Recently, another complex and contentious issue—taking personal responsibility for your own health—has been has been injected into the debate about health care reform.
See Health Reform Idea: Put Down the Doughnut at http://www.msnbc.msn.com/id/32306655/ns/health-health_care/. The article states
There’s no doubt that the bulk of the nation’s health care costs are self-inflicted. Smoking, high blood pressure and being overweight are the top risk factors for early death…with physical inactivity, high blood sugar and alcohol use not far behind, according to an April study by the Harvard School of Public Health.
Take, for example, the “358-pound diabetic who didn’t take his medication for two days and then stayed up all night playing poker,” cited by Dr. Steven Spady, a dedicated and hard-working emergency physician in rural Kentucky.
According to the article, Dr. Spady is part of a growing chorus of medical professionals, researchers and ordinary citizens who contend that the touchy subject of individual responsibility has been all but ignored in the current debate over how to reform the nation’s health care system—and how to pay for it.
It needs to be discussed, they say. It’s a matter of simple fairness!
I’ve thought quite a bit about this issue. Maybe, “agonized” would be a more accurate word. I’m tempted to agree, but I just can’t.
Reasons I’d like to agree
*** Some of the factors listed are largely within personal control. So at one level, it doesn’t seem fair that I should have to pay, however indirectly, for health care for someone who appears to take no personal responsibility at all.
And, frankly, it’s really hard for me to summon up a lot of sympathy for Dr. Spady’s 358-pound diabetic patient.
*** Taking personal responsibility by eating healthy and exercising are low-cost, low-tech ways to to prevent or manage disease.
*** And I know from my own experience how powerful eating right and exercising have been in helping me manage type 2 diabetes.
But I just can’t
*** Defining the boundaries of personal responsibility—what’s preventable and what’s not—is anything but simple. There’s a link between obesity/physical inactivity and type 2 diabetes. But that doesn’t mean that anyone who has Type 2 diabetes could have prevented it.
It doesn’t even mean that anyone who’s overweight could have prevented that. Many things can cause people to gain weight, including the side-effects of certain medications or an underactive thyroid gland.
*** Besides, there are risk factors for type 2 diabetes which are not preventable, such as age, race or ethnic background, family history of the disease, and having large birth-weight babies (associated with a condition called gestational diabetes).
This last one is not well-known, and often when I mention it to people, they are surprised. It was one of my risk factors: My first baby weighed in at 10 pounds 4 ounces—a bit over the combined weight of twins born in the same hospital about the same time.
*** When I was diagnosed with type 2 diabetes, my age also put me at risk. I’m not sure about family history, but my mother died of a heart attack in her sixties, and diabetes is a risk factor for heart attack and stroke. So she may have had it without it being diagnosed (which is still common these days).
*** The main point, though, is that blame doesn’t help. What helps is providing a supportive environment and developing strategies to help people change in a supportive environment. That’s what organizations like Weight Watchers and Alcoholics Anonymous do, and that’s why they work.
Getting people to take personal responsibility for their health is a win-win. We get lower costs and better health. But legislating it is completely unworkable. Instead employers and insurance companies should be encouraged to set up voluntary programs to help people take responsibility for their own health.
photo by lifeontheedge