Building H #86: What Does It Take to Be Healthy?
We came across an interesting profile of renowned systems biologist Lee Hood in (perhaps aptly) Popular Mechanics. Hood – bless him – is trying to shift health care further upstream, to be proactive and preventive, rather than reactive and oriented around treatment. He believes that we will get there through measurement, data, screening, risk assessment and very intentional efforts to forestall and the diseases for which we are most at risk. Our ability to gather data, to analyze it, and to develop highly personalized interventions has grown dramatically in the past decade or so and Hood is demonstrating how to take advantage of these advances through his own lifestyle: at 84, he does a 40-minute workout each morning; takes 25 supplements; tracks physical activity, sleep and other data on his Fitbit and his Oura ring; and has blood draws every six months to check his lipid profile, cholesterol, inflammation markers, and other levels. It is a process of constant monitoring and adaptation on the way toward maximizing not just longevity, but healthy longevity.
You can hear the echoes of Hood’s approach in the work of Peter Attia, who’s been getting a lot of attention for his book Outlive: The Science & Art of Longevity. In his interview with the New York Times Magazine’s David Marchese, Attia also preaches (as he practices) long workouts (he’s at two hours per day) and lots of testing and monitoring as well. Both Hood and Attia seem to be arguing that with enough data, time, resources, attention and discipline, people can create long, healthy lives for themselves. This vision rests on several key premises: 1) that an abundance of data will lead to strong science; 2) that that science will be translated into clear, actionable information; 3) that, informed by that information, people will consistently choose to act in the best interest of their health; and 4) that those choices will be realistic and within reach for everyone. Let’s examine these premises.
Amanda Mull speaks to the first premise in her recent column for The Atlantic: Being Alive Is Bad for Your Health. Nutrition science is rather notorious for its various shifts in conclusions over time (see the fluctuating understanding of fats and carbohydrates, for example) and Mull, a reforming Diet Coke drinker, uses the rumored to be imminent WHO classification of aspartame, the sweetener behind many no-calorie sodas, as a “possible carcinogen” to delve into the issue. She notes that the science, which is too often based in observational studies that struggle to pinpoint causation, is often too inconclusive for meaningful recommendations and that the language we use is often too imprecise to be actionable (“possible carcinogen,” for example, reflects the level of confidence in the relationship while saying nothing, but implying a lot, about the severity of the concern.) This dual failure leave us, in Mull’s view, rather paralyzed:
“Taken in aggregate, this morass of poor communication and confusing information has the very real potential to exhaust people’s ability to identify and respond to actual risk, or to confuse them into nihilism.”
Food labels are a great example of the challenge that Mull describes. The FDA’s Nutrition Facts label has been around for nearly 30 years (a period during which obesity in the US has nearly doubled). Now the FDA seeks to supplement the Nutrition Facts label with front-of-package labels, which raises more uncomfortable questions about how to decide what food is healthy.
Even if the science is clear and reliable and the translation and communication of it are cogent, we run into the question of how people make behavioral choices, which even if we rely on the outdated idea of rational economic actors, are still subject to perfectly reasonable tradeoffs of personal utility (Marchese pushes Attia on this quite well, asking how people can balance adhering to a very demanding health plan without “letting that plan get in the way of the pleasures that make life worth living in the first place?”) And let’s not forget that behavioral economics has shown that people make decisions for all sorts of reasons (e.g. expediency, fatigue) that don’t look like cold, rational reasoning. A recent study even showed that obesity can affect how the brain processes food signals – and that the effect doesn’t appear to get better after considerable weight loss.
And then there’s the most serious concern – about whether healthy choices are accessible to everyone. The routines that Hood and Attia follow are a lot – and Attia even acknowledges that the amount of disposable income and, especially, the time needed to follow his regime are beyond the circumstances of many Americans.
The pushes to leverage the explosion in data and data analytic techniques to discover new knowledge about health and to shift the paradigm of health care toward a more preventive orientation are both laudable and important. The key question becomes what, as a society, we do with this elevated knowledge. The profile of Lee Hood has this wonderful quote from Boston University epidemiologist Sandro Galea:
“It doesn’t matter how good we are at precision treatment. Unless we actually are creating conditions for people not to get sick to begin with—housing, food, education—we are going to continue having an unhealthy society.”
To return to a metaphor we’ve used before, people trying to stay healthy in the US are essentially swimming upstream against very the strong currents of the food environment, the built environment and what we call the product environment and the precision, data-driven, individually-focused approach to health amounts to teaching them to become better swimmers. Which is all good, but to Galea’s point, it all seems in vain if we continue to let those currents grow stronger. We need the imagination and the political will to change the conditions that shape behaviors so that living a healthy life is not a time-consuming, attention-draining endeavor. Even when we know what conditions we need to create, we can struggle to do so. The Wall Street Journal’s recent story Are Lawmakers Seeking Healthy Limits on Junk Food or Acting as Food Police?, which describes the debate in Congress about whether the SNAP program should pay for unhealthy food (or create more incentives for healthy food consumption) doesn’t inspire much confidence. In another example, Henry Grabar writes in Slate about a new Brookings Institution study that found that there’s a very simple answer to the problem of Americans spending too much time in cars: build more stuff they need to reach closer to where they live. It sounds simple, but making that sort of change, at scale, requires a coherent vision about the designs of communities that prioritizes health considerations like more physical activity and less pollution, connects that vision to zoning, development, and transportation considerations, and overcomes the interests that gain from Americans spending more time in cars. It requires a commitment to creating conditions for health so that people who choose to pursue healthy lifestyles can do so without having to make health the focus of their lives.
How can we make that commitment happen? Comments are open.
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