Competition as a Public Health Problem

Competition as a Public Health Problem By Pauline Vaillancourt Rosenau, Ph.D Professor Management and Policy Sciences E-915 School of Public Health 1200 Herman Pressler Houston Texas 77030 (713) 500-9491 Fax: (713) 500-9493 E-mail: pauline.rosenau@uth.tmc.edu Prepared for presentation at the Annual meeting of the APHA, Philadelphia, November 2002 AB STRACT The objective of this paper is to review existing research and specify the known public health consequences of various types of competition The results of such a review suggest that competition is not as benign as has been commonly assumed Certain forms of competition may have quite serious negative effects on human health and productivity The dynamic by which they so are known and have been extensively studied - for example, they increase stress at the individual level Destructive competition may also exacerbate already existing inequality among individuals, within societies, and between countries Increased inequality is one of several social determinants of health While commonly assumed to generate incentives for increased productivity, scholars in several academic disciplines have called the evidence for such an effect into question Organizations that restrict the level of internal competition are more productive and appear to have a more stable, more highly motivated workforce A substantial portion of the population has been found to be more likely to function to full capacity where the level of competition is moderated To assure that all individuals are provided the opportunity to lead healthy lives and produce to their full capacity requires reconsidering common educational practices and workplace organizational structures Similarly at the global level limiting destructive, winner-take-all forms of competition may be necessary if all nations are to develop to full capacity in the long term and contribute to a healthy and productive international environment There is little evidence that the current forms of unrestricted global competition maximize the health of populations or improve productivity Competition as a Public Health Problem By Pauline Vaillancourt Rosenau, Ph.D “The invisible hand conjures ill health along with wealth” (Burris, 1997, pp 1607-8) Experts suggest that competition maximizes societal well being by eliminating less competitive players from the field It is efficient, making the most goods available at the least price (Osborne & Gaebler, 1992; Scherer, 1994) Competition is assumed to yield the best, meanest, leanest systems of production with the least waste, whether it is among individuals, groups, organizations, corporations, or nations (FitzRoy, Acs, & Gerlowski, 1998; Van Hooff, 1991) It is praised for increasing productivity, rewarding innovation, encouraging each individual to perform to his or her utmost, wringing out excess market capacity, lowering costs, increasing organizational efficiency, raising standards, distributing what a society produces more adequately, protecting the public from government bureaucracy, promoting learning, and stimulating advancement in science and education (Bengtsson, 1998; Cronbach, 1963; Horowitz, 1968; Rich & De Vitis, 1992) It is thought to bring about needed change and to end bureaucratic rigidity (Osborne & Gaebler, 1992) Competition is even said to build character and improve interpersonal relations (Shaw, 1958) Experts agree that competition works its magic without reference to ethics or philosophy But even if this view is true, none of it is without costs including public health consequences This is especially the case if public health is defined in broad terms Public health’s mission as Charles-Edward Winslow put it in 1920 is the “fulfillment of society’s interest in assuring the conditions in which people can be healthy “ (Gostin, 2000, quoted on p.309; Institute of Medicine, 1988) This means everyone has a standard of living appropriate to the maintenance of health and the condition in which every citizen may realize her or his birthright of health and longevity (Hanlon & Pickett, 1984) It brings into public health a population health perspective It introduces socioeconomic status, inequalities, early childhood development, education, employment conditions, and social support systems into the public health equation (Terris, 1986, see p 55 for cite) Certain forms of competition interfere with the achievement of public health goals in several ways These are examined below, but not all forms of competition are the same in terms of their impact on human health and productivity Some are benign or even beneficial while others are destructive Much depends on how competition is employed to allocate society’s resources; how it rewards winners and sanctions losers Competition was not designed to redistribute society’s wealth Where that is the public-health-relevant goal other means are better suited to the task Sometimes the effect of competition on health is direct This is the case with regard to stress But the ways in which destructive competition constitutes a public health problem are often overlooked because the dynamic involved is often indirect and subtle For example, destructive forms of competition increase social inequality, a concern of population health approaches to