Editorial
The theft of well-being: a comment on Zunzunegui et al.
El gran robo del bienestar: comentario sobre Zunzunegui et al.
a Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
b Social and Cardiovascular Epidemiology Research Group, Universidad de Alcala, Alcala de Henares, Madrid, Spain
c Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC, Canada
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"apellidos" => "Kaufman" "email" => array:1 [ 0 => "jay.kaufman@mcgill.ca" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Social and Cardiovascular Epidemiology Research Group, Universidad de Alcala, Alcala de Henares, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0015" ] 2 => array:3 [ "entidad" => "Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC, Canada" "etiqueta" => "c" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El gran robo del bienestar: comentario sobre Zunzunegui et al." ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Yes, as through this world I’ve wandered</span></p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">I’ve seen lots of funny men</span>;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Some will rob you with a six-gun, And some with a fountain pen</span>.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">And as through your life you travel, Yes, as through your life you roam, You won’t never see an outlaw</span></p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Drive a family from their home</span>.</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0030"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Woody Guthrie, “Pretty Boy Floyd”, 1958</p></span><span class="elsevierStyleVsp" style="height:0.5px"></span></p><p id="par0010" class="elsevierStylePara elsevierViewall">There is by now an enormous scientific literature on the relationship between wealth and health<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a>. Over and over again, money heals and its absence cripples, wherever the goods and service that preserve health are commodities (and this is just about everywhere). In light of this overwhelming association, who could doubt that Spaniards relieved of their life's savings or forced from their homes by unscrupulous bankers might report feeling badly? It is easy to see how having one's home or savings swindled away might easily lead to outcomes such as depressive symptoms and lost sleep. From the small pilot study of Zunzunegui and colleagues comes some evidence that it is also associated with self-reported psychiatric diagnoses, chronic pain and diminished physical health<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">2</span></a>. The breadth of these associations is impressive, but not surprising. It is one of those hypotheses that simply has to be true, at very least for the subjective and self-reported outcomes like those investigated by these authors.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The predictability of these findings does not diminish their importance as a menace to the well-being of citizens in modern societies. History shows repeatedly that losses to institutional malfeasance are more catastrophic than to common crime, and that these perpetrators are less severely punished<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a>. Recent developments in many countries have shown the importance of a systematic study of financial fraud and its consequences. For example, US-based Wells Fargo, the world's second-largest bank, was the center of a financial fraud scandal last year in which its employees created over two million fake accounts. The bank settled for a $185 million fine, but this followed a series of previous fines and fraud scandals, including settlements for discrimination against minority borrowers, money laundering, deceitful fees, fraudulent mortgage practices and home appraisals, inflated insurance premiums, violation of credit card laws, and insider trading<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a>. Similar stories of bank employees incentivized or coerced into defrauding customers have emerged in many other countries as well<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">5</span></a>, including Spain<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The response to these repeated assaults on the livelihoods of working men and women from the public health research community has been minimal. Despite an enormous literature on the health effects of giving small amounts of money to people<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a>, there has been almost no attention to the potential effects of swindling away large amounts of money through dishonesty and breach of trust. Lichtenberg and colleagues<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> did observe increased incidence of fraud among participants of the Health and Retirement Study, and noted that psychological vulnerability was predictive of fraud victimization, but they did not study its health consequences. Likewise, Conrad et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> considered the measurement of “financial exploitation”, but not the consequences of this exposure for health. The new paper by Zunzunegui et al., while admittedly preliminary, therefore serves as an important step in quantifying the association between financial fraud and adverse physical and psychological symptomatology. Obviously, the cross-sectional design employed by these authors renders it impossible to distinguish factors that predispose to victimization from factors that result from it, but the association is equally worrisome in either direction.