Monday, January 22, 2018

Check Your Privilege Before Talking About Health And Personal Responsibility

This was first published in September 2016 in US News and World Report.
I was sitting and chatting with a journalist this past weekend. She's hearteningly passionate about her work, and hers is a health beat. She wanted to know how she and the media as a whole might do better at helping the public adopt healthy habits in the name of improving obesity and other chronic diet and lifestyle responsive diseases.

I think my answer may have surprised her. "Not that there aren't ways the media could improve upon their reporting," I said, "but I'm not sure it really matters in that the folks who both read about healthy living and have lives that are appropriately and realistically conducive to change are an incredibly privileged and small subset of the population."

Spelling that out more succinctly here, personal responsibility-based healthy living efforts require privileges that the vast majority of people don't possess.

First, there's the privilege of time. Yes, we all share the same 24 hours a day, but there's little doubt that for some, the time required to intentionally exercise, shop for fresh, whole ingredients, prep foods and cook rightly play second fiddle to working long enough hours to pay for their and their family's necessities. There's also the time involved in caregiving responsibilities, which could include looking after children with special needs, aged parents or an ill spouse.

Second, there's the privilege of personal health. People with disabilities, chronic pain, severe fatigue and other conditions may find purposeful behaviour change to be literally too difficult or figuratively too low a priority, given their day-to-day pain and challenges. That latter bit brings us to the most commonly overlooked privilege: the privilege of life being settled enough to even consider personal responsibility-based healthy lifestyle change.

Even if a person has the time and personal health to allow a run at intentional behavior change, how high on the list of priorities do you think healthy living lies for someone whose children struggle with substance abuse, or whose debts are staggering, or whose spouse is hobbled with post-traumatic stress disorder? Or someone with any of those same issues who is also unemployed?

Working in Canada where health care is socialized and so too are the bulk of my office's programs, I have the fortune of being able to work with people from every socioeconomic strata, and I can tell you that though everyone possesses the theoretical ability to focus on healthy habits and lives, many people's realities make lifestyle reform a nearly impossible luxury.

The longer public health and public opinion focus their attentions on the personal-responsibility narrative of obesity and other chronic non-communicable diseases, the longer we'll wait to see population level changes. If any amount of desire, guilt or shame were sufficient to drive sustained change, we'd have been rid of the so-called lifestyle diseases decades ago. We're not going to swim our way out of this flood, as not everyone can afford swimming lessons, not everyone has the time for swimming lessons and even though knowing how to swim is an undeniably good thing to know how to do, not everyone is interested in taking swimming lessons.

While it's always wise to ensure swimming lessons are available and affordable, more important to a population is ensuring we build a levee. We need policies that will help make healthier lifestyles occur by default, or that make purposeful changes easier or more valuable. Whether those changes are sugar-sweetened beverage taxes, front-of-package health claim reforms, banning advertising that targets children, improved school food policies and programs, zoning laws affected where fast food and convenience stores are located and more, there are no shortage of options. Right now, we're facing a torrential current of calories, ultra-processed foods and a culture of convenience that considers the use of junk food to reward, pacify and entertain our kids and ourselves at every turn as entirely normal. It doesn't matter how strong a swimmer you might be, or how great available swimming lessons are. Swim against this powerful a current, and even the strongest swimmers tire.