What is Health?

I’ve been thinking lately about health. It seems that the more you go through life the more this subject comes up. At least in the United States, the traditional medical community/ bureaucracy focuses on a narrow definition of health. They think of health mostly as the absence of disease; if you are not sick, then you are deemed healthy. Or if you have a chronic condition, the condition is “under control.” The healthcare “system” – which is of course not really a “system” but a fragmented hodgepodge of insurance companies, government agencies, hospital systems, and doctors- ends up with poor results on an aggregate basis. We spend way more on healthcare than other advanced economies, and when it comes to outcomes measures like life expectancy we get relatively poor results.

 

The reality seems to be that the medical community at least in the U.S. has much more to do with treating problems than with staying healthy. This is not to diminish their accomplishments – even though aggregate results don’t look good, I still think if you get really sick and you are a “special case” – as happened to me once- you can get great care if you are in the right hospital system. After all, when you are sick you don’t care about what happens in aggregate, you only care about getting better.

 

I believe being healthy has to do with way more than avoiding illness. Ultimately, it’s about figuring out how to live a productive and energetic and eventful and joyful life. This starts with personal choice and personal responsibility – a medical professional may have suggestions, but if you are dependent on them to tell you what to do you are headed for trouble. A big part of the reason why health outcomes are so poor is that they are determined by personal lifestyle choices and behaviors. The obesity epidemic is an example of this – unambiguously, Americans are on the whole gaining weight and unambiguously this is bad for our health. There is a huge gap between what most Americans know to be actual good health practices – eating right, getting enough sleep, getting some exercise, taking time to deal with stress- and what they actually do.

 

When you look at the hard facts, there is little indication that people “knowing what to do” and taking personal responsibility will change health outcomes for the better. Almost 40% of American adults and 20% of American children are considered obese, using measurements of Body Mass Index (BMI); and 70% of Americans are considered overweight. These rates are higher than all other advanced industrial economies. Despite the need for Americans to eat better, there is no evidence that they are actually do so. Anecdotally, a trip by the drive-thru at any suburban fast food chain at about 5:30 pm on a weekday will tend to confirm these data points. Exercise is a little more confusing – recent data from 2016 and 2017 indicates that Americans are, at least according the self-reporting, exercising more. But no one can explain yet why that is not resulting in less obesity – one theory is that it is the people who are already normal weight who are exercising more.

 

The Urban Dictionary defines insanity as follows: “doing the exact same f***ing thing over and over again, expecting shit to change. That. Is. Crazy.”

So, the obesity epidemic is a nasty problem and I don’t have the complete answer for what to do about it. But I think emphasizing personal responsibility for health might be some version of the Urban Dictionaries definition of insanity. And I say this as someone who is fanatical about my own weight and runs half-marathons these days for fun. Thankfully, not everyone is like me.

 

I have three ideas.

 

The first is to stop thinking about “health” as something that is just a personal issue and problem- or just an issue for the medical/industrial complex which has demonstrated it doesn’t know how to keep us well (and may not even really need to be incentivized to do so). We need to start thinking more about Organizational Health, Community Health and Social Health. Anyone who has worked in an organization can tell you that some organizations are healthy places to be and some are not; secondly, anyone who has walked around a city or community can tell you that some places are healthy to be, and others are not.

 

Secondly, I’m intrigued by the work of Dan Buettner regarding Blue Zones – places where more people than usual live healthily into very old age, and Blue Zones Projects – communities that invest in health and are getting demonstrable improvements in population health http://bluezones.com/. It seems that there is something very powerful about getting community members to support each other and improve their health together.

 

Finally, and I realize you may not agree, there is a compelling argument in my view for getting the government involved in how to support healthier lives. The reality is that the government is easily the largest single payer for healthcare in the United States, and therefore we taxpayers as a whole absorb the cost when people are unable to take care of themselves. Yet, as a recent New York Times article noted, government policies actually contribute to making us fatter:

“Seventy percent of American adults are at least overweight, and body weight is strongly influenced by biology; we can’t blame individuals and expect personal responsibility to solve the problem. Instead, we need the government to pass a suite of policy changes to encourage healthy diets.

Right now, the government is doing the opposite. Farm policies have made low-nutritional commodities exceptionally cheap, providing the food industry with enormous incentive to market processed foods comprised mainly of refined grains and added sugars. In contrast, vegetables, whole fruits, legumes, nuts and high-quality proteins are much more expensive and, in “food deserts,” often unavailable. Processed foods are heavily advertised, even in educational materials directed at young children. And as cheap calories have flooded the environment, opportunities to burn off those calories at school, in recreation and through physically active modes of transportation have declined.” (“The Toll of America’s Obesity”, David S. Ludwig and Kenneth S. Rogoff, New York Times, August 10, 2018).

As the authors -on an economist and the other a pediatrician – point out, it’s possible to envision having different policies that are much more conducive to healthy eating – perhaps starting in the school lunch cafeteria and extending to banning ads for junk food on TV like we’ve banned cigarette ads in the past.

Whatever we do, we need to do something and something different. Otherwise, we are expecting stuff to change for no good reason and, as the Urban Dictionary says, That. Is. Crazy.

What do you think?