Improving Americans' Health, With or Without Health Care Reform

Though millions of words have been written about the health care reform that may or may not become law in 2010, very few actually address the health of the American citizenry. Apparently it's assumed that expanding health care insurance is the same thing as improving the health of the American people. Not true. As I hope to make clear, "improving health" is not the same as "providing health care insurance." While health care insurance certainly improves access to treatment, it doesn't necessarily improve the overall health of the American people.While interest groups' lobbyists and members of Congress duke it out over hundreds of pages of arcane insurance-related legislation, the American people are eating (and sitting) themselves to death -- and maintaining the status quo with a reform bill will do very little to change that, if it's even passed.

The State of American Health

Two charts from the Centers for Disease Control on obesity trends tell us a lot about where we stand. The charts depict the percentage of adults who are classified by the CDC as obese (those with a body mass index of 30 or higher) by state in two years, 1985 and 2008, roughly one generation apart.

Clearly, an epidemic of obesity and the related chronic lifestyle diseases which are reducing lifespans and burdening millions of Americans with painful and difficult diseases has occurred in the past two decades. Recent studies suggest that two-thirds of American adults are overweight (having a body mass index (BMI) of 25 or more) or obese (having a BMI of 30 or more) and that if current trends continue 45 percent of Americans will be obese by the year 2020.

The standard explanations of this explosive rise in obesity include the entry of women entered the workforce en masse, so home-cooked meals went by the wayside; the increasing consumption of fast-food; and the decline in the number of jobs which requiring hard physical labor.

The problem with these explanations is that all these conditions were already present in 1985. While a majority of women may have been homemakers in 1955, by 1985 women had long been integrated into the U.S. workforce. Fast-food outlets were already on every corner in 1985, and the percentage of the population involved in hard physical labor had already dwindled, as most of the economy was already service-related.

Claiming that factors which were already in place in 1985 somehow explain the staggering rise in lifestyle disease from 1985 to the present just doesn't cut it, so we have to look elsewhere for the causes.

More Sugar Water, Less Exercise

Some Americans point to the dramatic rise of sugary additives such high-fructose corn syrup (HFCS) as one possible cause. I assembled a chart on HFCS from this interactive page on the USDA website.

This rise in the use of sweeteners has been matched by a rise on soft drink consumption, which is now over 600 12-ounce servings (12 oz.) per person per year. Since 1978, soda consumption in the U.S. has tripled for boys and doubled for girls. Regardless of what the soft drink industry's public relations offices may claim, common sense and science alike suggest that "sugar water" (to borrow Steve Jobs' famous description of soft drinks) is fundamentally empty calories.

One of the more striking segments in the recent documentary King Corn features a taxi driver in New York City who consumed a liter or two of soft drinks a day. Unsurprisingly, he soon weighed over 300 pounds and became diabetic. Another documentary making the rounds in America now is Food, Inc. which documents how the largely grain-fed cattle of today are quite different than the cattle of two generations ago which were grass-fed (free-range) for up to two years before being fattened up with a few months of grain.

Getting Serious About Health: The Army Fitness Test

The health benefits of moderate exercise for all age groups are well-documented; these include reducing the odds of contracting cancers, lowering blood pressure, improving metal health and reducing the risk of cardiovascular disease. If Congress were truly serious about improving Americans' health instead of merely placating its many well-funded medical and insurance-related special interests with a 1,000-page collection of taxpayer-funded giveaways, then some of the $1 trillion that will likely be allotted over the next decade to "health care reform" could go to reinstate the fitness programs which successfully improved American students' fitness two generations ago, when the Kennedy administration created new national exercise programs.

There is a simple test for fitness which is available right now: the Army Physical Fitness Test (APFT) which consists of three basic tests for strength and endurance: situps, pushups and a two-mile run. Recruits must score at least a 50 in each event in order to graduate Basic Combat Training, while active duty soldiers need to score at least 60.

Since each of us is in a small way a laboratory for dietary and fitness improvements, I decided to take the APFT myself to see how I measured up against active-duty soldiers.

My background is common enough: heart disease runs in the family, and my paternal grandfather died of a heart attack. Ten years ago, when I turned 46, I decided it was time to get off the stick and do something to reduce the chance of a heart attack in my 50s.

So I bought a bicycle which I ride as often as I can, weather permitting, started walking, and began doing some basic stretching/fitness exercises a few hours a week. I don't go to the gym every day at 5:30 a.m. (too lazy for that) and I'm not training for the half-marathon or other strenuous event. I make moderate efforts to stay fit, and have found that the exercise helps clear my mind and improves my spirits, just as studies suggest.

One recent morning, I warmed up with my usual modest stretching routine and did 35 pushups, 40 situps and ran two miles. As a result, I passed the APFT for 37-years old active-duty soldiers -- men almost 20 years younger than I am. I did not strain myself, and felt fine the next day, suggesting that highly beneficial fitness levels are not beyond a typical person.

A National Fitness Program?

If a 56-year old with limited athletic ability can pass the APFT for active-duty U.S. soldiers with little difficulty, then certainly it can't be too much to expect high school graduates to pass the lower level for recruits, if they were provided with the proper fitness and nutrition education, training and spirit.

What if every high school senior was required to pass the APFT and a short exam on diet and nutrition? What if a fraction of the $2.3 trillion the nation spends on health care each year were devoted to reinstating the basic fitness programs launched by President Kennedy two generations ago?

Another idea: give any adult who passed the APFT earned a 40% discount on their health insurance, or a cash payment in lieu of that sum. It would certainly be money well-spent, as it would dramatically lower the risks of diseases that require costly treatments. If I suffered a heart attack, my medical insurance provider would be on the hook for hundreds of thousands of dollars if I needed surgery and other treatments. Isn't providing an incentive for better health a cheaper alternative for the nation?

A rebate for fitness would not only improve Americans' well-being, but it would lower total health care costs for the nation. If Congress were looking at ideas like this, perhaps the focus would shift from escalating the amount of taxpayer money spent on paperwork and insurance to actually improving the health and well-being of Americans.
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