As I write this, health care reform is much in the news, and I amin Chicago where I came to participate in the annual Nutrition andHealth conference convened by Dr. Andrew Weil and others. The eventbegan with a public forum on Mother's Day, in which Weil, celebritychef Rick Bayless and I discussed health and food in front of alarge crowd. Among the topics Weil and I broached was health carereform, and among my comments was that whatever changes we make willlargely be about disease care, not health care.
That's not a criticism, just an observation. I am a doctor, andhave abiding respect for the general power and occasional marvels ofmodern medicine. But nothing we do with pills and procedures,syringes and scalpels is about the nurturing of health, howevereffective it may be at arresting the progression of disease.
The basic nurturing of our kind, and the paths to vitality, donot begin and may not even run through the CCUs, ICUs, clinics, ORsand ERs where 'health care' is rendered. True vitality, in fact, ispretty good at avoiding just such places. The only true source ofhealth care reform is ... us: you and me. Because each of us -- witha little help from friends and loved ones -- is the only true sourceof our health.
In 1993, McGinnis and Foege, two leading epidemiologists,reoriented our understanding of the 'actual' causes of death in theUnited States, a perspective refreshed by Mokdad and colleagues atthe CDC in 2003, both groups publishing in the Journal of theAmerican Medical Association. The leading 'causes' of prematuredeath, along with untold suffering, are not diseases such as heartdisease and cancer, but the factors that cause the diseases that sooften cause premature death. Those factors are dominated by a listof 10 modifiable factors, which are in turn dominated by just three:tobacco use, dietary pattern and physical activity.
Were we to apply what we know about lifestyle to the promotion ofhealth and the prevention of disease, we could reduce heart diseaserates by some 80 percent; diabetes by 90 percent; and cancer bybetween 30 percent and 60 percent, with similarly stunning advancesacross a range of other conditions. What stands in our way is notlack of knowledge, but a lack of both collective will -- anduniversally accessible ways -- to convert such knowledge into thepower of action. The mandate to move in that direction iscompelling, if not overwhelming.
But that movement needs to play out in settings other than healthcare. What we do with our feet and forks each day has much more todo with the origins of health than anything anyone does with astethoscope.
Recent studies reaffirm that simple behaviors we all control, intheory at least, are the principal determinants of both years inlife, and life in years. A paper in the April 27 issue of theArchives of Internal Medicine showed that the practice of just fivehealthy behaviors -- eating well, being active and not smokingaccounting for most of the variation -- could prevent nine out of 10cases of new-onset diabetes.
Along with the power of lifestyle to influence health comes thecritical message that this is health in real people. It may notbring a tear to your eye to hear that 80 percent of heart disease or60 percent of cancer could be prevented. But part the veil ofstatistical anonymity, and see the faces beyond. Think of the peopleyou know who have had a heart attack or cancer or developeddiabetes. Now think about eliminating that suffering for eight outof 10 of them, and eight of 10 of their families.
We talk about health care in the United States, but we reallymean disease care -- the care rendered by clinicians to those whoare sick. Even when we speak of prevention, we generally meanclinical preventive services, such as cancer screening. Valuable asscreening is, it does not prevent cancer outright -- it finds itearly. Finding cancer early is better than finding it late, andunderutilization of services such as mammography and colonoscopycomes at a tragic cost in lives.
But not getting cancer at all is far better than finding it early-and lifestyle change offers the power of that very outcome. Highintake of fruits and vegetables, limited intake of red meat, regularphysical activity and weight maintenance, for instance, areassociated with less risk of colon cancer.
We do, indeed, need health care reform in the U.S. Issues ofinsurance coverage, access and costs must be addressed.
But health care is not exclusively, and perhaps not evenpreferentially, the province of the health care provider. It mustplay out in schools and supermarkets, shopping malls and suburbanneighborhoods; city centers, cinemas and kitchens; worksites andrestaurants; legislatures and living rooms. To realize the dramaticadvances in the human condition the conversion of our currentknowledge into powerful action would accord us -- the addition ofboth years to life, and life to years -- we must move from ournarrow vision of health care to a prevention-oriented system that istruly about the cultivation of health at its diverse sources.
To put it quite bluntly, you can initiate health care reformtoday, all on your own: Take good care of yourself!
Dr. David L. Katz can be contacted at www.davidkatzmd.com.
