Tag Archives: lifestyle

Healthy lifestyles: Social class. A precarious optimism

Social determinants of health. Marmot, WilkinsonContinued from the previous post, where I noted that the Lalonde report — despite its good intentions — was followed by an emphasis on healthy lifestyles and personal responsibility for health, as well as increased health care costs.

Personal responsibility and social class

In Why Are Some People Healthy and Others Not?, Marmor et al, writing in 1994, were disappointed that the Lalonde report had not effectively prompted governments to address the underlying causes of health and disease. One reason for this, they believed, was that health policy reflects public opinion. If the public holds traditional views on what makes us sick (pathogens), what prevents disease (medical care), and what we can do to be healthy (take personal responsibility), new policies that include social determinants are unlikely. Those who are on the forefront of professional, scientific opinion may very well understand the importance of social determinants, but public opinion changes slowly. Without an education program, such as the relatively successful anti-smoking campaign, the public is unlikely to endorse change.

This is certainly true, although I believe there’s also something more fundamental at work here, namely, how a society accounts for the different life outcomes of its citizens. In Unequal Childhoods: Class, Race, and Family Life, Annette Lareau describes the assumptions people make when they hold others personally responsible for their life circumstances. Read more

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Healthy lifestyles: The unfortunate consequences

Healthy lifestyles yoga poseContinued from the previous post, where I discussed the expansion of universal health care prior to the 1970s, how this created a growing demand for health care, and the problem health care costs posed for governments, especially when the economy suffered a downturn in the seventies. One response to the situation was to consider new ideas. Rather than limit strategies to what could be done by the health care industry, why not directly address the underlying causes of disease by considering social determinants of health.

Canada’s Lalonde report

In 1974, Canada produced the Lalonde report. It has been described as

[the] first modern government document in the Western world to acknowledge that our emphasis upon a biomedical health care system is wrong, and that we need to look beyond the traditional health care (sick care) system if we wish to improve the health of the public.

The US Congress emulated this thinking in 1976 by creating the Office of Prevention and Health Promotion. The US Department of Health, Education, and Welfare began publishing the document Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention in 1979. The response in European countries — caught in the same bind of greater demand, increasing costs, and the financial consequences of a deteriorating economic landscape – was similar.

The common thread in these new perspectives on health was the assertion that health could be improved — without increasing health care costs — if we concentrated on such things as the work environment (occupational health), the physical environment (air and water pollution, pesticides and other carcinogens in food), genetics, and healthy lifestyles. The approach was broad: the environment was considered at least as important as the promotion of healthy lifestyles. Read more

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Healthy lifestyles: The antecedents

Healthy lifestyles yoga poseIn the 1970s, public health policies began to promote the idea that individuals are responsible for their health and therefore have an obligation to adopt healthy lifestyles. Over the ensuing decades, health became both an extremely popular topic for media coverage and a lucrative market for vendors of health-related products and services. What followed was a substantial increase in health consciousness and greater anxiety about all things that concern the body.

Do healthy lifestyles actually produce better health? That they should may seem like common sense, which is one reason it’s been so easy to promote the idea that they do. The question is difficult to answer with absolute certainty, however. For one thing, the behavior that counts towards a healthy lifestyle does not readily lend itself to the objective measurements required for reliable scientific evidence. Defining health is also tricky. Lifespan is often used to compare the ‘health’ of different nations, but this fails to capture the subjective sense of health that is meaningful to individuals. Perhaps most important, while in theory a healthy lifestyle might improve health, that does little good if – as is now obvious – it’s extremely difficult to maintain behaviors that require things like changing what we eat and how often we exercise.

A related question would be: Did the promotion of healthy lifestyles reduce health care costs? This too seems like a sensible assumption, and the assertion is quite popular, especially among politicians. Health care costs have increased to hand-wringing levels. Promoting healthy lifestyles costs governments next to nothing, while the cost of health care is all too easily quantified. Read more

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A more equitable future? US reveals its true intentions

Occupy Wall Street: Light at the end of the tunnelWhy is it so hard to convince policy makers worldwide to address the social determinants of health, including poverty, hunger, and income inequality? Judging by the excerpt below, we shouldn’t count on the US to champion this cause any time soon. It’s from a document called “The Future We Want,” issued by the Rio+20 conference last June. The US requested changes to the document, indicated in bold (additions) and strike-outs (deletions).

