Thursday, February 01, 2007

Cultivating Health

Perhaps the greatest concerns in our country today are related concerns: the state of this nation's health, and the health of our health care system. A compelling case, of course, could be made for the consumption of fossil fuels, a non-replenishable fuel source that emits the greenhouse gases that are linked to global warming and deepens our dependence on foreign oil - even oil which generates revenue for terrorists and those who support them. But as great as that concern is - and the threats posed by global warming and terrorism are nothing to sneeze at - our generally poor state of health, and the poor health of our health care system, may be even greater threats to our collective well-being.

Today, at least 44 million Americans have no health insurance coverage, and an additional at least 80 million Americans have inadequate coverage. Another at least 40 million - mostly students - have coverage for only part of the year. This means that over 160 million Americans have either no access or limited access to the kind of care that they need to maintain their health without risking financial ruin.

Additionally, due to basic lifestyle and dietary choices, we are on the brink of a health crisis. While it is true that many, many health indicators are on the rise - in the last hundred years the average life expectancy of an American has risen from 41 years to over 70 years and climbing; over the last fifty years, adjusted for population increase, death from heart disease is down 60% and death from stroke is down 70%; over the last twenty five years infant mortality is down 45%, to just 0.7% of live births; most occurrences of cancer have declined since their peak in the early 1990s, and cancer deaths have been declining by about 1% per year since 1993 - there are also a few disturbing trends. Obesity and diabetes have been steadily increasing, and if these trends are not abated they may create an epidemic.

Over the last two decades, the number of overweight children in the United States has more than doubled. In some areas of the country Type 2 diabetes - caused by lifestyle rather than genetics - has replaced Type 1 diabetes as the most common form in children. Coupled with the rise in obesity among adults, which isn't exactly news, this isn't promising. Not only are we fatter than we've ever been, our children are fatter than they've ever been, which, if not addressed, will lead to increasing problems.

The increase in obesity among both American adults and children, coupled with the attendant increase in other lifestyle related health problems, has put a tremendous strain on the health care system. As of 2003, we are spending roughly $75 billion per year on obesity related heath problems, with over half of that being paid for by the federal government. That is a tremendous, and preventable, expenditure, and it places a drain on the whole system.

Currently roughly 20% of the population account for roughly 80% of the health care costs. However, as more and more Americans grow fatter and fatter, they will join that 20% of the population and increase the drag on the system. So, while advances in medical technology have thus far dramatically increased the average life span and dramatically decreased instances of preventable death by heart disease and stroke, those advances will not be able to keep us artificially health forever. At some point we will have to face the fact that what we eat and how we live matter, and that no pill yet developed can allow us to eat whatever we want and sit on the couch without suffering some serious health consequences.

As a culture we have a generally pathological approach to health. That is, we assume a baseline measure of health, and see any deviation from that as a kind of disease that needs to be addressed, and addressed medically. This model has its advantages. It is often able to describe and improve our condition. I may have a certain baseline health, and then my body may be invaded by a virus or a bacteria, causing a disease. The pathological model of health is able to identify and attack that invading pathogen, and thus fight off the disease that prevents me from being as healthy as I could be. Or, I may be basically healthy, only to fall down and break my wrist. The pathological model is able to identify and treat my acute injury, and help restore function to my wounded limb.

However, there are limitations to this pathological model. While it is true that the invasion of pathogens or acute injury can be obstacles to health, they are not the only obstacles. And, even when they are obstacles, they are not best fought off only by medical intervention. Our bodies are magnificent organic systems, and medical science in only just scratching the surface in understanding them. And while drugs and other medical technologies help heal injury and fight off invasion, those tasks are also natural tasks, performed by the immune system.

Every time you take a drug there are both intended and unintended consequences. This is the nature of taking powerful chemicals into your body. These chemicals change things. Some changes, of course, are beneficial. Others, however, are not. These unintended medicinal consequences are often called "side effects," though perhaps the best term for them would be "collateral damage." In the fight against disease, sometime health is put at risk.

I am not arguing that we should not take medications. I fact, I am currently taking an asthma medication that may well be saving my life. For the past month my asthma, which I though was under control, has been kicking my ass. By the end of last week I could barely breath. I often wake up in the middle of the night fighting to force air into my lungs. If it weren't for a medication, a drug, a powerful chemical that I take into my system, I may find that I can't breath at all, and slowly die in the middle of the night.

