In light of recent news regarding cigarette labeling (substantial warnings and photos), cutting toys (though not necessarily calories) out of happy meals and the increasing amount of cheese in American diets (thank you pizza) – in light of all of these things perhaps a reality check is in order about the health of Americans. It is common in the U.S. to laud the opportunities that all Americans have (or should) to choose – their food, their drink, their schools, their mileage, their insurance, etc. And now, given the imminent shift of power in D.C., accompanying discussions around repealing health insurance legislation (watered down though it was already), and broad programmatic cuts promised in an effort to reduce the deficit – well, now perhaps it is an important time to reexamine American health from that uniquely American perspective of individual responsibility.
First some clarity about the best health care in the world – and it’s not here. In 2000 the World Health Organization ranked U.S. health care 37th in the world (behind Chile, Morocco, and significantly behind Singapore). Although WHO no longer tries to rank the health care systems globally, there is plenty of data about actual health status (much easier to measure) among citizens of the world. In 2010, out of 153 countries rated, Americans were the 19th most obese in the world. Who says we can’t compete internationally? Out of 223 countries rated, Americans ranked 29th highest in rates of diabetes. And yet, the U.S. spends the highest percentage of its GDP on health care of any nation in the world. But understand, we are free to choose our super sized meals, two liter bottles of soda and prepackaged lunches – that is the beauty of choice! And for that matter we are also free to choose to light up – well, at least some things – no matter that lung cancer kills more Americans than nearly all other forms of cancer combined. Freedom baby!
Of course, if you exercise that freedom then we hold that you are solely responsible for the results – heart disease, diabetes, obesity, lung cancer. You are also for the accompanying costs to society for your medical care – especially if you have chosen to not be able to afford health insurance.
Let’s look at three sources of irony in this system of individual freedom and responsibility as they relate to health: high fructose corn syrup (coming soon to you re-dressed as ‘corn sugar’, but with the same toxic personality), fast food and couch potatoes.
Parents have the freedom and responsibility to choose for their children and themselves a wide variety of foods. High fructose corn syrup is in just about everything today – not just the baked goods and sodas that you might expect, but innumerable commercial food from cereals and lunch “kits” to ketchup, to half of what you order at “family style” restaurants. Why? It’s super sweet, and thanks to government subsidies, it is super cheap. Is there any societal or governmental responsibility to have school systems that teach about this type of “nutrition”? About how to read labels in a meaningful way? Explore real world examples of processed food content? What about getting really crazy and teaching critical analysis of food commercials? This is hard to do in a system that has fast food chains sponsoring school lunch menus or given a place in the cafeteria, or where the food “choices” are processed, prepackaged and shipped nationally. [As for the sodas, “sports” drinks, and “juice” punch targeting the young ones and their parents – the impact of this is not only weight gain, but higher cavity rates as well – already five times more common in children than asthma. And in rural areas there is a widely recognized, severe shortage of dentists.]
But let us get back to fast food in general. Obviously any “good” parent knows to limit the amount of fast food that their children get – regardless of how overscheduled their children’s week may be, or how late they have to work. Is there any concordant obligation (of anyone - schools, press, legislators?) to ensure a community has access to healthy food (never mind affordable, healthy food)? City development grants, tax incentives and creative leveraging can promote building of grocery stores in urban environments that are otherwise “food deserts”. But cautious politicians need public support, feedback that this is of value. Unfortunately, the most vulnerable urban environments include disenfranchised citizens the least likely to vote or have political connections. Which means that other folks would have to care about this issue also, in order for there to be a push for change. One of the most successful moves (if embarrassing for the FDA) at a national scale however, supported by tax payer dollars, was support of a private chain’s effort to make bad pizza better (and worse) by tripling the amount of cheese on top. Sales are up and stomachs are bigger.
But surely exercise is an area that we can all agree is no one’s responsibility but each individual’s! So is there any responsibility for cities to ensure neighborhoods have safe lighting, sidewalks and low street crime to allow for walking, running and cycling? Public pools or parks? Do school systems (and the bodies that legislate their funding and priorities) have any obligation to ensure schools maintain physical education programs? These have been cut mercilessly across school districts in response to the academic demands of No Child Left Behind. Is there an outcry for suburban models that allow for children to easily walk or bicycle the short distance to school rather than bus a labyrinth of cul-de-sacs?
Should we blame corporate America for any of these systemic challenges to our health? Builders or food manufacturers or producers? They are doing exactly what they are supposed to be doing to please their shareholders – and remember these shareholders are a combination of institutional , and private investors like you and me: working hard to keep costs down, demand and profits up.
If each of our individual freedom of choice and responsibilities have to contend with these challenges solo – without an education system or a critical press or a legislative body encouraging a broader societal sense of obligation – well, we still have 18 countries to beat to get to be the heaviest in the world!
What does that Janis Joplin song say? Freedom’s just another word for … another pound to lose?Pages: