population from children to elderly people is experiencing a dramatic degradation of the human immune system that can no longer be ignored. 


Moreover, due to an overstressed and collapsing healthcare system, patients in many countries are facing increasingly long waiting lists for highly needed care. Quality and safety of healthcare are declining with more risk for misdiagnosis and unnecessary harm, with women and minorities most at risk. 


At the same time, more children show permanent absenteeism from schools. In the OECD interim February Outlook ‘Strengthening the Foundation for Growth,’ it is stated that the impact of lockdown on children’s education during the Covid pandemic may have set economic growth 40 years back. Also, the immune system is less developed than it used to be, resulting in more children facing serious infectious diseases. In just three years, child mental health cases soared by 50%


For elderly people, the availability of nursing home rooms and home care is becoming a huge problem due to the high sickness and retention rates in this sector. At the same time, there are more aging people now than before. Moreover, doctors, patients, and caregivers are confronted with a shortage in medical supportive materials and medicine, resulting in more emotional and often physical stress. 


Care and education assistance are becoming a problem for family and community members. Voluntary unpaid work, most frequently delivered by women, is another responsibility that fills the priority list of the working-age population. This leaves them at increased risk for burnout, mental health problems, or other chronic diseases.


Moreover, the pandemic, climate measures, and a cost of living crisis have increased austerity and have driven an alarming number of people to the brink of poverty, even for healthcare employees in low-wage jobs with small contracts. Worldwide, policies have driven 70 million more people to extreme poverty. Malnutrition, undernutrition, and cold are the main drivers of severe disease and death, with increasing pressure on the exhausted healthcare and social system. This is a downward spiral that urgently needs a U-turn to save human capital.


Bridging the Divide

Tomorrow’s businesses that will survive the upcoming catastrophe worldwide will be led by trusted business leaders who understand that profit is a result of investments in human capital. 


While alarming signals have been there for more than two years, many business leaders are neglecting their ‘gut’ feelings and are choosing continuous improvisations instead of working on a long-term strategy. The focus is short-term: a contract over the Green Deal, mergers and acquisitions, technology-based innovations, and/or moving business to low-wage countries with less absence and less stringent climate rules. They hoped times would turn for the better as soon as the pandemic was over. 


In the end, there will be no escape: tomorrow’s C-suite risk management will shift the framework of each business leader to investments in creating belonging and employee health and well-being as a priority. 


An increasing number of people are seeking a transformation for a healthy future. They prefer to work for companies led by supportive, transparent leadership. They seek a culture that stimulates interdependency and autonomy, where people dare to come forward and influence decision-making. 


Leaders who love to guide uncertainties and rebuild societies will succeed. These leaders strive for open and respectful communication and do not avoid a dialogue on the effects of pandemic measures, climate-neutral policies, and the cost-of-living crisis. They take responsibility for mitigating the use of toxic words, stimulating free speech, bridging the divide, and creating belonging. They offer excellent salaries and stimulate eating natural nutritious food and a healthy lifestyle.


Moreover, it will be leaders who create opportunities to rehire former employees who have been excluded for choosing bodily autonomy and/or different well-argued opinions. They will support and invest in employees with disabilities via programs that will help them return to their own work and ensure that they are not shut out into low-wage jobs or unpaid voluntary work.


