Get Out of Debt For Your Health

We have all read that stress harms health. Sustained anxiety contributes to depression, disturbed sleep, worse blood pressure control and a weakened immune response. We readily accept that poor sleep, poor diet and inactivity drive that stress. We rarely ask whether money does.

The biggest nerve in the human body is the one that runs to the wallet.

However you take that, the underlying observation holds: we are emotional about money, and the emotion usually arrives as worry. Unless the financial situation is comfortable, most people carry at least a low hum of it.

This is not a hunch

When I first wrote this piece I was arguing from clinical impression. I can now do better than that.

A systematic review and meta-analysis examined the relationship between unsecured personal debt and health across 65 studies. Being in debt was associated with substantially higher odds of mental disorder, depression and problem drug use — and, strikingly, with completed suicide.¹ The association held after adjustment for income, which is the crucial detail: debt appears to carry a burden of its own, beyond simply having less money.

The direction of causation is genuinely difficult to establish, and the authors say so. Depression makes managing money harder; unmanageable money makes depression more likely. In clinic that distinction matters less than it does in a journal, because either way the two travel together and both need attention.

The uncomfortable practical part

It is genuinely hard to escape a financial hole. Losing a job, owing more on a house than it is worth, or simply finding too much month left at the end of the money — none of these yields to positive thinking.

What I have observed, in patients and in myself, is this: the deeper the hole, the more radical the response has to be, and the more reluctant people are to be radical. Most want a solution that leaves the shape of their life untouched. Those solutions are usually the ones that do not work.

I am a physician and not a financial adviser, so I will not pretend to expertise I lack. What I can say is what I have seen help:

• Write down the actual number. Vague dread is more corrosive than a known figure, however unpleasant. Uncertainty is the part that keeps people awake.
• Deal with the smallest debt first if you need momentum, or the highest interest first if you need efficiency. The evidence on which is better is mixed; the evidence that having a plan beats not having one is not.
• Involve the person you share a life with. Financial worry carried alone damages both the health and the relationship.
• Talk to your creditors before you miss a payment, not after. Options narrow sharply once accounts default.
• Use free, regulated debt advice. In the US, a nonprofit credit counselling agency; in the UK, StepChange or Citizens Advice. Avoid anyone who charges a large fee upfront to consolidate what you owe.
• Protect sleep and movement while you sort it out. They are free, and they are what keeps the stress from becoming illness.

And if you are the one being told to eat better

If your doctor has advised more fresh produce and better food while your finances are stretched, it can feel like advice from another planet. A few things genuinely help without much money: dried beans and lentils are among the cheapest sources of protein and fibre available; frozen vegetables are nutritionally equivalent to fresh and cheaper; oats cost very little per serving; and tinned fish is inexpensive.

It remains true, and worth saying, that money spent on supplements is almost always better spent on food. That is the single most expensive mistake I watch people make, and it is made most often by those who can least afford it.