“Health brings a freedom very few realize, until they no longer have it.” – Bronnie Ware; Author of the book, Top Five Regrets of the Dying
For decades now Americans have been suffering and dying from preventable “lifestyle” diseases, despite a widespread belief that since we’re a free country our health is a matter of choice and personal responsibility. Whether that message is coming from politicians, public health officials, or the health and fitness industry, the dominant line is “your health is up to you!” Yet, when it comes to our health and well-being, free-will could be doing more harm than good. In other words, how free are you if you’re suffering from chronic pain, mental illness or a chronic disease, mainly due to a culture that promotes sedentary behavior and an economy that is unstable and unfair to most. And if you’ve worked hard most of your adult life but are confined to your home during retirement because of debilitating health issues related to longtime sedentary behavior, are you truly free?
US Life Expectancy
Despite industry groups advertising that “healthy living is a choice” and government officials declaring “personal responsibility truly is the key to good health”, Americans has seen the largest drop in life expectancy since World War II. A new study found that Americans’ life expectancy is often correlated with state policies and laws, e.g. expansion of Medicaid, access to health care, policies on minimum wage, tobacco control, gun legislation, drug addiction and the environment. States that have supported these policies have longer life expectancy. But states that don’t, have taken the conservative stance of “the less government the better”, while preaching freedom of choice and personal responsibility. Consequently, these states have the least healthy populations and lowest life expectancy, and also have more “deaths of despair” from suicide, drug overdose, and alcoholism. Social and economic factors play a role in life expectancy as “over 11% of the U.S. population — about one in nine people — lived below the federal poverty line in 2021”. But economic insecurity has made life harder for most people in our country.
Conservatives would argue that “people are taking the lazy way out of responsibilities, so they choose alcohol, drugs, and welfare and disability checks over a commitment to hard work, family, and community”. But some economists would argue that the problem isn’t that people are lazy. It’s that the economy and the structure of work today are not the way they used to be. For instance, my dad was able to make a good living and support our family with a white collar job, without a college degree. Many of my friends’ dads who worked union, blue collar jobs also provided the means to support their family. Not so today. Nearly 80 percent of U.S. workers live paycheck to paycheck. Americans without bachelor’s degrees or union representation have struggled to support themselves and their families in a precarious gig and retail economy. The work that the less educated can find in this economy is unstable – wages don’t meet cost of living standards, hours are more uncertain, job duration is shorter and benefits like health insurance are often not available. Is it any wonder then that those with job insecurity are more vulnerable to deaths of despair?
Choice and responsibility can be motivating factors for people to improve their health. But they distract attention from the role of cultural, environmental and economic factors in shaping our health. These are factors that individuals generally have no control over, such as pollution, public safety, income inequality, education, access to healthy foods and affordable health care, and jobs that provide a living wage. What’s more, “many everyday environments in the United States make healthy behaviors difficult, expensive, time-consuming, or counter-normative, whereas unhealthy behaviors are often cheap, convenient, widely promoted, and normative”. Yet, the narrative of “health is your choice and your responsibility” may be one reason why Americans are so sick.
The food and beverage industry in the United States spends billions of dollars yearly to market cheap, convenient, tasty, but unhealthy foods and beverages. Do you ever wonder why there’s an abundance of junk food at grocery checkout lines or fast food outlets at most highway off ramps in cities? Often, these convenient and inexpensive foods are what most working Americans struggling to get by are able to afford. Consequently, the rates of obesity, mental illness and chronic disease continue to climb, affecting more younger adults. Sadly, the next generation of Americans, which includes my daughters, risks being the first generation to live shorter lives than their parents. This outcome is not just a matter of personal choice, but rather the choices and policies (our lack of) our government makes that undermine the well-being of citizens. Also, the choices society makes that normalize sedentary behavior and poor eating habits and are perpetuated by corporations that put profits over the health and well-being of society. Unless we want to keep dying younger or end up more dependent on medicines to cope with the symptoms of preventable diseases, we need government intervention to help modify our behaviors and environments.
Our Societies Health Problems Needs Government Action
A fundamental responsibility of government is to advance the common good, which is necessary for our individual well-being. It operates on the principle that “we’re all in this together, not that you’re on your own”. The U.S. began seeing dramatic increases in life expectancy in the early 20th century, mainly a result of government intervention to improve public health, such as vaccines, sanitation and food quality. However, as life expectancy rates drop and the quality of life as we age declines, we’ve fallen short in government action to protect the common good of our citizens.
