Your health: Your responsibility?


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 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. 

My conclusion

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

Comments on this entry are closed.

  • Madeleine Kolb 08/31/2009, 8:20 pm

    Anastasiya, I appreciate your comment, and I agree. There are many reasons why people don’t manage their own health. Certainly, having a family history of heart disease is a significant risk factor, but it’s not destiny.

    A friend where I used to work had a father who died of a heart attack in his 40’s or 50’s, and my friend exercised like crazy. He rode a bike (sometimes long distances), ran, skiied, went dancing with his wife, and on and on. I think he’ll live to a ripe old age. But he’s not typical.

    It’s a huge problem, and we don’t seem to have a lot of answers.

  • Anastasiya 08/31/2009, 7:54 pm

    I’ve been thinking about this health reform a lot recently. Of course, it’s still too early for me to think about Medicare but the costs of health insurance are just driving me crazy sometimes (My husband and I are self-employed that is why we have to pay health insurance fees for us and for our babies out of our pocket).
    I guess the most difficult part is to encourage people to take care of their own health. Some people just do not care about tomorrow, they just want to do what they are used to and what feel comfortable for them without thinking about consequences.
    One of my friends eats steaks and hamburgers every day, his cholesterol is waaaaaay up and no matter what doctors tell him, his answer is “My great grandfather died at 50 from heart attack, my grandfather died from heart attack at 60, my father had a heart attack in his middle fifties. This is genetics. I can’t change, I’ll keep doing what I like: eat hamburgers and drink Coke every day.” This is just one example and there is no way you can change this person’s way of thinking.
    I personally do not know what it would take to encourage a lot of people to be health conscious nowadays. They are just digging their own grave and using our money to go down there.