public health Here competition’s influence takes place indirectly, via the social determinants of health Winning and losing at each level, be it the individual, the group, the organization, the corporate entity, or the nation, is not random (Gorney, 1972) Under conditions of unrestrained competition, results are predictable This is because at the outset, competitors seldom starts at a point of equality Some have more resources, attributes, and wealth than others Even those attesting to the virtue of the invisible hand in the marketplace agree that “one cannot explain the pattern of output or results in any market system by pointing exclusively to market transactions, for the pattern is always a result of both the transactions and the prior determinations taken together” (Lindblom, 2001, p.171) The rewards of winning are often cumulative (Frank, 1985, p 4) Eventually, and in the absence of any outside interventions, competition increases differences and sustains a negative spiral of winning or losing, thus generating even greater levels of inequality As the process moves along over time, it leads to big winners and continual losers Competition continues, and too often, the winners, often at the expense of the losers in previous competitive encounters, influence the terms of play People become discouraged when they repeatedly lose (Campbell, 1982; Drucker, 2001, p.11) The intrinsic motivation to try and put forth one’s best effort is reduced by losing over and over again (Deci & Ryan, 1985) Repeated losers, be they individuals, organizations, or societies, have poorer health (Lynch, Kaplan, & Shema, 1997) and lower productivity Lower societal productivity is a matter of public health concern when it means that a substantial portion of the population cannot maintain a standard of living sufficient for health and longevity In the end everyone is worse off, because even when a minority of the population is unable to work to their full capacity, because of psychological or physical health impediments, the quality of life is compromised for all members of society The same dynamic plays out at the global level where unrestricted competition increases inequality between the developing and the developed countries Different Kinds of Competition Efforts to define competition and to distinguish among its various forms are few Certain types of competition are more likely to have negative health effects rather than others Competition can be structured in various ways and each has significant but different consequences Goal-oriented competition encourages each player, each person, to their best and to work with others to achieve an objective An example is how the World Health Organization encourages each country to set time-specific national goals for improving population health and then strive to attain those goals Each country is competing with itself to reach national health objectives (U.S Department of Health and Human Services, 1992, 2001) Inter-personal competitiveness is not so benign because it emphasizes doing better than others, winning over others for its own sake (Morey & Gerber, 1995) Johnson and Johnson suggest that there are important differences as well between zero-sum competition and appropriate competition (Johnson & Johnson, 1989; Johnson & Johnson, 1994; Stanne, Johnson, & Johnson, 1999) Zero-sum competition involves the distribution of rewards on a “winner-take-all” basis This means that I win, you lose Appropriate competition seeks to maximize personal well-being, improve overall societal productivity, and advance global community It is associated with four characteristics First, winning must not be so important that it generates the extreme anxiety that interferes with performance Second, all participants in the competition must see themselves as having a reasonable chance to win and thus remain motivated to give it an honest try, their best effort Third, the rules of the competition need to be clear and fair as to procedures and criteria for winning Finally, those competing should be able to monitor how they are doing compared to others This feedback may, in fact, be more important than actually winning (Johnson & Johnson, 1989) Destructive, excessive, or unfettered competition seems to be associated with serious, negative, though sometimes unintentional, side effects.1 Examples of destructive competition include cutting costs by polluting the environment, “competing” by reducing worker safety and protection measures, or competing at socially irresponsible, damaging financial speculation Destructive competition drives out constructive competition For example, “Firms will not be able to compete at the skillful management of the production process if they are undersold by firms that are competing at evading waste-treatment costs” (Johnson & Johnson, 1989, p32-33) Groups, individuals, and countries practice destructive competition when they win by cheating on the rules—or when they cheat more than their competitors In the business world many aspects of public health are conducted as a business in United States today destructive competition is about price wars that benefit those who have the resources to outlast others, some of whom may be more efficient than the survivors (Swisher, 2000) Destructive competition involves undercutting