Real reform begins with me


I was a mile into a recent treadmill workout when coverage began to air of President Obama’s healthcare forum at the White House. As I watched, I found myself gradually gaining speed, growing more and more upset.

His plan to provide affordable, accessible healthcare for all Americans is strikingly flawed. It demands fundamental change from insurance companies, hospitals and healthcare providers -- and fails to address what healthcare consumers themselves should do.

During Obama’s campaign, the soon-to-be president spoke frequently of sacrifice and self-responsibility. When it comes to healthcare, however, he’s failing to hold people accountable for their own unhealthful behaviors and the overwhelming financial effect they have. He needs to insist that everyone play a part in solving our national healthcare crisis.


Although people frequently perceive ill health as something that happens to them, they’re often responsible for making themselves sick.

The most obvious example is smoking. Smoking dramatically increases the risk of cancer, heart disease and stroke (along with a number of other diseases), and is the leading cause of preventable disease and death in the United States. Despite the known risks, more than 40 million Americans light up every day.

Bad habits

Smoking is just the tip of the iceberg. Americans indulge in a host of unhealthful activities irrespective of their effect on health. Overeating has practically become a national pastime, and the percentage of people who are overweight or obese has soared to more than 60%. Being overweight not only increases the risk of heart disease, stroke and diabetes, but also osteoarthritis, gallbladder disease and endometrial, breast and colon cancer.

We not only eat too much, we eat all the wrong things. Fewer than 25% of adults consume the recommended five servings of fruits and vegetables each day, and fewer than half of children get adequate amounts of calcium in their diet. Soda has emerged as our national drink; recent surveys estimate that roughly 40% of young children and more than 60% of adults drink soda each day. These sugary drinks provide little nutritional benefit, and studies suggest that they lead to unintentional weight gain, increase the risk of diabetes and undermine bone strength.

We live sedentary lives. According to statistics maintained by the Department of Labor, men and women in the U.S. spend between two and three hours each day watching television and less than 20 minutes participating in sports and exercise. And, too often, we refuse to take even simple steps to keep ourselves healthy and safe. We go without bicycle helmets, drive under the influence of alcohol, carry weapons and ignore warnings about the consequences of unprotected sex; we fail to get important health screenings, opt out of recommended immunizations and neglect to take prescribed medications.

Americans are paying dearly for their bad choices -- both in lives and dollars. According to the federal Centers for Disease Control and Prevention, medical expenditures associated with being overweight or obese may exceed $78 billion annually. For smoking, the numbers are thought to approach $75 billion each year.


Inactivity is estimated to cost us an additional $24 billion, according to a Harvard University study published in 1999. Sexually transmitted diseases run more than $8 billion a year, according to the Kaiser Family Foundation. Drug-use costs roughly $15 billion, says the Office of National Drug Control Policy; and alcohol abuse $26 billion, says the National Institute on Alcohol Abuse and Alcoholism.

Keep in mind, these numbers represent only medical costs; when you look at the total economic burden the unhealthful behaviors impose on society, the numbers are much, much larger. Expenditures related to drug abuse, for example, soar to more than $160 billion when productivity losses and criminal justice system costs are considered.

Hard to change

Holding people personally responsible for their behavior isn’t a popular position. It’s often perceived as blaming the victim. Daniel Wikler, professor of ethics and population health at the Harvard School of Public Health, believes that for many people bad habits are simply hard -- if not impossible -- to break. “They want to change, but just can’t seem to do it,” Wikler says.

He points out that with addictive habits such as smoking, the battle can be particularly difficult because nicotine keeps smokers coming back for more. “For a lot of people, smoking isn’t a treat, it’s simply a way of getting withdrawal symptoms to go away,” Wikler says.

The “change is difficult” argument may bear out for certain behaviors, but it can’t rightfully be applied to all of them. Soda tastes good, but it isn’t that difficult to put aside and replace with a glass of water or milk. TV is entertaining, but it’s simple enough to hit the power button and create time for exercise. Clearly, sometimes change doesn’t happen because people simply don’t want it badly enough.