Author: dr. Carla Peeters

First published at Brownstone Institute


By Carla Peeters March 13, 2025
Many countries now face a growing problem with an aging population and declining childbirths. Too many infants still die unnecessarily before the age of five years. Countries increasingly struggle to keep their economies stable. While Public Health experts communicate to focus on healthier future generations, declining health in young females is ignored. The healthiest generation with a flourishing economy is achieved by a holistic strategy addressing Young Women’s Health as a Public Health priority. The Healthiest Generation of the World in 2040 A Federation of Organizations involved in Public Health in the Netherlands has the ambition to reach the healthiest generation of the world in 2040 . Health is aimed at all levels; mental, social, and physical. To achieve this goal, the Netherlands needs the healthiest young females of the world. In contrast, data analysis from the Netherlands shows the opposite; the health of young women is declining fast. In other Western countries, it won’t be much better. The health of young women has worsened worldwide; it is time to face reality. Women’s bodily functioning and metabolism differ from men and need specific female-adapted health support. While many health problems in a population could be prevented when young females are supported for optimal health prior to pregnancy, this is not a priority of Public Health Agencies. Good health for the next generation starts with a strong and resilient immune system before pregnancy and during the first 1,000 days around pregnancy, birth, and postpartum breastfeeding. Childbirth and children’s health are declining; the number of women dying during pregnancy (within 42 days after labor) is increasing, as well as the number of abortions. Without change, these conflicting trends may develop into a disaster touching all levels of society. The Public Health Future Outlook of the Netherlands predicts that close to 12 million people will have a chronic condition by 2050. Young Women’s Health Is Declining Around half of the young people aged 6-25 years in the Netherlands experience mental health problems. Moreover, 47% of the people aged 15-44 years are diagnosed with at least one chronic disease, with young women more often diagnosed than men. When diagnosed with a chronic disease, people work less, experience more sick leaves, and are less productive. Unfortunately, not being able to work contributes to poorer health and income. An even larger percentage of young people (79%) still suffer from a negative impact of the pandemic, with women and lower-educated individuals hit hardest and experiencing mental problems like emotional exhaustion, stress, and hyperactivity. A recent study published in PNAS showed a faster aging of the brains of young females as compared to young males, which might be related to chronic stress exposure. Students experience more stress than before due to worries about inflation and the high costs of living. Within the EU, the Netherlands has grown into the most expensive country to live in. Unfortunately, there is much more that is troubling the health of young females. Increased Drug Use and a Dangerous Beauty Myth During the pandemic, the use of antidepressants increased by 16% for those aged 16-24 years and for children. Women are prescribed antidepressants earlier and take them twice as much as men. While the positive effects of SSRI have been criticized repeatedly and women report more side effects than men, these medicines are still frequently prescribed by medical doctors. One in four young people in the Netherlands use Ritalin or Concerta ( methylphenidate ) without a medical prescription to improve concentration and study results. Most people are unaware of the potential risks, like sudden death, that are well-known as a potential side effect. Research has shown that 5.5-22.5% of the young have used ADHD medication without a doctor’s prescription. Furthermore, in mid-2023, a worrisome increase in NSAID like paracetamol (Tylenol or Acetaminophen) and ibuprofen use was observed, especially in young girls, increasing the risk for poisoning. The use of antibiotics like amoxicillin increased for children 0-10 years (55%) and for those aged 11-20 years with 50%. As 2023 was the first year after the pandemic with all festivals open to the public, an increased use of party drugs (like ecstasy ) among those aged 16-35 years was noticed with regularly registered symptoms of poisoning. The online and interconnected world exposes the risk of cyberbullying among young people. Ironically, many are feeling lonelier than ever before and are struggling with their weight and self-confidence, setting them up for poor health as adults. The beauty myth is another danger. During the years 2019-2022, the use of fillers increased by 80%, and the use of Botox doubled among young women. Exposure to microplastics, nanoplastics, and nanoparticles has increased. Furthermore, the concentration of PFAS/PFOA in Dutch drinking water is found to be above the norm and may decrease the fertility of both women and men. On the other hand, the use of oral hormonal contraceptives by young girls diminished in the Netherlands, with only a slight increase in the use of an intrauterine hormonal device. Recent studies showed that there is an increased risk, although small, of myocardial infarction or stroke when using hormonal contraceptives. The use of an intrauterine device with levonorgestrel did not show the risk. Given the extensive and ongoing reliance of millions of young women on these drugs, ensuring their safety remains a critical responsibility of the medical community. As well as medical doctors informing young women of potential harm based on the latest scientific literature by informed consent. Over the past 4 years, girls and young women have been exposed to repeated HPV vaccinations and Covid-19 mRNA vaccines