#1 Cause of Death in U.S. Rooted in Not What We May Think

Madelaine Weiss
4 min readOct 6, 2023

Table of Contents

What is the #1 Cause of Death?

Heart disease is the #1 cause of death in America, but then maybe you already knew that.

Axios posted the graphic below, also reporting increases in both heart disease and cancer from 2021 to 2022, and an alarming quadrupling of fentanyl-overdose deaths subsumed under “Unintentional injury.”

This particular Axios piece did not unpack ‘Why so much heart disease?’ but I found one that did — and this article put a lot of the blame on the workplace.

Blaming the Workplace

Why not blame the workplace? These days it seems people blame much of what ails them on the workplace, or their boss, or leadership, or co-workers, or you name it, about work.

A new study, published in Circulation: Cardiovascular Quality and Outcomes, highlights two work-related stressors that may increase heart disease risk: Job strain and effort-reward imbalance. Here is how they define the terms:

“Job strain refers to work environments where employees face a combination of high job demands and low control over their work. High demands can include a heavy workload, tight deadlines and numerous responsibilities, while low control means the employee has little say in decision-making and how they perform their tasks,” Lavigne-Robichaud explained.

“Effort-reward imbalance occurs when employees invest high effort into their work, but they perceive the rewards they receive in return — such as salary, recognition or job security — as insufficient or unequal to the effort. For instance, if you’re always going above and beyond, but you feel like you’re not getting the credit or rewards you deserve, that’s called effort-reward imbalance.”

Notice the word “perceive” and the words “if you’re always going above and beyond, but you feel like you’re not getting the credit or rewards you deserve.”

Look, I am not saying that employers, and employees too for that matter, should not treat each other with care and respect. But that only goes so far when individuals continue to mistreat themselves. The Inner Critic (TIC) may mean well, let’s say to keep you motivated, to keep you on track, but can unfortunately wind up messing up everything.

Taming the Real Tyrant

People may not even know they are mistreating themselves, but who else is doing the ‘perceiving’ that is causing the stress that may be causing the disease? Who else is deciding to go above and beyond, for reasons they might not even know, and reasons they may think make no sense once they did know.

Does anybody remember Pogo? Pogo is a character in Walt Kelly’s political satire comic strip. To make the point on how we may create our own problems, then blame them on not-us, a popularized version of what Pogo said has become, We have met the enemy and he is us.

Three people all on the same day, back-to-back this week, did it. That is, all three of them attributed the angst they felt about work to something other than what was going on in their own heads. And yet, in all three cases it turned out that no one was doing much of anything wrong, except to have ‘perceived’ that someone was.

The truth is that all three of them are amazing, so amazing that they’ve all made it into work environments filled with other amazing people just like themselves (some even more seasoned). And they are feeling the adjustment to their new place in the scheme of things.

Now they understand that they need to keep an eye on how they are coping with what is going on inside to make sure they are serving themselves and others as well as they can.

In the How of Happiness, Sonja Lyubomirsky shares her research suggesting that the circumstances we think are to blame for everything only account for 10% of our happiness.

Lyubomirsky tells us that 50% of our happiness is just the way we came into the world, genetics. And, a whopping 40% are the steps that we can take ourselves to make our lives great. Intentional activity. How we think and feel, and then what we do or don’t do, is a big part of that.

Practice, practice, practice…see what happens, and let us know. For help with this or something else, Contact Me at weissmadelaine@gmail.com



Photo by Freepik



Madelaine Weiss

Licensed Psychotherapist, Board Certified Executive, Career, Life Coach. LICSW, MBA, BCC