Off and on during the current health reform debate, politicians, leaders and pundits have raised the issue personal responsibility. For instance, take these comments from the John Mackey, the CEO of Whole Foods:
“…many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese. Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices.”
That is a refrain many of us who think and discuss American medicine are used to hearing. In fact, I wrote an article over a year ago in Salon emphasizing the role of individuals in taking care of their own health. That being said, though, I think (especially after having read my readers’ comments about that piece) the view doesn’t take into account the socio-economic factors that pressure many Americans into chronic illness.
Let’s look at obesity as an example that illustrates this. Almost one-third of adults and children are obese, a problem that costs us $100 billion dollars a year. In California, where I live, our State Controller estimates that “the economic cost to California of adults who are obese, overweight and physically inactive is equivalent to more than a third of the state’s total budget.”
Those are the facts, and as Mackey so obviously says, a proper diet and exercise can help to prevent obesity. But for many, that’s not so easy.
To illustrate what I mean, consider the following experiment: a while ago, I decided to take a trip to the grocery store with $40. I spent half of that money on fresh, healthy foods and the other half on processed foods. I took my grocery bags home and counted up the calories per dollar that I spent on both types of foods. For the healthier choices, I got 140 Calories per dollar; for the processed foods, I got 370 Calories per dollar.
That little experiment has real-world implications when you think about middle class families, with two (or one or zero given our current unemployment numbers) working parents, trying to make ends meet. Even people living paycheck to paycheck know what food choices are good for them. But if you’re one of the millions of families just scraping by, popping a couple of DiGiorno pizzas in the over for dinner is cheap and calorie-laden enough to soothe your hunger pangs. It also leaves one less battle to fight with your kids between getting them to finish their schoolwork and getting them ready for bed.
Add the consequences of my little experiment to some other factors, like the lack of access to fresh foods in poorer communities (Mr. Mackey, do you have any stores in low-income areas?), or a lack of safe places to get out and exercise, and you can see that prevention has as much to do with class, income, and communities as it does with personal responsibility.
Dr. Rahul Parikh is a Pediatrician in the San Francisco Bay Area and a frequent contributor to Salon.com and THCB. Dr. Parikh practices with the Walnut Creek Medical Center and Kasier Permanente.