standards, and manipulating or exploiting others Examples include stock market manipulation, tricky accounting mechanisms, confusing fares and fee schedules, deceptive advertising, marketing ploys, and less than truthful sales promotions It lends to the exploitation of vulnerable populations who may be too trusting or who simply lack alternatives (Culbertson, 1985, pp 27-28) Competition can also be described as either constructive or destructive though such descriptions are not a definition (Culbertson, 1985) To define competition solely in terms of its effects would constitute circular reasoning The terms destructive and constructive are adjectives not nouns They are employed here to help distinguish the negative aspects of competition from its positive dimensions, not as mere post-facto labels Stress, The Individual and Health Status Accumulating evidence links destructive competition to stress and stress, in turn, to ill health Many forms of stress appear to increase the risk for disease and death At the molecular level stress effects have been closely studied in the last 50 years These can be devastating The link between competition and stress is of more recent interest(Rosenau, 2003) At the biological level, competition-generated anxiety and stress reactions disturb normal hormonal processes especially as regards those who lose If pushed to the extreme limits, biological self-correction mechanisms are overridden Hormonal imbalances persist on an almost permanent basis This reduces the ability to well in future competitive situations (Campbell & Furrer, 1995) Stress, high anxiety, distraction, and low concentration all diminish the probability of winning even more At the same time, winning increases the desire to compete again All these processes contribute to the self-reinforcing spiral of destructive competition at the biological level Competition Increases Stress Exactly how stressful social processes like competition affect human health at the biological, molecular level is not fully understood though promising hypotheses abound (Wilkinson, 2001) Learning more about the precise chemistry of the wear and tear on the body’s cells and the acceleration of the aging process are central to this research topic Social stress is thought to upset the equilibrium of the neurological, endocrine, and immune systems (Brunner & Marmot, 1999; Everson, Kaplan, Goldberg, Salonen, & Salonen, 1997; Marshall et al., 1998; Sapolsky, 1996) The independent regulation of these systems and their joint interaction are disturbed by too much stress Stress interferes with the autonomic nervous system and its huge network of intricate activities, including heart rate and breathing that are all so carefully coordinated in normal circumstances The hypothalamic-pituitary-adrenal axis of the endocrine system is similarly affected In short, stress plays havoc with our hormones Competition-related stress-effects in humans have been studied in different contexts The effects of stress are greater when the competitive pressure is increased, and are higher in actual competitive conditions than in sports training sessions Intense competition leads to acute abnormal elevation of heart rate and blood pressure (Fenici, Ruggieri, Brisinda, & Fenici, 1999; Kerr & Pos, 1994)2 Highly competitive educational situations generate stress effects on individuals Twelve percent of medical students experience stress, attributable in good part to competition, to the point of psychiatric disorder (Liu, Oda, Peng, & Asai, 1997) For many individuals, stress increases with a variety of other competitive educational experiences, including classroom presentations followed by formal evaluation (Bristow, Hucklebridge, Clow, & Evans, 1997) Stress Has Consequences for Health Status: At The Biological Level Almost all antecedents of stress that affect health outcomes so in a complex fashion (Staw, 1984) and competition is no exception Biological research indicates that when destructive competition increases stress, it leads to hormonal changes that effect metabolic and physiological processes that in turn influence health Stress can protect and restore the body, but it can also damage it, with severe consequences in certain cases (McEwen, 1998; McEwen & Stellar, 1993) Some individuals are more susceptible to It is the competition aspect of sports that generates stress, not physical exercise itself In fact, regular noncompetitive physical exercise has been found to counteract stress and facilitate positive psychological health (Wankel, 1993) It is recommended for those who want to improve health and have a better overall quality of life Some believe that exercise actually increases longevity though the evidence for this benefit is far from certain negative stress effects than others.3 However, at higher levels of stress, such as those associated with destructive competition, almost everyone suffers some harm Mild levels of stress may improve performance, encourage creativity, and promote innovation But prolonged, unremitting stress is likely to be dysfunctional (Anonymous, 1997, p 396; Gordon, 1991; Herbert & Cohen, 1993; Welford, 1965) Biological, physical reactions to stress are normal and healthy But rapid return to base line is essential if disease is to be avoided (Brunner & Marmot, 1999) Stress, if