Imagine a magic elixir that’s free and grants much longer life (12 years for men, 14 years for women.) Despite benefits radically dwarfing the advantages of all health care, the elixir is almost universally spurned. For to receive this magic elixir individuals must put up with what are commonly regarded as unacceptable intrusions: they must sometimes walk; eat fruits and vegetables; not smoke tobacco; only occasionally drink; and keep their weight down. Such demands are rejected by 92-98% of different American groups.
Yet the “magic elixir” is nothing more than the “Five Healthy Habits” recently reported in a long term Harvard Study of 123,000 people. The numbers are both eyepopping and expected. Lots of other studies produce similar results. So why is public health so desperately unpopular? Why do people resign themselves to early illness and shorter lives? Below are some reasons and potential answers:
Health, Not Health Care
Most Americans like economic growth. They think it’s one of the great motives of America – our capacity to innovate, to produce. Yet they don’t accept that a healthy economy requires a healthy population or that sick people often can’t work and cost a lot of money, a proposition most of the the rest of the world has accepted for a very long time. They don’t know the results of many studies, like one in Britain, arguing that over much of the past two centuries 30% of economic growth was due to better health and nutrition.
Notice the word – health. Americans conflate health with health care, a very wrong equation. Notice that none of the Five Healthy Habits necessarily involves health insurance or health care workers. They’re about lifestyle – what you can really do to influence the health of you and your family. Universal health care often produces worthy results, but ask your doctor if she can semi-guarantee an extra 12-14 years of life. The basics of public health success remain what they’ve been for centuries: education, nutrition, sanitation and vaccination. Which is why countries that spend small fractions of what the US does on “health care,” like Chile and Costa Rica, have the same longevity statistics.
So here are some immodest proposals to get the population more capable of obtaining each of the Five Healthy Habits:
1. Physical Activity. Walking works. Walking, gardening, biking, moving 30 minutes a day is not an insuperable obstacle. It’s something humans are born to do. We’re walking machines. We grow new brain cells when we move. We get more biologically intelligent.
So it’s time to make cities fully walkable, which includes enforcing pedestrian laws – people walk less when they fear becoming roadkill. It’s for schools to emphasize ordinary physical activities as healthy, and for national public health programs showing people even tiny bits of exercise count and high intensity ones count more, like walking quickly up the steps of your home or work. We can pay for these programs by properly taxing pharmacy benefit managers for price gouging (why that $5 dollar antidepressant prescription costs you $100) or by increases taxes on tobacco:
2. Smoking. When cigarettes cost more people smoke less. And though I and others have advocated ecigarettes as a way station for smokers to quit, there is no excuse addicting teenagers to candy flavored vaping. Tobacco companies recognize vaping as their future, and they’re addicting kids. We’re letting the merchants of death make their comeback, and it’s wrong.
3. Alcohol. The booze industry has a lot to answer for. Recent British studies demonstrating that for a sheaf of diseases there is no clear safe level of alcohol, should get their own national health campaign. The drinks industry has quite consciously gotten away with murder pointing out the small useful effect of alcohol on heart attacks. It’s time national education programs portray the many avoidable deaths from heart disease, cancer and dementia alcohol causes. It’s not just drunk drivers, folks. Alcohol is a pantoxin.
4. Food. Lots of attention is paid to the bioengineering of addicting kids and adults to tobacco and nicotine, but very little to the decades of similar work performed by the food industry. There are lots of ways to addict people, and junk food researchers have studied lots of them, with fabulous financial results. What could be more profitable than a product that people can’t resist, and want to use all the days of their lives?
Though food regulation often gets vilified, there are reasons Mexico is taxing sugary drinks, and why the WHO is considering exogenous sugar as a carcinogen. Humans are built to eat whole foods, but we can be taught to enjoy taste-engineered garbage a whole lot more. This is a place where schools and governments have a big job to do.
5. Weight. Of the five healthy habits, this may be the toughest problem for the general population. Genetics is part of it, but modern American life seems organized – through electronic screens, food choices, and lack of public transport – to make Americans weighty.
Making Americans big does not make America great. There are remedies. We should encourage self transport. It’s healthy and often mood enhancing to walk or bike to the store when it’s not miles away. We can educate people about food, where it comes from, how its grown and how it’s prepared. For the poor, who get hit the hardest, we can subsidize whole foods, especially plant based ones. We need people to keep moving and meeting through their homes and neighborhoods. And we can make public what food companies do to make junk food “irresistible.”
Personal health and survival depend on public health. Yet American policy makers don’t even know the difference between health and health care. Neglecting it means not just lost lives but lost jobs and economic growth. The Five Healthy Habits reportedly reduced cardiovascular death risk by 82%, and cancer death risk by 65%
Have you looked at the Federal debt recently? Getting people healthy may be the cheapest, most effective way to reduce it.