Eradicating poverty is the greatest global challenge facing the world today and an indispensable requirement for sustainable development. In this regard we are committed to free humanity from extreme poverty and hunger as a matter of urgency.

We recognize that promoting universal access to social services can make an important contribution to consolidating and achieving development gains.

We strongly encourage initiatives at all levels aimed at providing enhancing social protection for all people. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (4) The abnormal part

Abnormal psychologyContinued from parts one, two, and three.

A year ago, when I decided to call my declining rate of blogging a ‘sabbatical,’ I wrote down some questions to explore while I took time off to read.

How did we find our way into the dissatisfactions of the present – the commercialization of medicine, the corporatization of health care, the commodification of health? Does understanding the path we followed offer any insight into finding a better direction? Was the increasingly impersonal nature of the doctor-patient relationship inevitable once medicine became a science? Or was it only inevitable once health care emphasized profits over patients and the common good?

At the time I thought I would read primarily in the history of medicine, and that was how I started. Appreciating the historical context of medicine is important for understanding both how medicine ended up where it is today and what medicine could become. “The texture and context of the medical past provide perspective, allowing us to formulate questions about what we can realistically and ideally expect from medicine in our own time,” I wrote.

Now that I’ve become more familiar with the social determinants of health, I’m less optimistic about the future. The problem is not simply that the corporatization of health care has increased dissatisfaction among both doctors and patients. The problem is that our focus is so narrowly limited to health care systems that we fail to see the larger issue. As one metaphor puts it, doctors are so busy pulling diseased patients out of the river, there’s no time to look upstream and ask who’s throwing the bodies into the water. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (3) Connections

Continued from parts one and two, where I defined the terms used in the following diagram of my blogging interests. Click on the graphic for a larger image.

Blog topics and their connections

If I had written the previous two posts a year ago, I would have realized how much my interests were intertwined. I guess I wasn’t ready to do that. Anyway, in this post I catalog some of the connections.

Healthism

~ Healthism and psychological and physical conformity: Healthy lifestyle campaigns promote an ideal way of life that encourages individuals to alter their behavior and appearance. Although it’s true that we would all be better off if we didn’t smoke, that doesn’t make anti-smoking laws any less authoritarian, i.e., requiring conformity (see the section on anti-authority healthism in this post). The fitness aspect of healthy lifestyles promotes the desirability for both men and women of acquiring (i.e., conforming to) specific body images.

“Self-help is the psychiatric equivalent of healthism.” That’s a slogan I made up. I’m not sure yet if it will stand up to scrutiny. Certainly the self-help industry encourages self-criticism, which leads to a preoccupation with those aspects of personality currently considered undesirable. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (2) Economics & the socio-political

Continued from part one, where I discussed the first three of my six interests: healthism, medicalization, and psychological and physical conformity. Click on the graphic below to see a larger image.

Blog topics and their connections

The social determinants of health

Social determinants of health (often abbreviated SDOH) refers to unequally distributed social and economic conditions that correlate with unequal and inequitable distributions of health and disease. Presumably there is a causal relationship between the two, not merely a correlation. Definitively identifying the causal mechanisms, however, is difficult. A great many things influence our health (including things we’re not even aware of yet), and it can be difficult to isolate and scientifically study some of the ones we strongly suspect, like poverty, isolation, or a sense of being socially inferior.

The medical model is the preferred framework in modern westernized societies for explaining the distribution of health and disease. It emphasizes risk behavior (smoking, diet), clinical risk factors (blood pressure, blood sugar, cholesterol levels), genetics, health care access and quality, behavioral change, and patient education. One common characteristic of the medical model’s explanation of health and disease is that causes are located in the individual (behavior, genes), not in the individual’s economic and social environment. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (1) Bodies, minds & medicine

It’s always hard to be sure about these things, but I think the reason I decided to take a ‘sabbatical’ from blogging last July was that I was interested in too many seemingly unrelated topics. Writing about all of them left me feeling like I never got to the ‘meat’ of any one of them. And I couldn’t convince myself to focus on just one or two things, since that would mean abandoning the others, which I was unwilling to do.