within a short period of time, for both of which side effects in women have been reported to be more frequent and severe. Possible interactions and/or interference with these vaccines and long-term effects on the immune system and microbiome have not been investigated beforehand. Neither was knowledge available when it started in 2021 on the possible risks and short- and long-term effects when four vaccines before 22 weeks of pregnancy were introduced. Nutritious Food Not Affordable for Many The importance of daily consumption, as recommended by the WHO, of 400 grams of fresh fruit and vegetables, meat, milk products, and eggs for a healthy life and joyful social and working life is unknown by many young people. For most of them, it has become unaffordable . (Ultra)processed foods are the cheapest satisfying foods with a well-designed composition of low-cost ingredients, sugar, fat, and salt that change the microbiome. Home, school, commercials, social media, influencers, mobile phones, and retail environments are driving obesity and being overweight in children and adolescents, often concurrent with undernutrition and anemia. A growing body of evidence shows that the billions of microorganisms present in our body are intimately involved in weight gain and loss and immune training and modulation, as well as overall host homeostasis. Around 33% of the population in the Netherlands does not consume fruit and vegetables daily. As of 2024, 7.1% of Dutch children live in poverty, and this number is still growing . More children might be undernourished, which is associated with impaired growth, neurodevelopment, and increased infectious morbidity and mortality. To reverse the problem of malnutrition, the delivery of free meals has recently started at primary schools. Unfortunately, this does not make a difference for the children at secondary schools. While sending funding to developing countries to prevent malnutrition, a similar problem appears in front of our eyes in the Netherlands. The young generation predominantly eats more plant-based foods, as it would improve climate change. Almost 30% of young women prefer to shop for vegetarian food, and 0.7% of the Dutch population is vegan. In addition, the EU introduced novel food products such as insects and worms, lab-grown meat, and Bovaer for cows to reduce methane production, which might affect the human immune system. Almost one in five adolescents vape. Long-term effects are yet unknown. In the Netherlands, vapes with synthetic liquids that taste like cola, vanilla, apricot, etc., have now been forbidden . Although smoking is declining in adults, young women more frequently smoke than boys but drink less alcohol. All internal and external environmental factors may contribute to weakening or strengthening the resilience of the immune system and may therefore influence the period of pregnancy, labor, nursing, and the health of mother and child for future generations. Pregnancy Is Regulated by a Unique Complexity of the Immune System Pregnancy is a unique immunological state. The changes of the immune system in the three stages of pregnancy (very early, mid, and late stage) are meticulously timed. In the very early stage, the immune system adjusts to prevent her body from rejecting the fetus while at the same time still being strong enough to keep out foreign pathogens. In the late stage, the body is preparing for labor, which is driven by an inflammatory response. A full-term pregnancy will follow an immunological clock . Changes in this immune profile could help to predict and possibly prevent preterm labor. Studies show that pathologically-driven inflammation might trigger pre-term birth (before 37 weeks). In the Netherlands, 14.8% of the children born are preterm with 9.7% low birth weight for the duration of the pregnancy (Big2). Interestingly, in the case of a preterm child labor, the inflammatory reaction is more heated as compared to a full-term child labor. Preterm birth is an important indicator of a risk for early death, chronic and infectious diseases, sepsis, stunting, and delayed neurological and brain development. This may manifest throughout one’s lifespan. Very early birth and extreme early birth occur in only 1.5% of the Dutch baby population and are responsible for 50% of the deaths of newborn babies. The number of abortions jumped in two years in 2023 to 39,000, with most by women aged 25-34 years of age. Abortion in the Netherlands is allowed until 24 weeks of pregnancy. The number of childbirths has declined dramatically to 167,504 in 2022. That is 1.49 children per woman, with a mean age of 30.3 years. The number of women breast-feeding is also decreasing. At 6 months, women feeding breast milk lowered from 60% to hardly 30% of the young mothers. Each year, around 661 babies in the Netherlands die. Mothers dying within 42 days after labor are around 11 persons a year with an additional 5 women dying by suicide each year, and not counting women who died from cancer. Over the past years, mothers’ deaths have been increasing worldwide, with the leading cause being heart diseases and blood clots. Pregnant women with stress , depression , or anxiety , as well as obese women with gut inflammation and chronic disease, have altered immune systems and, as a consequence of malnutrition, have an altered microbiome. A weakened immune system suggests an increased risk for preeclampsia, high blood pressure, HELLP syndrome, gestational diabetes, preterm labor, and/or low birth weight. ‘Gut Feeling’ a Turmoil for Healthy Future Generations The gut presents 70-80% of the immune cells in the human body. In the mucosal layer of the intestine, neuronal cells, endocrine cells, and immune cells cooperate to manage its metabolism and bodily functioning. Recent studies in mice showed villi of the mucosal layer expanding twice its volume during pregnancy and breastfeeding, slowing food passage, improving digestion for an optimal use of available