Taking charge of your health

Lucy is a good student. She works hard to be somebody in life and help her family. Lately, she has started to skip some meals and lose some sleep. She feels like she’s walking on a tightrope. “Yesterday,” she says, “I fell asleep during lecture! Can you imagine that?” Embarrassed, she confesses, “I’ve got to stop doing this to myself. This is not healthy.” Lucy wants to establish some practical health habits in order to actually enjoy college life. However, she doesn’t know where to start. “What can I do to be healthy?”

Charles is a well-educated person taking his fellowship in international relations. He is concerned about health issues in the world. He knows that despite a decline of heart disease in some countries, the world still suffers from this illness. By 2020, heart disease will be a leading cause of death, not only in developed but also in developing countries.1,2 Scientists expect that developing countries will not be able to afford the same treatments as developed countries. In the United States, only 20 percent of hypertension cases are adequately controlled, and in developing countries this figure falls between 5 percent and 10 percent.3 Furthermore, a lack of efficient health-care systems, a strain on financial resources, and an underestimation of a healthier lifestyle threaten millions. Charles is now reflective. “Who has enough power and influence to change such projections? The government? Are governments alone responsible for keeping people as healthy as possible?”

The experiences of Lucy and Charles are extreme examples. One focuses on personal health, the other on collective health. Lucy, of course, needs to take some personal action. However, Charles’s is a big problem: global health.

The history of health and medicine in the world is full of trials, errors, and ignorance. Wars, famine, and poor medical knowledge were abundant, thus decreasing life expectancy. Archeological evidences of skeletal remains in the Old World and in Pre-Columbian America as well as historical registers show that people’s life expectancy then was barely above 34 years.6-8 A healthy person was defined as someone “without disease” or, one who was born without physical defects and infectious diseases. Many societies needed physically tough people to fight in wars and to work on farms. People considered themselves victims, passive receptors of “external forces” that predetermined not only their health but also heritage conditions and social status.6

When, in the 19th century, the first military hospital services and city health departments were established during America’s Industrial Revolution, life expectancy was around 40 years, with a mortality rate of more than 20 per 1000.7,9,11 By 1900, the mortality rate had declined to 17.2 per 1000, and 75 years later it was less than nine deaths per 1000 people.11 By 1993, 71 percent of the people living in the United States were expected to live to at least 70 years of age. Roughly, 80 percent of this survival surge occurred between the 1890s and 1940s. This was in large part due to (a) radical changes in food availability and better understanding of nutrition, and (b) sophisticated public sanitary conditions, including clean water supply, drains, cleaner streets, urban regulations, ventilated houses, rat proliferation controls, pasteurization of milk, and vaccines for disease prevention. The United States enjoyed several years of systematic preventive medicine, approached mainly through government leadership and a growing individual/collective consciousness that saw “dirty” habits as “bad.” For example, spitting, sneezing, and coughing openly were not just looked down upon, but prohibited.6,11,12 Because health concerns became massive, the preventive health enterprise was more socially than personally focused.

During the 1930s and 1940s the discovery of antibiotics such as sulfas, penicillin, and streptomycin opened a new horizon in curative medicine. Governments promoted more spending towards curative medicine, and hence less towards preventive medicine. Medical technology, too, burst into the expansive—and more expensive—age of curative medicine. Hospitals became the visible recipient of curative medicine, and gradually the hospital system gained priority over the preventive health system, and hospitals increased in number and size to satisfy the needs “for better health.” When curative medicine became the standard practice for health in the 1950s, life expectancy increased to 65 years in the United States.7 People believed that improvements in survival came from “marvelous new technological procedures.” The truth, however, was a real stagnation in the survival rate between 1950 and 1970 in the United States (see Figure 1).

The U.S. medical crisis of the early 1990s

Taking action against risky patterns of behavior in other diseases was almost lost because of an exaggerated focus on curative medicine. In the 1980s three vital factors escalated to create a crisis in the early 1990s: An increase of “human-made diseases,” health expenses, and complaints from pro-health interest groups.6,7,13

Public health reports show that “human-made diseases” such as heart attacks, strokes, cancer, automobile accidents, suicide, violence, diabetes, drug abuse, and environmental pollution rose rapidly to the top of the major causes of premature death.7 (See Table 1.) It was evident that people acquired these diseases by developing health-threatening habits early in their lives. Such habits include tobacco use, alcohol abuse, fatty diets, stress, hostile behavior, etc. However, investigators also noted that other lifestyles were protective (preventive) against premature death (for example, exercise, a fruit and vegetable diet, and good rest). Since the 1980s the mortality rate has begun to decline slowly but consistently for the first time in 30 years because an increasing number of people engaged in a healthy lifestyle.

