Rising health care costs and an expanding obesity pandemic are forcing leaders around the world to consider drastic measures to improve public health. In New York City Mayor Michael Bloomberg’s ban on 16-ounce sodas will go into effect later this month. In Europe the Hungarian government recently passed a law to tax foods high in fat, sugar, and/or caffeine. If successful, the tax of 53 cents on these foods will raise approximately $100 million per year for health care costs. Although similar initiatives are under consideration by many governments, none of them seem appealing to the general public.
People should be able to eat and to drink (and be merry) as they please, right? In the United States, the home of the free, the answer to that question should be a resounding yes. Recent medical research, however, suggests some intervention may be worth consideration. Earlier this year the Institute of Medicine released a report titled “U.S. Health in International Perspective: Shorter Lives, Poorer Health.” The authors analyzed health data of high-income countries from the past four decades. Their findings further define the great American health care paradox: Even though the United States is one of the wealthiest countries in the world and spends more money on healthcare, Americans are unhealthy and die at younger ages.
Compared to other high-income countries, consider the following findings in the report with regards to U.S. Health:
1. Americans are dying at younger ages than people in almost all other high-income countries.
2. Americans have a longstanding pattern of poorer health that is strikingly consistent and pervasive over the course of a lifetime from birth through adulthood.
3. Americans, as a group, fare worse in at least nine health areas: 1) Infant mortality and low birth weight; 2) Injuries and homicides; 3) Adolescent pregnancy and sexually transmitted infections; 4) HIV and AIDS; 5) Drug-related deaths; 6) Obesity and diabetes; 7) Heart disease; 8) Chronic lung disease; and 9) Disability.
Many of these conditions reduce the odds that Americans will live to 50. For individuals who do live to 50, the conditions contribute to poorer health and greater illness later in life. Although our behavior cannot be held accountable as the primary reason for all of the above problems, it is a significant causative factor for many of them. According to the study the behavior of Americans in comparison to populations of other high-income countries is characterized as follows:
1. Americans consume more calories per person.
2. Americans have high rates of drug abuse.
3. Americans are less likely to use seatbelts.
4. Americans are involved in more traffic accidents that involve alcohol.
5. Americans are more likely to use firearms in acts of violence.
Surprisingly, even Americans who do not drink and are not overweight have higher rates of disease than similar groups in peer countries. Explanations for these patterns of poor health are complex and multifactorial. There is no easy fix. Complexity, however, should not be a deterrent to communication about the problem and to the development of strategies to improve our current condition.
Charles Darwin, the 19th century British scientist, once said: “It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change.” During the past four decades, our society has experienced dramatic changes in the nearly every aspect of life. The combination of consuming more unhealthy products, partaking in riskier behaviors, and exercising less has not been a successful adaptation. No other problem reflects this point better than the current obesity pandemic. Likewise, in 2011 a report from the United Nations stated that non-communicative diseases (diabetes, cancer, and heart disease) are a greater threat to world health than infectious diseases.
Some scientists would argue that taxation is an ineffective method for influencing consumer behavior and for improving public health. Indeed, no matter how much you tax a particular substance, its availability is still within reach of the consumer. Nevertheless, government initiatives to improve public health are becoming more aggressive and focused on the individual. As the Hungarian Prime Minister Viktor Orban said, “Those who live unhealthily have to contribute more.”
Should the onus really be placed on individuals for the decline in the health of a nation? Perhaps before taxes on unhealthy foods gain widespread appeal, government leaders should consider how to use their power to influence the food and advertising industries to promote healthier foods and lifestyles. Government policies could challenge manufacturers to produce more foods with less or no sugar. They could also encourage employers to engage their employees in health improvement programs. Government subsidies could be used to make healthy, non-processed foods more accessible and affordable for everyone. Overall, intervention through these types of policy change stands as a more meaningful strategy to improve public health.
At the heart of this matter is the raging debate between personal freedom and public health. Both are worth fighting for but as Americans continue to die unnecessary deaths, we must find a balance between the two that allows us to reverse our current course. Complacency is not an option.
Mark Twain may have had it right when he said, “The only way to keep your health is to eat what you don’t want, drink what you don’t like, and do what you’d rather not.”
Changing is not easy, but it is necessary to become a healthier nation – emotionally, physically, and financially. It will require government intervention and personal initiative. Being proactive may be a better option than waiting for the government to implement a tax on fat foods or place restrictions on our lives in an attempt to make us healthier. If we commit as individuals to leading healthier lives, the health of our communities and nation will improve as a direct result of our efforts. And, hopefully, the next report on this issue by the Institute of Medicine will describe better health and longer lives among all Americans.
Note to readers – Dr. Michael DeFranco is an orthopedic surgeon at CGH Medical Center’s Main Clinic in Sterling. He specializes in sports medicine and shoulder surgery. He is active in community health education on issues such as sports injury prevention, sports concussions, arthritis, osteoporosis and healthy lifestyles. For more information, call his office at 815-632-5071.