I keep seeing this term “healthy” being used in research papers and in discussion online.
“Healthy individual,” “healthy lifestyle,” “healthy diet,” “healthy foods.” I don’t know what these phrases mean. There’s certainly not one definition for these ideas.
Let’s take exercise, for example. Various government or professional entities recommend a certain amount of exercise a day or a week, usually based on a person’s age and/or gender. If a person doesn’t exercise for the prescribed amount: is that “unhealthy?” What if someone exercises twice or three times the amount? Where does that fall in the spectrum?
I find it frustrating to see so many entities promoting this idea of toxic individuality when it comes to health. The truth is that so much of our outcomes in regards to health are not under our direct control.
Your zip code has more to do with your health than your genetic code does. How does it help to tell people to “eat healthy” when inflation is out of control and the FDA approves so many unnecessary food additives? How does it help to tell people to “get exercise” if they don’t have a safe space in which to do so? How does it help to tell people to make “better choices” when most people have no control over the level of pollution in the air and water in their cities and towns?
People who have money and access live longer. Because they can afford the green spaces, the wild caught salmon, better health insurance, and a gym membership. Whenever I see a study which shows that people who engage in an activity or food choice that is more expensive have “better” health: I have to ask if it’s because they can afford other things that support their health.
Pushing all the responsibility back on people’s individual choices when the healthcare system and our society has set them up to fail is wrong. When I see phrases like “healthy lifestyle choices can prevent X% of ABC disease…” it makes my blood boil.
Because what does that even MEAN? Does it mean that we made ourselves sick with our “choices?” To me, this language is patient blaming. In truth: we have little in the way of “choice.” Our health outcomes are far more complicated than deciding whether or not to eat a hot dog.
I’m not an expert in this. I will almost certainly use wording and thought patterns that get it wrong, even when I am trying to get it right. What I do know is this: we have to keep pushing for systemic change in order to have better outcomes for everyone. And that looks like calling for things like better health education, the expansion of Medicaid, and stronger environmental regulations.
And we can do those things. We can. We are choosing NOT to do them.
I like actionable things. Once I point out a problem, I feel that it is important to also offer a call to action to be part of the solution.
I don’t know how to solve this.
My call to action this time is vague: we all need to be participating in the reframing of health. This means voting, interacting with your elected officials, and understanding social determinants of health. It could mean anything from advocating for safe recreation spaces in your area, to volunteering at patient advocacy organizations, to running for office yourself.
It also means asking lots of questions, especially of authorities that aren’t demonstrating an interest in helping people achieve their personal health goals.
And lastly, it means engaging in critical thinking, and not accepting that something is above criticism because it was published in a medical journal. As patients, we have the right to demand that we are discussed in ways that are dignified and fair.
Graham GN. Why your zip code matters more than your genetic code: Promoting healthy outcomes from mother to child. Breastfeed Med. 2016;11:396-397. doi:10.1089/bfm.2016.0113.
KFF. Status of state Medicaid expansion decisions: Interactive map. March 27, 2023. Available at: https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/
Magnan S. Social determinants of health 101 for health care: Five plus five. National Academy of Medicine. October 9, 2017. Available at: https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five/
Powell A. The costs of inequality: Money = quality health care = longer life. The Harvard Gazette. February 16, 2016. Available at: https://news.harvard.edu/gazette/story/2016/02/money-quality-health-care-longer-life/
Tulane University School of Public Health and Tropical Medicine. Health inequality: Examining public health disparities by zip code. November 18, 2020. Available at: https://publichealth.tulane.edu/blog/health-disparities-by-zip-code/