That’s not to say that change is easy. And, in some cases, real barriers stand in the way of even those who are most motivated. Socioeconomic factors stymie some. Eating right is difficult for people who can’t afford fresh fruits and vegetables, screening tests may not be an option for those without medical insurance and exercise might be more difficult for people who can’t afford a gym membership.


In other cases, especially the finer points of health, people may not actually understand what constitutes healthful behavior. Relatively few people are aware of the health benefits of omega-3 fatty acids, for example, or the potential downside of consuming too much mercury-laden fish.

Healthy inspiration

That said, I would argue that, more often than not, we’re our own biggest barriers to more healthful living. We feel overwhelmed by the prospect of change -- whether it’s losing 50 pounds or finding time in our day to be active; we don’t know where to begin or how to go about doing it successfully.

This is where the government can play an important role. For healthcare reform to be effective, it needs to provide more than just universal coverage. The government must also motivate Americans toward healthy change and help provide people with the tools and strategies necessary to meet challenging goals.

True, most of what has been tried hasn’t worked and no one appears to have a good idea of what will. It’s likely to take a big investment of research dollars to uncover viable solutions. Although that may be a difficult pill for the government to swallow just now, if solutions are uncovered, the payoff will be enormous.

For now, it’s up to every one of us to initiate and sustain healthier habits. As for me, I hate running on the treadmill. I find it exhausting, inconvenient and boring. Three miles feels like a marathon, and I spend every minute on the machine dreaming up reasons to cut my run short. But, with rare exceptions, I go the distance. I do it because I know that the short-term costs will add up to long-term benefits; I do it because being healthy is of utmost importance to me.

We all need to face up to the fact that good healthcare doesn’t start in the White House; it starts with each and every one of us taking responsibility for our own health.



Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. The M.D. appears once a month.



Young patient, heal thyself

Each year, researchers at the federal Centers for Disease Control and Prevention question thousands of teenagers and young adults about their health-risk behaviors. According to the results of their 2007 survey, bad habits clearly start at a young age.

* 11.1% had rarely or never worn a seat belt when riding in a car driven by someone else.

* Of the 66.8% who had ridden a bicycle during the 12 months before the survey, 85.1% had rarely or never worn a bicycle helmet.

* Of the 24.3% who had ridden a motorcycle during the 12 months before the survey, 33.9% had rarely or never worn a helmet.

* In the 30 days before the survey, 29.1% had ridden one or more times in a vehicle driven by someone who had been drinking alcohol.

* In the 30 days before the survey, 10.5% had driven a vehicle one or more times after drinking alcohol.


* 18% had carried a weapon (e.g., a gun, knife, club) at least one day in the 30 days before the survey; 5.2% overall had carried a gun.

* 20% smoked cigarettes; 8.1% smoked them frequently.

* More than 44% drank alcohol; 26% were binge drinkers.

* Almost 20% of students had used marijuana and more than 3% had used cocaine one or more times during the 30 days before the survey.

* 13.3% had sniffed glue, breathed the contents of aerosol cans or inhaled paints or sprays to get high at least once; 7.8% of students had used hallucinogenic drugs; 2.3% had used heroin; 4.4% had used methamphetamine; 5.8% had used ecstasy.

* 35% were sexually active; of those, more than one-third did not consistently use condoms.

* In the seven days before the survey, only 21.4% had eaten fruits and vegetables five or more times per day; 14.1% had consumed three or more glasses of milk per day.

* Roughly two-thirds failed to meet the recommended levels of physical activity.

* On an average school day, 24.9% played video or computer games or used a computer for something that was not school work for three or more hours per day; 35.4% watched television three or more hours per day on an average school day.


* 13.0% were obese, and an additional 15.8% were overweight.

* Only 10.3% wore sunscreen with an SPF of 15 or higher most of the time or always when outside for more than an hour on a sunny day; 17.4% routinely practiced sun-safe behaviors like wearing a hat and staying in the shade when possible.

Source: 2007 National Youth Risk Behavior Survey