This post will make you uncomfortable. You should read it anyway.
I'm going to talk about health behaviors and dangerous diseases. And we don't like to think about disease and death, and so we avoid it.
Instead, we talk around disease and death. For example, right now, there is a real uproar over the recommendation that women should not start having regular mammograms until they turn 50. Opponents of health-care reform have taken this recommendation as the first shot in the war to ration health-care to Americans.
How is this talking around disease and death? It is easy to express outrage that the government might take steps to limit our access to health care. What is hard is for each of us to recognize that there are lots of behaviors we could engage in every day that would have significant benefits on our long-term health and would cost little or nothing to perform. That is, we would prefer to shift the blame for our future illnesses to someone else-anyone else-rather than take on that responsibility ourselves.
I'll give two examples in this post.
The first is breast self-examination (BSE). BSE is a technique that women can learn to perform that takes about 10 minutes a month that looks for lumps and abnormalities in the breast. Population-wide, studies suggest that BSE is not actually that effective for detecting cancers. However, the American Society of Breast Surgeons has data that indicate that BSE is as effective as mammograms for women who have a high risk for breast cancer (because they have a family history of breast cancer). Yet a wide range of studies suggest that the compliance rate with BSE is about 10-20%. That is, only about 10-20% of women actually perform BSE.
Why?
Well, nothing will ruin your day faster than finding something that might signal that you have a serious illness. Just like you might be prone to avoid reading this post because the material is uncomfortable, you are likely to avoid doing a self-diagnostic test because it might tell you something you don't want to hear. So, here is a test that is free. No government will stop you from doing it. Yet, women are highly unlikely to perform it.
Now, let's try another one. Obesity is a huge problem in the United States. (Sorry, couldn't resist the pun.) Most Americans are carrying more weight than they should. And this extra weight has been associated with a variety of health problems.
The formula for maintaining your weight is simple. If the number of calories you take in equals the number of calories that you burn in a day, then your weight doesn't change. So, if you want to lose weight, for example, you need to either decrease the number of calories you take in, or increase the number of calories you burn.
Easier said than done, of course. And I'm not about to answer the question of how to diet effectively here.
But think about your average day. How often do you look for the parking space closest to the store you are about to go into? How often do you take the elevator up one flight rather than walking up the stairs? How often do you hop in the car to go get lunch rather than walking a few blocks?
For each additional mile that you walk in a day, you burn about 100 calories. For most of us, getting an extra mile of walking wouldn't be that hard with just a few simple changes in our routine. For example, park your car at the edge of a parking lot and walk rather than parking close to the store.
But, in the moment, we are thinking about minimizing the time we spend on errands. We don't factor in the health benefits of an extra hundred yards of walking. That would require thinking about our health. And we don't really like thinking about health.
So what's the point here?
On the road to health-care reform, we must ensure that we maximize the number of Americans who get health insurance. At the same time, we must ensure that this increase in coverage does not compromise the standards of care that we have come to expect. At the same time, though, we cannot shirk our responsibility for our own health by resting it solely on the shoulders of the medical system. There are lots of things we can do to maximize our own health. These activities have almost no cost.
But they do require that we be willing to think about health and sickness in order to do them.
