The Health of the Americans

By Paolo von Schirach

August 30, 2007

WASHINGTON – Former Arkansas Governor Mike Huckabee, for the moment a second tier candidate for the republican presidential nomination, warns about obesity in America and the health and economic damages that it causes. A former obese himself, he talks with the passion and credibility of the reformed food addict. Recently he proclaimed the obesity epidemic to be so widespread that, according to recent statistics, 61 per cent of US active duty troops are overweight. So even those who arguably should be fit and combat ready are somewhat impaired by excess weight. Other recently released statistics indicate that obesity has increased, with special incidence in many southern states. Most alarmingly, children are increasingly overweight and obese.

The ill effects of obesity, for the individual and for society, are well documented. This is a public health crisis with significant economic consequences (increased medical costs, lost productivity due to debilitating ailments) according to many studies and projections. And yet, while talked about, this issue has not acquired the character of urgency that it deserves. And this is the country that is arguably one of the world leaders in medical research and epidemiology.

True, the subject is not totally ignored, but the effort made to educate the public is modest; its impact –as the ravaging obesity epidemic shows– insignificant. While there are here and there messages aimed at fostering a healthier lifestyle, contrast them with the systematic bombardment of publicity for drugs/devices aimed at helping people cope with chronic ailments caused by obesity that could be prevented, at least in many cases.

For instance, in the last couple of years, there has been an explosion of TV commercials about more and more sophisticated blood testing devices for diabetics. The individuals featured in these commercial are often overweight. The millions of overweight people who have developed diabetes –largely on account of obesity due to bad diet– may be delighted in learning that their annoying glucose checking routine may have become less invasive, due to refinements in technology. Medical technology companies, in turn, must be extremely happy in the growth of the population of diabetics. Their market grows and sales will soar. 

But is there an equivalent amount of public health messages in the airwaves aimed at explaining to the public how drastic life style changes may go a long way in preventing/eliminating diabetes and thus the attendant need to monitor blood sugar levels? Certainly the device makers are not going to advertise the benefit of preventative actions that may reduce their customer base. So who will?

From a libertarian stand point, there should be no public authority nannies telling people what to do about their personal habits. The individual has freedom of choice. If people want to overeat, let them do so and face the health consequences of obesity later in life. But we know that it is not so. When a problem reaches these dimensions, its costs are shared in terms of overcrowded medical facilities and increased insurance premiums for all. Besides, the contemplation of such a huge self inflicted wound in terms of waste of human potential in one of the richest nations on earth should invite some reflection. And then there is the added problem of children who, lacking the maturity to know any better, tend to follow the example of their obese elders. Thus they develop early on bad habits that it will be difficult to shed later in life, even with a good dose of will power.

What is suggested here is not coercion to force people to change their life styles. But there is a need for a deliberate, multi year, sophisticated campaign aimed at providing the scientific evidence of what can and will go wrong with bad nutrition and lack of exercise. At the same time, as a matter of urgent remedial action, public authorities should immediately modify all nutrition programs delivered through the school systems and other venues so that only healthy food is offered to children. There is some movement in this direction.

A much more daunting and complex task, extremely difficult to craft, but crucial for future success, is an education system that would help people discover for themselves the value of “well being” as a life goal.

Given the seriousness of this predicament, it is astonishing that progress across the board is so slow. In the case of policies aimed at school children, it is largely dependent on the vigor and decisiveness of individual administrators. The scientific community knows what needs to be done and the urgency of the problem. America’s political leaders know this. And yet, with the exception of former governor Huckabee mentioned above and California’s governor Arnold Shwarzenegger, (a former body builder), who has engaged in a statewide campaign to promote more exercise and better school meals, this is not a hot topic in the United States.

As a minimum, a simple question comes to mind: what good does it do for America to have some of the most sophisticated public health research institutions and medical care delivery system in the world, if we are unable to reverse this massive epidemic that clearly points to a reduction in quality of life and life expectancy for millions, with an even worse future projected for the younger generations?