For decades now, obesity and chronic diseases have been regarded as preventable “lifestyle” diseases, with the onus focused on the individual. Public health efforts to educate people through exercise and healthy eating guidelines, along with dire statistics of the consequences of an unhealthy lifestyle, have mostly fallen on deaf ears. Even when we’re suffering from these chronic diseases and our doctors try to encourage us to eat better and get more exercise, it’s still not enough to motivate us to change our behaviors.
One of the most confounding aspects of human behavior is our willingness to engage in activities that we know will harm our own health. We know that overeating, smoking, and excessive consumption of alcohol and drugs are bad for us, and that exercise and eating healthy foods are good for us. It is also clear that vaccines against COVID-19 are extremely effective and safe. Yet a significant proportion of Americans, including those who are well-educated, choose to ignore this advice. Men in particularly “are among those for whom risk-taking in the short term is likely to be more important than long-term health considerations”.
Rather than simply encouraging people to make better health choices in the face of considerable social, cultural, and economic barriers, wouldn’t it be more effective to shift the focus from the individual to the common good of society—to change the environment in ways that make healthy behaviors easier and unhealthy behaviors harder to do? For example, we already have government policies that protect children, including bans on smoking and alcohol for minors. We also have bans on smoking in public and warning labels on cigarettes and alcohol, as well as taxes on tobacco, alcohol, and sugary beverages. Given the magnitude of diet-related diseases such as type two diabetes, state governments can take steps to mandate warning labels on ultra-processed foods and fast foods and to regulate advertising for junk foods, as we do for cigarettes and alcohol.
For increased physical activity, local governments can make their cities safer and more walkable and require buildings to make stairs more accessible than elevators. And why not use policy to regulate technology companies so that children and teenagers are not exposed to social media content that is harmful to one’s mental health? “The number of children and adolescents with anxiety and depression has risen nearly 30% in recent years, while nearly 1 in 3 high school girls reported having seriously considered suicide.” Technology also affects our physical health by enabling more sedentary behavior in children and adults alike. Many private and some public schools are restricting students from using their phones while on campus. Another intervention that would encourage more physical activity in public schools would be emphasizing physical education and play, rather than organized sports.
Freedom, independence and the liberty of the right to choose are precious democratic values. You should have the right to decide what to do with your body as long as it doesn’t harm others. However, what is often overlooked is how our unhealthy lifestyle behaviors extend beyond the individual and affect families, friends, and broader communities. For example, there’s a heavy emotional toll when caring for and watching a loved one suffer from preventable diseases such as diet-related type two diabetes, or smoking-related lung cancer or alcohol-related liver disease. When a partner or parent dies, we lose their companionship and support, and when a life is cut short we lose that person’s potential to contribute to their communities.
Furthermore, if government continues with their “laissez-faire” attitude towards our nation’s health, it not only will continue to cause ill health and shorten the lives of our citizens, but it also threatens our economy, military and healthcare system. For example, the American workforce continues to experience increased sick leave and high death rates from chronic pain and preventable diseases. Also, “seventy-one percent of people between the ages of 17 and 24 do not qualify for military service, with obesity being the leading medical disqualifier”. Finally, the COVID pandemic not only exposed the fragility of our costly and inefficient healthcare system, but also our underfunded, public health and prevention programs. It should not have been a surprise that most who suffered and died from COVID were already in poor health with preventable chronic diseases and many without healthcare insurance. A new study highlights that “universal health care could have saved more than 338,000 lives from COVID alone”.
Although personal choices are clearly important for individual health, our country’s fate may rest on government to focus less on personal responsibility and start working on policies to improve public health for the common good of our country. First, by making healthcare affordable to all Americans. Second, to increase funding for public health prevention programs to address the social and economic determinants of health and inequality. And last, by creating policies that make healthy choices available, inexpensive and easy to choose – all of which can lead to lasting health and wellbeing for American citizens.
Having a sound body and mind gives you the freedom and choice to live a much larger life, especially as you age. Living without the need of medications, caregivers and a stressed healthcare system to keep you barely functioning and alive sounds like true Independence to me. And if you’re free from pain and free to be active with a body that allows you to do what you want, when you want, now that’s what I call Freedom!