it is positive, increases cardiovascular and catecholamine hormone responses but it only temporarily raises cortisol levels Stress is negative if it is due to intense fear and distress, or if it persists over a prolonged period of time and becomes chronic (Lovallo, 1997, p 73) For some individuals, certainly a minority through repeated, over-stimulation the inactivation mechanisms become inefficient This has serious health consequences (Bremner et al., 1997; McEwen, 1998; Syvalahti, 1987) The most destructive forms of competition may cause the sympatho-adrenal pathway or the hypothalamic-pituitary-adrenal axis (HPA) to overreact (Brunner & Marmot, 1999) In the extreme, the health effects of very high levels of stress may include muscle wastage, hypertension, impaired immunity (Marshall et al., 1998) and even infertility (Lacour & Consoli, 1993; Sapolsky, 1990, p 120) Lower stress levels have fewer negative health effects on the immune system and endocrine system, but people vary a great deal in terms of their reactions (Wilkinson, 1996) In addition, individual hormonal reactions to competition and stress vary across the population, with some people being highly susceptible and others not, for a variety of reasons (Frost, Morgenthau, Riessman, & Whalen, 1986; Lovallo, 1997; Turner, Wheaton, & Lloyd, 1995) In humans, known characteristics are associated with stress sensitivity These factors include early life experiences, personality, gender, marital status, age, occupation, and work environment(Rosenau, 2003) Stress raises cortisol levels, which may damage the hippocampus Stress-related increases in cortisol and beta-endorphins are probably associated with poor self-esteem and affective instability (Zorilla, DeRubeis, & Redei, 1995) In some humans, the stress that causes psychological problems is directly linked to competition (Short, 1997) This suggests “individual differences in basal HPA-function are associated with individual differences in psychological functioning following stress” (File, 1996; Zorilla et al., 1995, p 591) Stress-generated serotonin deficiencies appear to be correlated with increased irritability, insomnia, and depression (Coppen, 1973) Stressgenerated endocrinological changes can increase or decrease the tendency to be impulsive, aggressive, or even violent (Megargee, 1993) Increased cortisol is associated with nervousness (Booth, Shelley, Mazur, Tharp, & Kittok, 1989; Mazur, 1994), depression (Chodzko-Zajko & O'Connor, 1986; Loosen, 1976; Peeters & Broekkamp, 1994), and impaired memory function (de Quervain, Roozendaal, Nitsch, McGaugh, & Hock, 2000) Disruptions of hypothalamic regulatory function increase with elevated blood pressure for older patients (Gotthardt et al., 1995) The role of stress in heart disease appears to be as great as that of hypertension and high cholesterol (Langer, Criqui, Feigelson, McCann, & Hamburger, 1996; Rozanski, Blumenthal, & Kaplan, 1999) Observations of the same individuals over several years, across many points in time, indicate that stress leads to an increased probability of hypertension, cardiovascular disease, diabetes (Raikkonen, Keltikangas-Jarvinen, Adlercreutz, & Hautenen, 1996), heart disease (Moyer et al., 1994), depression (Vanpraag, 1996), and mortality (Phillips et al., 2001) Laboratory experiments involving closely controlled temporal relations have established a causal link between stress and reduced 10 American Society of Chartered Life Underwriters and Chartered Financial Consultants, & Ethics Officer Association (1997) Sources and Consequences of Workplace Pressure: Increasing the Risk of Unethical and Illegal Business Practices Belmont, MA,: Ethics Officer Association Amick, B C., McDonough, P., Chang, H., Rogers, W H., Pieper, C F., & Duncan, G (2002) Relationship between All-Cause Mortality and Cumulative Working Life Course Psychosocial and Physical Exposures in the United States Labor Market from 1968 to 1992 Psychosomatic Medicine, 64, 370-381 Anderson, C A., & Morrow, M (1995) Competitive Aggression without Interaction: Effects of Competitive Versus Cooperative Instructions on Aggressive Behavior in Video Games Personality and Social Psychology Bulletin, 21(10), 1020-1030 Angell, M., & Kassirer, J P (1996) Quality and the Medical Marketplace Following Elephants New England Journal of Medicine, 335(12), 883-885 Angier, N (2001, May 6) Together, in Sickness and in Health The New York Times Magazine, pp 67-69 Anonymous (1997) The Merck Manual of Medical Information Home Edition Whitehouse Station, NJ: Merck Research Laboratories Argyle, M (2001) The Psychology of Happiness ( 2nd ed.) 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Health Affairs, 15(2), 185-199 55 ... indicate that stress leads to an increased probability of hypertension, cardiovascular disease, diabetes (Raikkonen, Keltikangas-Jarvinen, Adlercreutz, & Hautenen, 1996), heart disease (Moyer et al.,... January 31, 2000 crash of an Alaska Air plane off the coast of California, mechanics at the Seattle maintenance facility said they had been “pressured, threatened and intimidated” to cut corners... the competition paradigm, such an addiction may even be viewed as an asset rather than a liability But to adopt this uncritical view would be a mistake When competition is addictive, withdrawal