nutrition. The intestinal mucosal layer is strongly connected to various stages of pregnancy with altered gut microbiota, metabolites, and cytokines. These bioactive metabolites modulate and change the ‘innate’ and ‘adaptive’ immune system. Together, the microbial composition and the mucosal layer of the intestine determine long-term health. Mothers’ intestines influence the biodiversity of the microbiome and the resilience of the immune system, which is transmitted to the baby during pregnancy, labor, and nursing. Earlier periods in life facing hunger, extreme stress, or severe diseases may influence health during pregnancy and may transmit to the baby throughout one’s lifespan and even with intergenerational effects. Specific nutrients may have positive effects during pregnancy, labor, and nursing. Sufficient vitamin D , present in sunlight, nutrition (fish, milk products), or supplements, is a prerequisite during this precious time in life for both mother and child. For young women who wish to become pregnant, it is important to learn how to balance the immune system and the microbiome. The immune system of young women could be the most important regulator of the healthiest generations and a population’s workability and income. Author: dr. Carla Peeters First published at Brownstone Institute
By Carla Peeters March 13, 2025
The increasing number of suicides and fatal overdoses of women healthcare workers has accompanied rising sickness, disability, and women leaving the sector. The total social and economic costs of a workforce in despair are yet unknown. A shortfall of 10 million healthcare workforce (of whom 80-90% is female) is projected by the WHO for 2030 and is of critical concern. When the health of those who look out for people’s health is at risk, the whole population and economy are at risk. This is an emergency of unprecedented scale that needs attention at the highest Public Health level. Humanity and nutrition instead of medicalization as a coping strategy urgently needs to return in the healthcare sector. Alarming Warnings by Healthcare Workers in Despair Recent studies noticed death by suicide and the risk for fatal drug overdose among women in healthcare is much higher as compared with the general population (1-10). It is not only female physicians, but the risk is even higher for nurses and other healthcare workers, especially for those with the lowest-paid jobs and heaviest mental and physical workload who have been most stretched to the limits (7). Worldwide over the last several years thousands of healthcare workers have died by suicide or fatal overdose leaving family, friends, and the workplace in shock and grief. Suicide and self-harm have substantial social and economic costs (12). One death by suicide was calculated in the UK to cost the economy an average of 1.46 million pounds (13). In 2022 more than 360 nurses attempted suicide, and 72 medical professionals took their own lives in 2020 in the UK as data from the Office of National Statistics indicate. Analysis of mortality data from the US Centers for Disease Control and Prevention from 2007 to 2018 identified 2,374 suicides among nurses, 857 among doctors, and 156,141 in the general population. However, the number of death by suicide or fatal overdose is grossly underreported. The WHO reports that over 50% of suicides happen under the age of 50 years (14). To address this avoidable burden, a better understanding of effective and non-effective strategies is paramount. Even before the Covid pandemic started women in healthcare reported substantial workplace stressors (9-11, 15-16). The past four years have put additional strain on women’s health. This is especially true for those women working as front-liners and first responders in highly demanding stressful situations. Increased complexity of care, understaffing, long working hours, additional bureaucratic tasks, moral injury, diminished autonomy, lack of decision-making ability, and low-paid jobs take a burden on their health. Moreover, women routinely face tougher challenges at work and at home such as institutionalized barriers to career advancement as well as additional pressure for domestic labor by frequently being a caregiver for children and/or parents (9). In all parts of the world healthcare workers are at high risk for violence with 8-38% suffering some sort of violence form in their careers. In 2023 for the first time in history, 75,000 healthcare workers in the US went on strike (17). Women are more frequently diagnosed with burnout, major depression, Post Traumatic Stress Syndrome, ME/CFS, and Long Covid. Long Covid is more prevalent in healthcare workers (11,18-20). These diagnoses of chronic illnesses have many symptoms in common that are known to exacerbate the risk for suicidal thoughts, suicide attempts, and suicidal completion beyond occupation and established risk factors such as socioeconomic status and education (7-8,20-24). An Epidemic of Emotional Trauma and Distress Healthcare workers are trying to hide their symptoms by pushing themselves to work despite extreme pain, fatigue, memory inconsistency, exhaustion, and grief of not being able to deliver the quality of care patients need. Being overstressed and with long-term understaffing, healthcare workers hardly take time to eat a nutritious meal. Many have become undernourished, and sleep-deprived. Potential disparities in help-seeking and healthcare access might manifest in non-medical use of prescription drugs among some healthcare workers, which has implications for workers’ safety and well-being (25). Many of the medicines used by healthcare workers might be unprescribed and unnoticed (1-8, 23). Toxic Cocktails: A Danger for Women’s Health Suicides among the healthcare workforce often take place at work. The most frequently used method of suicide is overdose or poisoning (1-8). New studies suggest that most overdoses are caused by psychiatric drugs and multiple medications in