In the health-care reform debate, personal responsibility and its flip side, chronic disease, surface often but rarely with the clarity of recent dueling letters to the editor.
“Seventy-five percent of our country’s health-care costs are for chronic illnesses, and many of them – obesity, hypertension, heart disease, diabetes, complications of alcoholism, emphysema and lung cancer – can be prevented, but people with unhealthy lifestyles don’t want to put out the effort to make the change,” wrote Albuquerque physician Torre Near.
He adds that unhealthy people have no incentive to improve their lives because premiums are the same for the healthy person as they are for “the person who is fat, smokes, drinks, whose exercise is working the remote and who sees the doctor every two weeks…”
Robert Schwartz, a professor of law and pediatrics at UNM, rebuked Near for blaming one particular group for the problem. He argues that people with unhealthy habits don’t cost us more because they’ll die soon. But the nonsmokers, for example, will actually consume more health-care resources because they live longer.
So there you have it. You salad eaters, joggers and nonsmokers are the problem!
But seriously, folks, Near has a point. How do we address chronic disease related to personal choices?
Back in May, Sen. Jeff Bingaman introduced The Obesity Prevention, Treatment and Research Act of 2009 to come up with “a comprehensive strategy to prevent, treat and reduce the prevalence of overweight individuals and obesity.”
Do we really need more research to tell us how fat we are? Not really. Can obesity be addressed in a government program? No and maybe. Let me explain.
One recent study says of eating habits and weight gain: Like mother, like daughter; like father, like son. Another reports that nearly 36 percent of black Americans, 29 percent of Hispanics, and 24 percent of whites are obese. A Center for Disease Control epidemiologist said poverty limits food choices but added that Blacks and Hispanics are more accepting of high weight.
I would argue the notion of acceptance. Looking at my own family, it’s really a sense of resignation: When everyone around you is heavy and has diabetes, that’s your expectation for yourself. When all the people in your life can’t live without a Big Mac and fries, what will you learn?
And yet, even my family has its success stories. My nephew lost 150 pounds and boasts a normal weight for the first time in his life. What was the trigger?
“Nothing, really,” he said. “It was just time.”
Any particular diet?
“No, I just tried to eat better – more fruit and vegetables – and started taking a walk after dinner.” As he lost weight, his walks grew longer. Then he took up hiking. His wife joined him and lost 60 pounds.
The point is, he knew he had a problem – they all do – and he knew what he needed to do. His journey began, literally, with a single step.
The market for health-care coverage is dysfunctional, but the weight-loss market is pretty effective. (Same for smoking cessation.) It’s not hard to find a gym, a Weight Watchers or Jenny Craig program, or a diet book, and grocery store shelves bulge with healthy choices.
But the market doesn’t serve poor people, so there’s a modest role for government. Improving school lunches is a step. Bingaman’s bill would increase funding to the Department of Agriculture’s Fresh Fruit and Vegetable Program, among other things.
Even more can be done locally. Las Cruces has a community-wide obesity prevention effort aimed at families and kids. And a few years ago Zuni Pueblo, responding to spiraling diabetes rates, built a walking trail and launched a public information campaign.
With community programs, there’s less Big Brother and more, We’re All In This Together.
© New Mexico News Services 2009