'Well' Explores The Social And Political Underpinnings Of Health
The typical American conversation about health focuses on personal choice as a key driver — the foods we choose to eat, the number of steps we log each day, the doctors we visit and the medicines we take. But epidemiologist Sandro Galea says that way of thinking is the wrong way.
In his new book, Well: What We Need To Talk About When We Talk About Health, the dean of Boston University School of Public Health says not only does the belief in the power of personal choice fail to fix America's health crisis, it also diverts us from real issues underlying our nation's poor health.
"We can choose the food we eat, but our options are limited by what we can afford and by what kinds of food are available for purchase near our home," he writes. "These factors, in turn, depend on the quality of our neighborhood and the size of our income, which depends on larger social economic forces over which we have little control."
The notion that one creates good health just by choosing to do so makes it easy to stigmatize obesity, addiction and other chronic conditions as byproducts of laziness or moral weakness, further obscuring their actual causes, he warns.
"Telling you that you should exercise more when you're worried about getting out of your house and getting shot; when there is no park around you which has a nice place for you to walk; when you're working two minimum-wage jobs and you can't afford gym membership is simply absurd," he tells NPR.
Galea says understanding that our health is a product of the world around us serves to remove "our reflexive stigmatization."
And that's important, he says, because stigma itself is known to erode self-esteem and confidence, which in turn causes social isolation that can further trigger other health problems.
Galea says his book, represents a culmination of 20 years of studying and working in public health. He was motivated to write it by the the huge gap between what the U.S. spends on health care and the relatively low return on that investment.
"Part of my job is to make sure that the world understands what it really takes to generate health," Galea says.
As he discusses early in the book, the United States spends a whopping $3.3 trillion on health care, according to federal figures from 2016. Yet U.S. life expectancy — which is the lowest among all comparable nations — has actually fallen in recent years. He points out that the lifespan of a baby born in the U.S. today is now five years shorter, on average, than it would be if that baby were born in Japan, a nation that spends half of what we do on health, per person.
"There's no other sector where we outspend all our peers and we get less for it," Galea says. "Would you buy a smartphone if it cost you 40% more than the next closest competitor and your phone functioned 40% worse? The answer is no, you wouldn't."
To improve the nation's overall physical and mental health, Galea says we need to understand that a slew of factors that may seem to have little connection to health are actually the drivers of it.
"The lens that we adopt makes a big difference in how we invest our resources and how we tackle this problem," Galea says.
He says we need to start talking more about some neglected factors that shape health. These include some themes familiar to students of public health — poverty, environment and policies — and some more surprising ones, including fundamental human values that Galea believes deserve more attention. Key drivers of health to pay attention to include:
Galea predicts a shift in the American health conversation will require a grassroots approach that starts with each of us changing how we talk about health with friends and family; with electing local, state and national leaders who better understand what's necessary for health in the U.S.; and with supporting a private sector that's responsible not just to shareholders but to "common good in the world .... to generate health both for its employees and for the world around it."
"I think if we all did that," Galea says, "transformation of how we talk about health will happen sooner than we think."
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