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Zunzunegui et al. collected self-reports of physical and mental health indicators in people affected by two types of financial fraud (<span class="elsevierStyleItalic">preferentes</span> and <span class="elsevierStyleItalic">multidivisas</span>), and compared the prevalence of these indicators with national estimates from Spain. They found a substantially higher prevalence of poor physical and mental health among victims of financial fraud, especially in those that were not compensated for their losses. Both schemes were occurring commonly in Spain during the aftermath of the Global Financial Crisis of 2008, and are well-known in other countries as well<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The first scheme, <span class="elsevierStyleItalic">preferentes</span> or preferred shares, was a debt instrument in which clients would invest savings in preferred shares of the bank, under apparently very advantageous terms which were in fact misleading. Zunzunegui et al. found this mechanism to differentially affect older people in their sample. A key feature of the ongoing economic crisis in Spain over the last decade has been increased financial pressures on the elderly<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a>, since family members enduring high levels of unemployment rely increasingly on the public pensions of their retired elderly relatives<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">12</span></a>. This means that a ripple effect likely occurs throughout the dependents of these older providers, making the direct victims of fraud just the tip of the iceberg of all those who are adversely affected.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The second fraud mechanism, <span class="elsevierStyleItalic">multidivisas</span> or mortgages in foreign currencies, were problematic because of the instability of exchange rates that exposed new homeowners to unsustainable levels of debt. Again, these were peddled to consumers with rosy optimism, only to see many mortgages go into default and many homes repossessed. The Zunzunegui et al. study found the average age of these victims to be lower, as one would expect for mortgage-holders. Rather than losing savings, these victims faced default and eviction, which have been on the rise since the beginning of the economic crisis<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">13</span></a>. This type of fraud therefore also affects family members who are evicted together, making the impact broader than just the respondents themselves. In 2012 several prominent suicide cases linked to evictions received extensive media exposure, leading to popular outrage and increased attention towards grassroots organizations dealing with these social issues<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">14</span></a>. Several public health studies have looked at the consequences of such evictions on health in Spain, even if they did not measure financial fraud directly<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">15,16</span></a>. One of these studies found an increased prevalence of poor self-reported health and mental health in victims of foreclosures and evictions in Spain<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a>. These victims likely overlap, to some important extent, with the victims of financial fraud by mortgages in foreign currencies.</p><p id="par0040" class="elsevierStylePara elsevierViewall">It is worth nothing the small and unrepresentative sample employed by Zunzunegui and colleagues, suggesting that the findings should primarily serve to motivate more extensive and definitive research work in this area. A further limitation noted above is that psychological and physical morbidities can be both causes and consequences of victimization, making their observed association entirely ambiguous in a causal sense. Most likely, both mechanisms exist to some extent in a mutually reinforcing relationship, and it would require great effort and cleverness in the study design to distinguish these two pathways. On the other hand, the policy response that is urgently needed does not require this distinction. Bank customers should be protected from being conned and cheated as a matter of basic social protection, just as they should be protected from other forms of criminality and assault. Psychologically or physically vulnerable people may indeed be more susceptible to dishonest banking maneuvers, as suggested by some previous research<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">17</span></a>. And yet it is equally likely that loss of financial resources and eviction from one's home creates additional vulnerabilities. There is therefore likely to be an important feedback loop, with the distinction being that individual vulnerability of the defrauded investor may precipitate a financial catastrophe that in turn harms the entire household, multiplying vulnerabilities throughout the population. In any case, policies that reign in the unethical or criminal behavior of banks will mitigate harm stemming from both mechanisms.