|
Health care reform? Don't forget the simple things that matter most
By Thomas Kottke and Nico Pronk
In the U.S., the simple things that can make us healthy are the hardest to do. Personal commitment and communities that provide us with social and physical environments supporting healthy behaviors are the answer. As the Legislature assembles in St. Paul to deal with pressing issues of health and health care, it is worth keeping the following facts in mind.
More than 20 years ago, the World Health Organization observed that the root causes of heart disease, stroke, chronic lung disease, diabetes and many cancers are the same four behaviors - tobacco use, a diet inadequate in fruits and vegetables, physical inactivity, and high-risk consumption of alcohol. While this may seem obvious, the evidence is clear and overwhelming that these behaviors really are the difference.
In his book "The Blue Zones", Dan Buettner describes four populations with exceptional life expectancy: Okinawans, California Adventists, and populations on the Nicoya Peninsula of Costa Rica and Eastern Sardinia. All of these populations share the same attributes: Little or no tobacco use, a plant-based diet, a lifestyle that requires physical activity as a part of daily routines, and wise use of alcohol if it is consumed.
Other evidence corroborates that the four populations have exceptional health and longevity because of what they do, not because of where they live or because of their genes. In a United Kingdom population, the difference in life expectancy between individuals who practiced all four healthy lifestyle behaviors and those who practiced none was 14 years. A similar relationship was found in US nurses. Finnish men now live 10 years longer than they did in 1971, mostly because they are smoking less and eating more fruits and vegetables. The increase in life expectancy for Finnish women is eight years.
Earlier this year, the Institute for Clinical Systems Improvement (ICSI), the arbiter of applied health care science in Minnesota, released a guideline for the prevention of chronic disease risk factors. The actions recommended in the ICSI report - eliminating tobacco use, eating more fruits and vegetables, increasing physical activity, reducing risky drinking - are based on the evidence that preventing chronic disease is less about health care than it is about healthy behaviors.
HealthPartners data show that when an entire company pulls together to increase healthy lifestyle behaviors, productivity is higher, health care costs are lower and people are happier. The return on investment from reduced health care costs alone is 3-to-1. When productivity at the workplace is included in the equation, there is a $6 return on every dollar invested. Companies with worksite health programs will be healthier.
For Americans, healthy lifestyle behaviors might be described as "the simple things that are hard to do." But if they are so hard to do in America, why are they easy to do in Okinawa, Costa Rica and Sardinia? The healthy lifestyle behaviors are easy in these countries because the people see them as the right way to live, and their social and physical environments support the behaviors. In the United States, we must improve with walkable neighborhoods, stronger mass transit, laws banning trans fats in food and nutrition labeling in our food chains.
The evidence indicates that the crisis in health care can be solved only if the crisis in healthy lifestyle is solved, too. The impact of perfecting care for people hospitalized for heart attacks and other heart disease, we have calculated, is a fraction of the impact of healthy lifestyles.
If all Minnesotans commit themselves to the simple things in life - tobacco free, eating fruits and vegetables, working physical activity into daily life, and drinking alcohol responsibly - we can emerge from this crisis both healthy and happy. This fact is worth remembering.
Thomas Kottke is a cardiologist and medical director for Evidence-Based Health at HealthPartners. Nico Pronk is vice-president and health science officer, JourneyWell, at HealthPartners.
Published January 11, 2009 in the St. Paul Pioneer Press
|
|
