This article was originally published on forbes.com and can be viewed here.
Earlier, I wrote an article (“Four fundamental shifts required for improved population health”) in which I mentioned that a big reason for our health crisis is self-inflicted. As a society we have, over the past 40 years or so, made it easier and cheaper to be less healthy. There are several reasons for this phenomenon. We’ll look at some of the big ones here, and explore ways we are addressing or can begin to address these trends.
How have we made it easier to be less healthy?
We have changed the food paradigm for the worse
Prior to the dawn of industrialized food growth and production, the majority of Americans got their food from local sources, cooked it themselves, and had a much more varied diet. Food industrialization has brought convenience and abundance, for sure, but at a high cost. And our lifestyle choices—always busy and on the go—are making it worse.
Fast food and fast casual restaurants cater to busy families who want to eat together, or grab and go to keep up with busy lifestyles. But these foods contain higher amounts of sodium, fat and sugar: three ingredients designed to positively impact the palate, but then negatively impact the body.
In grocery foods, fillers, additives, and preservatives are used to bulk up meals and to ensure easy to prepare, shelf-stable meals. The down side is, there is little nutritional value in these packaged foods. Even our main protein sources (cattle, chickens, pigs) are being fed a processed diet, so the nutrients we used to derive from the grasses, herbs and other plants they used to freely consume is rapidly diminishing as well. As a result, we are consuming calories from a smaller pool of food sources, and our bodies are working overtime to absorb or remove the overabundance of some ingredients.
Judging from the poor nutritional state of our food system, it would be smart to include a pharmaceutical-style disclaimer with every processed, sugar and additive-laced, artificially colored and flavored food item: “Side effects may include: weight gain, high blood sugar, elevated cholesterol levels, high blood pressure, and digestive difficulties. Serious side effects may include: diabetes, heart disease, metabolic disorders and certain forms of cancer.”
Food advertising touts convenience over nutrition
This causes two big problems. First, it means that healthy food has been segregated by default. The shelf space for popular foods—ones that turn regularly, won’t spoil quickly, and enable profits to the grocers—is the centerpiece of the modern grocery chain. Other than the produce aisles and usually an aisle of “healthy” or “natural” living, healthy foods are relegated to the periphery of the store and to the top or bottom shelves in the main aisles, and we have to search high and low (literally) to find whole grain, organic, low sodium or gluten free options.
Second, if conveniently packaged foods with a long shelf life are cheap as well as quick and easy to make, healthier foods must, by contrast, be difficult to prepare and more expensive. This is partially true, but only inasmuch as there has not been a concerted effort to counteract this information. We don’t see many people making full meals on packaged food TV commercials, either. What we see is someone adding a protein to a boxed dinner and calling it a simple way for families to connect. There’s no mention of the high fat content or lack of complete nutrition that are the hallmark of these kinds of meals. They are touted as “part of” a healthy dinner, but for many folks pressed for time or money, it’s the only part.
We’ve moved away from moving
Our lives are more sedentary than previous generations. We sit at desks at work or school and are almost always rewarded for being still. Our movement is relegated to going from point A to point B before sitting down to do another task. More recent entertainment innovations (gaming, video streaming) mean we can amuse ourselves for hours at a time without moving many muscles.
Furthermore, as our economic circumstances improve, we hire someone else to move for us: We’re not necessarily the ones who mow the lawn or clean the house or even pick up the dog poop in the yard. All of these services free up time for us to do other stuff, but rarely are we substituting different movements to replace these automatic movement-generating tasks.
Worse, we over-value the regimented movement we may have put in our schedule. It’s a big mistake to think that 30 minutes at the gym 3 times a week will make up for the complete lack of physical activity the rest of the week. I’ve had a Jawbone UP for several years, and it’s sometimes very challenging to get to the recommended 10,000 steps per day. In fact, some days I have to go out of my way to figure out how to get to that number.
There’s a pill for that
Modern medicine has evolved from stopping death with miracle drugs like vaccines and antibiotics to helping mitigate the damage an unhealthy lifestyle can wreak. Billions of dollars are being poured into finding “cures” for a host of chronic diseases, the majority of which, according to the CDC, are caused by lack of physical activity, poor nutrition, tobacco use and drinking too much alcohol.