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The routine practice of deception or fraud by financial institutions is something that would warrant immediate policy interventions even if it did not affect health. Nonetheless, the momentum in much of the world seems to be in the opposite direction, giving banks more latitude to increase profits through any means necessary<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">18</span></a>. The motivation for a public health literature on these relationships arises from a need to understand social determinants of health and the mechanisms by which they are generated and reproduced. We already know that poverty and homelessness are causes of illness in some broader sense. It is now the task to simply connect the dots, and flesh out the mechanisms by which such misfortunes are generated on a mass scale. The new article by Zunzunegui and colleagues is a noble beginning to this work, and a spur to increase the scope, specificity and impact of this important new research program.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authorship contributions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Both authors contributed equally to the writing of the essay.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">There was no funding received to support this work.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">Usama Bilal was the recipient of a fellowship from the <span class="elsevierStyleItalic">Obra Social La Caixa</span> in 2013-2015.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Authorship contributions" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0095" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association between income and life expectancy in the United States, 2001-2014" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 4 | 2 | 6 |
| 2024 Octubre | 65 | 53 | 118 |
| 2024 Septiembre | 68 | 27 | 95 |
| 2024 Agosto | 64 | 31 | 95 |
| 2024 Julio | 62 | 31 | 93 |
| 2024 Junio | 65 | 15 | 80 |
| 2024 Mayo | 44 | 31 | 75 |
| 2024 Abril | 54 | 28 | 82 |
| 2024 Marzo | 80 | 31 | 111 |
| 2024 Febrero | 44 | 33 | 77 |
| 2024 Enero | 49 | 33 | 82 |
| 2023 Diciembre | 36 | 17 | 53 |
| 2023 Noviembre | 53 | 30 | 83 |
| 2023 Octubre | 49 | 34 | 83 |
| 2023 Septiembre | 37 | 30 | 67 |
| 2023 Agosto | 56 | 19 | 75 |
| 2023 Julio | 53 | 28 | 81 |
| 2023 Junio | 50 | 16 | 66 |
| 2023 Mayo | 68 | 12 | 80 |
| 2023 Abril | 48 | 23 | 71 |
| 2023 Marzo | 73 | 47 | 120 |
| 2023 Febrero | 65 | 13 | 78 |
| 2023 Enero | 58 | 25 | 83 |
| 2022 Diciembre | 115 | 46 | 161 |
| 2022 Noviembre | 98 | 62 | 160 |
| 2022 Octubre | 98 | 49 | 147 |
| 2022 Septiembre | 44 | 43 | 87 |
| 2022 Agosto | 61 | 80 | 141 |
| 2022 Julio | 63 | 57 | 120 |
| 2022 Junio | 56 | 44 | 100 |
| 2022 Mayo | 55 | 52 | 107 |
| 2022 Abril | 41 | 36 | 77 |
| 2022 Marzo | 69 | 57 | 126 |
| 2022 Febrero | 42 | 46 | 88 |
| 2022 Enero | 43 | 47 | 90 |
| 2021 Diciembre | 61 | 46 | 107 |
| 2021 Noviembre | 53 | 66 | 119 |
| 2021 Octubre | 60 | 59 | 119 |
| 2021 Septiembre | 54 | 53 | 107 |
| 2021 Agosto | 33 | 42 | 75 |
| 2021 Julio | 31 | 26 | 57 |
| 2021 Junio | 43 | 29 | 72 |
| 2021 Mayo | 57 | 51 | 108 |
| 2021 Abril | 144 | 82 | 226 |
| 2021 Marzo | 67 | 66 | 133 |
| 2021 Febrero | 36 | 22 | 58 |
| 2021 Enero | 59 | 19 | 78 |
| 2020 Diciembre | 44 | 24 | 68 |
| 2020 Noviembre | 41 | 21 | 62 |
| 2020 Octubre | 52 | 32 | 84 |
| 2020 Septiembre | 40 | 18 | 58 |
| 2020 Agosto | 55 | 27 | 82 |
| 2020 Julio | 31 | 22 | 53 |
| 2020 Junio | 53 | 32 | 85 |
| 2020 Mayo | 44 | 13 | 57 |
| 2020 Abril | 37 | 28 | 65 |
| 2020 Marzo | 43 | 25 | 68 |
| 2020 Febrero | 48 | 31 | 79 |
| 2020 Enero | 38 | 15 | 53 |
| 2019 Diciembre | 58 | 30 | 88 |
| 2019 Noviembre | 34 | 20 | 54 |
| 2019 Octubre | 50 | 24 | 74 |
| 2019 Septiembre | 20 | 13 | 33 |
| 2019 Agosto | 40 | 13 | 53 |
| 2019 Julio | 35 | 11 | 46 |
| 2019 Junio | 36 | 18 | 54 |
| 2019 Mayo | 37 | 21 | 58 |
| 2019 Abril | 104 | 181 | 285 |
| 2019 Marzo | 18 | 19 | 37 |
| 2019 Febrero | 27 | 24 | 51 |
| 2019 Enero | 21 | 15 | 36 |
| 2018 Diciembre | 28 | 25 | 53 |
| 2018 Noviembre | 24 | 24 | 48 |
| 2018 Octubre | 52 | 27 | 79 |
| 2018 Septiembre | 60 | 23 | 83 |
| 2018 Agosto | 44 | 16 | 60 |
| 2018 Julio | 70 | 22 | 92 |
| 2018 Junio | 57 | 21 | 78 |
| 2018 Mayo | 58 | 25 | 83 |
| 2018 Abril | 90 | 26 | 116 |
| 2018 Marzo | 133 | 34 | 167 |
| 2018 Febrero | 99 | 13 | 112 |
| 2018 Enero | 95 | 21 | 116 |
| 2017 Diciembre | 100 | 26 | 126 |
| 2017 Noviembre | 103 | 29 | 132 |
| 2017 Octubre | 216 | 76 | 292 |
| 2017 Septiembre | 462 | 157 | 619 |
| 2017 Agosto | 1 | 15 | 16 |
| 2017 Julio | 4 | 26 | 30 |
| 2017 Junio | 0 | 46 | 46 |
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