While there may be multiple factors that contribute to this disappointing picture, it would appear that the concept of public health in the US is not conceptually and practically tied to prophylaxes and to a complete understanding of what “well being” and how it should be promoted in order to help people discover its immense value. About public health, there seems to be a dominant compartmentalized approach that could be summarized as “until you can function reasonably well, you are OK; when you are sick, you go see a doctor, (if you can afford one) and he’ll fix whatever is wrong with you”.

The world class state of the art medical facilities (and the attendant accumulated scientific knowledge) are there to fix problems after they have manifested themselves. And, in many instances, they can do this extremely well, especially when direct intervention is the most logical answer. And this is attested, for instance, by more and more sophisticated surgical techniques. But, while surgery can be a life saver in many situations, a system that is geared primarily towards fixing the consequences of problems is not really helping people as it could.

Besides, it is neither smart nor cost effective. It looks at people only after they have become patients; in the same way as the fire brigade intervenes only if there is a fire; or the police is called upon after a crime has been committed. When there is an ailment there is a diagnosis and, if possible, a cure. From this perspective, the doctor is mostly a mechanic who is called upon if and when a problem manifests itself. (Actually auto mechanics can be more proactive. My mechanic sends me notices reminding me that it has been so many months since my car has had a tune up. I have never received a note from my physician reminding me about the need to have a periodical physical or even the tests that are now routinely recommended for people beyond a certain age, such as a colonoscopy).

Of course, this is a deliberate exaggeration. Indeed, there are many programs aimed at preventing some diseases, like breast cancer for women, based on frequent screening of people who appear healthy but may not be; as an invisible, not yet symptomatic, ailment, may be underway. The highly publicized campaign against smoking is another example. But these are ad hoc measures founded on the enormous publicity created around one or another particular ailment or issue by organized pressure groups.

Overall, there is no systematic effort aimed at educating people as to the psychological as well as physical advantages of a well balanced life; a life that would include healthy habits, including exercise of body and mind and good nutrition. And this should not be done in the name of hygene, just because “it is good for you”; but because it is a worthy objective aimed at making life truly enjoyable. 

But, beyond small circles of specialists, there is no debate as to why people seem to have such a hard time in discovering for themselves the positive consequences of healthy habits that would prevent something like the current obesity epidemic.

At the very best, we have some experts discussing the advantages of good habits in terms of prevention, But here the paramount objective is not an interest in the well being of the human person. The concern is primarily economic. Look at how much money, how many precious resources could be saved if people had good habits that would keep them healthy and so they would not need so much medical care. Clearly it is more cost effective to encourage healthy habits in the general population and to test people so that diseases can be caught early, as opposed to allowing the growth of degenerative diseases and wait until people require care and hospitalization thus causing much higher costs. Prevention is of course good; but, even if built into the system (and it is not), it would not capture the whole extent of the problem: that is a lack of interest in the complete well being of the human person.

And here we come to a gigantic paradox. It would appear that, in America, the collective understanding of the famous Jeffersonian “pursuit of happiness” that all people supposedly strive to attain–and that can take place in a condition of liberty– has been squeezed into the narrow confines of economic pursuits. Sure, economic prosperity is essential, for without it individual and societal choices are constrained.

But prosperity is a means to an end. The end should be a balanced person, enjoying a state of well being. There is a strident contradiction between people whose industry produces an overall prosperous country and an increasing proportion of the same people who produce prosperity engaging in what amounts to be self destructive personal habits that ultimately jeopardize the enjoyment of happiness. That very happiness whose free pursuit is made possible by the complex institutional machinery that we have created to protect it and uphold it.

If indeed a great deal of the wealth produced through assiduous work and the exercise of human ingenuity by the Americans is devoted to engage in personal unhealthy habits that inevitably increase diseases, diminish the quality of life, while shortening it, making people less happy in the process, one should really wonder what the point of all this is.