Economical reports confirm that preventive medicine achieved much of the improved survival and health status before the curative medicine revolution, with little increase in costs.

Pro-health groups’ complaints have become politically important. People who lead a healthy lifestyle or are interested in a change of lifestyle, consider it their right to live, for example, in unpolluted environments. Also, an increasing number of citizens do not consider it fair that individuals who do not take care of their bodies should consume a large portion of the national health budget.

What we can learn from passive vs. active behavior

Even though the history of health and medicine provides evidence that government initiatives have an impact on society, we cannot ignore the importance of individual attitudes toward health, illness, and death, that affect behavior and eventually society. Several anthropology and cross-cultural psychiatry reports agree that the preventive and curative health systems are culturally based, that is, are influenced by “the system of shared beliefs, values, customs, behaviors, and artifacts that the members of society use to cope with their world and with one another, transmitted from generation to generation through learning.”14,15 People who are active participants in their own health examine critically the concept of health and illness, and the underlying causes of how their behavior is culturally determined. For example, an individual who has a healthy lifestyle would not eat the greasy food common in their culture.16

On the other hand, individuals who perceive themselves as recipients of misfortunes are at higher risk of passive behavioral patterns regarding their health. For example, some patients who risk HIV infection tend to say: “Either way, I’m going to die.”17 What such attitudes reveal is this: To place complete responsibility for health care on the government, the social system, the hospital, or an international agency is to deny our own capacity to help ourselves.

So, what is health?

The “preventive lifestyle culture” places a certain responsibility on the individual for his or her life and health. No longer do we consider health as simply an absence of disease, or living longer. Vitality, optimal health, and wellness have very similar meanings. One of the best-known definitions of health comes from The World Health Organization: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”11

This definition opens up a multidimensional and multi-interacting range that defines the current profile of a healthy person. Aside from the physical, emotional, and social aspects, health also encompasses interpersonal, intellectual, spiritual, and environmental dimensions.

The profile of a healthy person

Physically, a healthy person avoids ingestion of harmful substances (especially tobacco and alcohol); eats well, has regular physical exercise, and tries to keep a normal weight; understands natural body limitations and the aging process, and accepts dying as the end of this process. Despite this reality, the person can maintain optimal health.

Emotionally, socially and interpersonally, a healthy person achieves a balance between self-esteem (the capacity of a person to consider himself or herself as valuable) and hetero-esteem (the capacity of a person to consider other persons valuable); between use and abuse; and among liberty (the capacity to choose or act), security (the feeling of confidence), and risk (awareness of danger). This consciousness is applicable to any aspect of preventive health, but it is especially useful for healthy sexual behaviors.

Intellectually, a healthy person is an active and responsible seeker of health information. He or she manages risk factors for diseases but looks for professional help if needed; tries to understand the health system and how to use it efficiently; and learns to manage high-risk behaviors in order to minimize their impact.

Spiritually, a healthy person understands spiritual dimensions and uses them actively to maximize serenity, comfort, and hope.

Environmentally, a healthy person has consciousness of potential environmental benefits or risks, and takes appropriate actions to keep healthy surrounding conditions.

Everyone can have better health

Even though poverty and inequality still exist in many countries, preventive health and individual participation are keys to satisfying universal health needs. Developing countries like Costa Rica, Sri Lanka, and the State of Kerala in India have achieved low mortality rates by establishing a strategy of smaller hospitals, public participation, dedicated physicians, and health workers who reach the poorest and least educated. Even without access to health services, very poor but educated Nigerian mothers are able to improve the survival of their children. Illiterate mothers can not.17

Our lifestyle has a major impact on our health despite poverty or wealth. A healthy lifestyle positively changes both person and society. The following is a strongly recommended recipe for personal health improvement:

First, take control of your health. (Identify the problem.)

Second, establish easy goals and plans.

Third, execute your goals and plans.

Fourth, set new goals and make plans to achieve them.

Fifth, avoid people, things, and situations that ruin your plans.

Sixth, call for help, if needed.

Esteban Poni (M.D., University of Venezuela) is an internal medicine specialist involved with health education and research, residing in Loma Linda, California, U.S.A. Email: este3808@hotmail.com.


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