their system. Co-administration of antidepressants and opioids deliberate or unplanned is common. Women are more likely to be prescribed and take medication like antidepressants and birth control pills and seem to be more sensitive and experience drug side effects than men. Pharmacokinetic interactions may increase the concentrations and severity of side effects of antidepressants (27-28). Studies demonstrate potential side effects of psychiatric drugs and opioids as insomnia, burnout, fatigue, anxiety, pain, and suicidal thoughts (21-25). The risk of opioid-involved overdose death was nearly twice as high experienced by healthcare support workers such as nursing home workers and home health aides as compared to other healthcare workers in the sector (7). The interaction and side effects of the use of multiple medicines and concentrations are mostly unknown. This is especially true for women as most drugs have been poorly studied in women. Some medicine might even have more disastrous side effects than any benefit as seems to be the case for psychotropic medicine (26). Moreover, interactions of psychotropic drugs with immunosuppressive capabilities and Covid-19 mRNA vaccines have been reported (17). Furthermore, pandemic measures that have been mandated for healthcare workers including long-term wearing of medical facemasks (with potential inhalation of toxins) and repeated Covid-19 vaccinations with women reporting more side effects than men (30-31) might have exacerbated potential risks. Recent publications repeatedly reported a global burden of absenteeism related to Covid-19 vaccine side effects which could negatively impact the strained healthcare system and jeopardize patient care (32-33). Medicalization as a Coping Strategy During the pandemic, prescription of antidepressants and use of other over-the-counter medication like acetaminophen (paracetamol) which is often advised to temper vaccine side effects, has grown substantially. Although harmless in low doses, acetaminophen has direct hepatotoxic effects when taken in overdose or a wrong combination and may cause acute liver failure. Accidental or unintentional overdose usually occurs in patients who have been fasting, or are critically ill with a concurrent illness, alcoholism, malnutrition, or have preexisting chronic liver disease (34). Acetominophen (single or combination products) is one of the most used medications in the United States with 25 billion tablets sold in 2016. It is expected that treatment of trauma ailments and increase in chronic illness will fuel the market sales from $9.8 billion in 2022 to $15.2 billion in 2033. However, after a report showed 8,700 poisonings with high rates of hospitalization and liver injury in 2019-2020 with a sharp rise among females, the Australian medicine regulator is considering restrictions on who can buy paracetamol (35). In Sweden, the sale of acetaminophen in supermarkets was banned in 2015 after they experienced an overdose hike. Increased use of over-the-counter and controlled drugs may fuel a rise in acute liver failure. Awareness of potential unintentional irreversible harm is highly needed among healthcare workers and the public, as many new drugs and vaccines have been introduced since the pandemic. Drug Theft and Diversion Job stress and occupational burnout have been associated with increased risk for opioid use disorder which in turn can increase risk for overdose. Those who prescribe or administer medication have ready access to opioids and other controlled prescription drugs. Drug theft and diversion of controlled drugs in hospitals and nursing homes appear to have accelerated worldwide, bringing healthcare workers and patients at risk (36-38). Taking prescription medicine at work, almost 100 healthcare workers have been fired in The Netherlands. Moreover, the problems with understaffing in the Dutch healthcare sector have introduced the use of falsified certificates with people from illegal drug networks entering healthcare organizations pushing the system to more errors and deficits (39). Increasing stress at work and too many night shifts in a row have contributed to a 70% increase in medicine thefts. Almost 50% of calming and sleeping pills were not delivered to patients putting them at risk for suboptimal treatment or contaminations and errors (40). Drug use may gradually become an attractive and convenient coping mechanism. Although professionals often think knowledge of the medicine may control their use, dependence may slowly develop. Many impaired healthcare workers feel guilt and despair and suffer from physical and mental problems and may be indifferent to the risk of overdose (38) A Return to Humanity in Healthcare The problem of the rise in sudden (un)intended death of healthcare workers comes against the background of increasing long-term sick leaves, permanent disabilities, and hundreds of thousands of healthcare workers leaving the sector, choosing for less stressful and better-paid jobs. This is an unprecedented sign by dedicated women for no longer willing to work in a toxic and overstressed environment with underpaid complex tasks for often severely ill patients. The healthcare system is facing increased clinical error rates and liability exposures while adversely impacting patient satisfaction and organizational reputation. This may develop into a catastrophe when Public Health Officials do not take responsibility for a highly needed change ensuring that the workforce has the tools and resources needed to turn the wheel. Hard times may turn positive when CEOs and insurance companies start to embrace the idea that quality of care and reputation starts with a healthy, fair-paid workforce, gender equity, and a working environment choosing for humanity and good nutrition. A vital well-nourished empowered healthcare workforce that is occupied to guide people to health and work will be a win for all.
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