High cholesterol from eating the wrong foods? There’s a pill for that. Need some help stabilizing blood pressure? There’s a pill for that, too. Two of our biggest health crises, Type 2 diabetes and heart disease, could be managed with a change in diet and an increase in exercise alone. I wrote a little bit bitingly about this in another article “Stop Penalizing the Healthy”. Until fairly recently, a person with elevated cholesterol could simply add a pill or two to his or her existing lifestyle and watch cholesterol levels stabilize or decrease.
To be sure, the doctor would admonish the patient to exercise more, eat healthier foods and lose some weight, all while handing over the prescription. And maybe the patient would make some minor lifestyle changes. Relatively speaking, however, for about $10 or $20 a month a “nuisance” condition can be controlled without too much personal effort. Behavioral changes are more difficult to manage, and fall outside the normal doctor-patient bond, so success is almost entirely dependent upon the attitude and motivation of the patient. And there’s not, yet, a pill for that.
Is there hope?
Yes. The trend toward healthier, more wholesome and less processed fast food started from the outliers. Folks like Snap Kitchen and juice bars like Daily Juice here in central Texas have entered the convenience game with portion-controlled, single serve pickup meals, delivery services and a host of nutrition data to back up their claims. Venture funds have been pouring billions of dollars into meal kit delivery startups around the country, many of which specialize in fresh, local, organic and healthy fare. These companies are pulling double duty: not only are they serving healthier foods in more convenient ways, they are also educating us about what makes good food, well, good. They are helping to change the conversation from short-term convenience to long-term benefits.
Fast food and fast casual chains have taken up the challenge as well. From removing trans-fats and adding calorie information to expanding menus to include salads and fruit offerings at McDonald’s Corp. to sourcing organic, free range ingredients (Chipotle Mexican Grill, Panera Bread Company) that help reduce the number of toxins in our food chain, big players are experimenting. Packaged goods companies also are getting into the healthy food game. Betty Crocker, by General Mills, has a line of gluten free baking mixes. General Mills and Kellogg Company are also touting more whole grain, gluten free, and reduced sugar options. Because these are recognizable names, we’re starting to see health food options hitting mainstream store shelving, and the natural foods aisle is being absorbed, bit by bit, into the whole store. “Free range,” “grass fed,” “hormone-free,” and “organic” are also labels we’re seeing in both the meat and dairy sections.
City and suburban planners are working to bring back pedestrian friendly retail and neighborhood designs that include wider sidewalks, bicycle only lanes, public transportation access hubs, and the like. When we can acknowledge the importance of multiple modes of transportation, as many “mature” cities (especially those outside of car-loving Texas) have already pioneered, we can begin to see movement rates improve. Workplaces that encourage walking, either through a network of trails connecting buildings or through wellness initiatives, are growing. Trends like stand-up and walking meetings are helping folks realize that taking small steps to more movement are easier to assimilate into their daily routines than grand fitness goals.
Finally, now that health care reforms are shifting the financial burden of health care costs to consumers, either by consumers directly paying for policies or absorbing higher deductibles in employer-offered policies, consumers are going to get very savvy, very quickly, about the true cost of their health.
When the economics of paying for a statin drug starts to equal or exceed the economics of buying a pair of walking shoes or an annual gym membership, we’ll start to see some positive leaps in population health. Companies like Nike and Under Armour will start devising ad campaigns touting the health benefits of their wares, not just the status factor. Entirely new clothing lines, with built-in sensors and instant feedback capabilities, are on their way and will bring with them a new definition and expectation of health care via wearable technologies.
Reimbursement models will change and we will start to see incentives for positive behavior as a way to control the medical costs of long-term negative behaviors. And those who are on the hook for keeping us healthy—the traditional health care establishment and the payers—will soon realize they need to pay as much attention to the people they aren’t serving, the healthy, as they are to the ones they always have served. This will open up entirely new financial models, where consumers will use dollars from their discretionary food and activity budgets to positively reduce the amount of money they spend when they are sick.
But the net net is that being healthy will, in the next decade or so, start to cost less than being unhealthy.
I’m looking forward in the future to bring Forbes readers insights into the technology and Human Internet of Things (HIoT) of healthcare.
It’s going to be an interesting ride!