Many, many medications work like this, preventing deaths which just a couple of generations ago could not have been prevented. But these medications do have consequences. My asthma medication, for instance, alters my heart rate. Over time it may even do some slight damage. That it keeps me breathing, of course, more than offsets this possibility, but it is still a possibility, and not a very pleasant one. That is the nature of taking drugs to fight off acute health problems.

And when we use drugs to solve problems that could be solved by other means - by a change in diet or lifestyle, for instance - then we accept unnecessary risk. Instead of cultivating health by helping to build up the immune system naturally, we take chemical short-cuts, not realizing that these short-cuts are expensive both in economic terms and in the terms of over-all health.

An entirely pathological health care model leads to an over-dependence on medical intervention, and as such fails to appreciate the maxim that, all else being equal, the least restrictive or least invasive intervention is best. By contrast, an organic or holistic health model - one that appreciates the interconnected nature of all bodily processes, and the value of building up natural defences and cultivating health, helps us appreciate that what we eat and how we live matters. The goal of such a model is, as stated in the description, cultivating health. It does not see health as a sort of baseline figure that is attacked by disease. Rather, it sees health as something that can be built up or torn down by the choices that we make.

Cultivating health - that is, engaging in behaviors which raise your over-all level of health - can help fight disease and injury in a much less restrictive or invasive way than most medical interventions. Of course, medical interventions are often necessary. While orange juice and other foods rich in vitamin C and anti-oxidants may help build the immune system to fight off basic colds, if you have bronchitis or pneumonia you would be foolish to think that a glass of OJ is a preferred treatment. And, while certain foods and behaviors may help reduce the risk of cancer, there is nothing you can eat or drink that will make much headway against a cancer after it has developed. And, again, while changing your diet may reduce you "bad" cholesterol level, if you have a genetic predisposition to high cholesterol - like, say, my grandmother - you may need to take a pill every day no matter what you eat.

A holistic health model should be held up next to a pathological model, because both models are useful, and both models both describe our experience and help solve concrete problems. And, no matter how healthy we become, no matter how well we cultivate our health, we will, each of us, at some point, get so sick that we need more drastic medical intervention. Basic health care will always be necessary.

And, in our country - despite having some of the best medical care and technology in the world - our health care system is failing. Not only do we, as outlined above, have a crisis of uninsured and underinsured persons that isn't going away any time soon; but we also have escalating costs associated with even the most basic health care. While some of this is due, as mentioned above, to increasing rates of obesity and lifestyle related diseases such as Type 2 diabetes (and I don't mean to sound unsupportive or unsympathetic of persons who struggle with their weight, their diet, and such lifestyle related illnesses - we live in a culture whose eating habits are dictated more by economic interests than by caloric needs or health impact, and that cultural environment shapes all of our habits), a great deal of this is due simply to overhead, to administrative costs.

While there is a basic belief among many in our country that the private sector is far, far more efficient that the government, a quick look at our health care system reveals that often the opposite is true. Administrative costs in an HMO, for instance, dwarf those of any federal program. About 4% of Medicare's expenses, for instance, are due to administrative costs. Many countries with a more socialized health care system have even lower administrative costs than that. Canada, for instance, spends only about 2% or less on administrative costs. If the private sector were, due to the demands of the free market system, far more efficient than the public sector, you would expect then that administrative costs in HMOs to be at 1.5% or less. However, contrary to public expectation, HMO administrative costs soar at over 30%. No government bureaucracy rivals, for sheer volume of obfuscation and raw paper work, that of a "well managed" HMO.

Because of this, I am throwing what little weight I have behind HR 676, a bill that would introduce a single payer health care system. This bill has the support of the United Methodist General Board of Global Ministries, and much of the medical community. I will happily host a discussion on the merits of a single payer health care system (which is not the same as universal health coverage, as universal health coverage, while solving the problem of uninsured persons, does not solve the broader problems associated with our current system) in the comments section of this post.

As a nation we simply have to take control both of our health, and the health of our health care system.

[Note: statistics concerning obesity came from The National Obesity Society. Statisics concerning positive trends in overall health came from The Progress Paradox by Gregg Easterbrook. Statistics concerning the number of uninsured and underinsured Americans came from the United Methodist General Board on Global Ministries. Information was also taken from an editorial by the Louisville Courier Journal from Feb. 17, 2006, titled "Health Care: The Single Payer Vision," as well as from articles by Dr. Marcia Angell, and by David U. Himmelstein, MD and Steffie Woolhander, MD. All other statistics came from a presentation by Kentuckians for Single Payer Health Care, who can be reached by calling (502) 459-3393.]

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