Healthcare on an Uneven Playing Field

The other night at a dinner party across the bay from San Francisco, as the warm sun sank over the Oakland hills, I sat with my friend Franck, as we waited for our host to prepare a sumptuous Italian meal. Glasses of wine in hand, we confessed our guilt before any of the appetizing cuisine had been served. "I'll work out twice as long tomorrow," I said; "Me too," Franck replied. After a pause, he said, "You know, my grandmother lived until she was 106, and she always told me this about eating: ‘Eat breakfast like a king, eat lunch like a princess, and eat dinner like a peasant.'" Originally from Venezuela, Franck noted that living in America and accomodating to our lifestyle, he tends to eat larger meals later in the day. How true, I thought, and then confessed that I sometimes simply don't make the time to eat properly during the day.

With the current debate over national healthcare, we see news reports on health research every day regarding overeating and obesity. For example, a recent New York Times magazine article addresses the question of whether overweight people should pay more for health insurance. While such discussions are interesting and compelling, they slant the focus on healthcare and prevention into a "who's to blame?" argument. Although obesity is a serious problem in the U.S., there are many other concerns that have been left out of the debates. For example, some medical research suggests that almost half of all patients in the United States are not compliant with medical recommendations. That's right, almost half.

People fail to take care of themselves in a variety of ways. Although most of us can get away with neglecting our health when we're young, as we age, our bodies are less forgiving. And though some people continue to engage in behaviors that they know are harmful (like smoking cigarettes), others simply can't make sense of health guidelines. For example, nutritional recommendations suggest 5 servings of fruits and vegetables per day (or is it 10?), 30 minutes (or is it 60?) of daily exercise, and drinking minimal amounts of alcohol (or is moderate drinking ok, and does this mean beer, wine or hard alcohol?). Such variation in recommendations are often confusing and suggest that one might need an advanced degree (or a lot of time and Internet access) to sort through the advice made available on personal health.

Those of us fortunate enough to live in the middle- to upper-classes are at an advantage in having enough time and sufficient access to resources to educate ourselves, yet even as a frequent consumer of health science research, I am still not sure what is "right." But class problems in healthcare are far more serious. There is a clear correlation between income and health. The more money people have, the more likely they are to live a longer life, and with less disease. Along with class differences, the actual provision of healthcare depends to some extent on one's ethnic background and minority status. For example, the likelihood of receiving a cardiac catheterization (a procedure used to diagnose and treat some heart problems) is largely dependent on race. A study conducted by the Robert Wood Johnson Medical School indicated that African Americans were less likely than whites to receive this potentially life-saving procedure.

While obesity is certainly a public health problem, so are class and racial discrepancies in healthcare. In future postings, I will explore these issues as well as aspects of preventative healthcare, including the many ways people are collaborative or noncompliant regarding medical advice. But for now, I wonder, is the focus on conditions like obesity really justified when we have not even figured out how to make healthcare equal for all?