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Do Unhealthy Americans Get Too Much Respect?

by Rick Blizzard, D.B.A.
Health and Healthcare Editor

At this summer's annual meeting of the American Medical Association, both the U.S. surgeon general and director of the U.S. Centers for Disease Control and Prevention warned that diseases related to tobacco use and poor dietary and exercise habits are the leading killers in the United States. Yet despite the well-documented risks of these and other behaviors such as excessive alcohol use, Gallup's annual Consumption Habits poll* indicates that sizable percentages acknowledge engaging in each. Twenty-five percent of Americans smoke cigarettes, 24% say they drink more alcohol than they think they should, and 43% acknowledge they are overweight (though the Department of Health and Human Services puts the percentage of overweight or obese Americans at close to two-thirds).

The poll also asked Americans if they are less likely to respect people because they smoke, drink alcohol, or are overweight. In all three cases, more than three-fourths of respondents said it makes no difference. This may be the politically correct response to this question, but given the fact that smoking, drinking, and eating are controllable behaviors, is it the response that is most constructive to Americans' well-being? If smoking, excessive drinking, and obesity were considered less socially acceptable, perhaps fewer people would engage in these risky health behaviors.

What Consequences?

The main keys to good health are simple and ubiquitous: Don't smoke. Don't drink excessively. Eat healthy. Exercise. For people engaging in negative health behaviors, the only path to improved health status is lifestyle change. So why don't more people follow the rules?

Increasingly, dialogue about healthy lifestyles may be offset by Americans' perception that modern medicine can cure every health problem, reducing the need for personal ownership over the bad habits that cause those problems in the first place.

Television, newspaper, and online ads offer pills that can supposedly help people lose weight without eating less or exercising more. But more reputable Food and Drug Administration-approved drugs prescribed by licensed physicians may have a similar effect. Medications that are part of a family of drugs called statins are prescribed to patients with high cholesterol, and are supposed to be combined with a healthy diet and exercise. But as a Newsweek article noted last July, "With Americans less inclined to do the things -- like eating less saturated fat and exercising -- that are known to lower cholesterol and reduce the risk of heart attack, statins have emerged as perhaps our most reliable weapon against a relentless killer." A recent comment by Surgeon General Richard H. Carmona sums up the tendency toward over-reliance on such drugs: "Too often we are forced to rely on great medicine to undo people's bad choices."

Media coverage of the state of Medicare and other healthcare entitlements may further weaken Americans' proclivity to take ownership of their poor health. With so much focus on government's responsibility to promote the health of the populace (62% of the public, for example, feels it is the federal government's responsibility to make sure all Americans have healthcare coverage), it may be easier to believe that if the medical system fails to cure one's health problems, then the system -- rather than the individual -- has failed.

The Power of Peer Pressure

If fear of consequences has weakened as a psychological barrier against poor health habits, low levels of social pressure to live a healthy lifestyle seem all the more problematic. Gallup data suggest that peer pressure to engage in healthy behaviors is low.

Seventy-seven percent of Americans say that the fact that a person smokes makes no difference in whether they respect that person. Eighty-three percent say the same about drinking and being overweight. However, it's important to note that these two behaviors were not positioned in the extreme -- excessive drinking or obesity.

With regard to drinking, this indifference is not surprising. When Americans were asked if they, personally, thought drinking in moderation is good for their health, bad for their health, or makes no difference, 73% said it was "good for health" or "makes no difference;" only 25% said that drinking in moderation is "bad for health." But the similar number who show indifference toward being overweight may be a less innocuous figure than it seems -- and may be contributing to this country's much-publicized "obesity epidemic."

Bottom Line

As long as individuals seek to blame others for their poor health, they will not be successful in taking an active role in their own health by engaging in healthy behaviors. The fact that society as a whole is generally accepting of poor health behaviors provides further license for people to engage in them.

It may be politically correct not to discriminate against people who smoke, drink, or overeat. But from a public health perspective, political correctness may be counter-productive. If engaging in these behaviors were viewed more strongly as a cause for disrespect, perhaps their pervasiveness could be more easily curbed.

*Results are based on telephone interviews with 1,006 national adults, aged 18 and older, conducted July 7-9, 2003. For results based on the total sample of national adults, one can say with 95% confidence that the margin of sampling error is ±3 percentage points.


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