Now that I’ve taken the past year to read and reflect, I find – duh! – that my interests are not as unrelated as I’d assumed. In hindsight, I should have realized this long ago, but, alas, I did not. I’m writing this post to clarify to myself what I now see as the common threads that connect my interests.

Here is a diagram that groups my interests into six categories. (Click on the graphic to see a larger image.)

Blog topics and their connections

Four of the six categories relate to all five of the others. The two outliers (neoliberalism and medicalization) are not as directly related as I feel the others are. Read more

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What is healthism? (part two)

Apple and stethoscopeIn part one of this post I explained the most common meaning of healthism (an excessive preoccupation with healthy lifestyles and feeling personally responsible for our health) and described an authoritarian sense of the term. Here I discuss healthism as an appeal to moral sentiments and as a source of anxiety. I also note an unusual definition of the term as the desire to be healthy, which leads me to end with a personal disclaimer.

Moral healthism

The directive to be personally responsible for our health – whether it comes from a government health policy, the medical profession, or an advertisement – is often fraught with unacknowledged moral overtones. People who practice healthy lifestyles (daily exercise, a Mediterranean diet) and dutifully follow prevention guidelines (annual cancer screenings, pharmaceuticals to maintain surrogate endpoints for risk reduction) are overtly or implicitly encouraged to feel morally superior to those who do not. This includes the right to feel superior to those who ‘choose’ to be unhealthy – after all, isn’t smoking a morally indefensible choice? The implication is that those who fail to take responsibility for their health are undeserving of our sympathy or assistance (especially financial).

This quality of healthism – like the anti-authority healthism discussed in part one – is possibly more common in the US than elsewhere. It’s unfortunate but true that in the US there’s a tendency to blame the poor and disadvantaged for not being able to pull themselves up by their bootstraps. There is a decided unwillingness to acknowledge that differences in wealth and social class during childhood have lifelong effects on behavior and health. Read more

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What is healthism? (part one)

Apple and stethoscopeThroughout history there’s been an understandable desire to find connections between our behavior and our health. Human beings have practiced health regimens involving diet, exercise and hygiene since antiquity. When medicine was based on the humoral theory of disease, for example, individuals were advised to purge the body in the spring and, in the summer, avoid foods or activities that caused heat. Bathing in ice water was recommended in the 19th century. Mark Twain quoted the advice: “the only way to keep your health is to eat what you don’t want, drink what you don’t like, and do what you’d druther not.”

In the second half of the 20th century many Americans adopted the idea that a ‘healthy lifestyle’ (diet, exercise, not smoking, etc.) was a good way to prevent disease and live longer. This particular attitude was a product of popular perceptions about health (a surge of interest in holistic/alternative practices, self-care movements such as Our Bodies, Ourselves) and prevailing social attitudes (such as desirable body images). Perhaps more so than in previous centuries, the growth of media consumption and the effectiveness of modern advertising allowed commercial interests (books, magazines, fitness merchandise, vitamins and supplements, weight loss pills, diet and energy foods, …) to exert considerable influence on health behavior.

Also at work was extensive media coverage of a presumed link between preventive lifestyles and risk factors for disease (conflicting opinions about salt and which type of fats to eat are good examples). Unlike the vague aphorisms of previous generations, this more modern source of health advice had the scientific backing of epidemiology, if not the proof that comes from randomly controlled trials.

One of the terms used to describe the enormous increase in health consciousness is ‘healthism.’ Judging from how I’ve seen the word used, it means different things in different contexts to different people. I’m going to describe a few of those meanings.

This post grew rather long, so I’ve divided it into two parts. In part one I discuss an anti-authority sense of healthism as well as healthism’s most common meaning: a sense of personal responsibility for health accompanied by an excessive preoccupation with fitness, appearance, and the fear of disease. Part two discusses the moralistic and anxiety-inducing qualities of the term, plus an odd use where healthism becomes another word for health itself. Read more

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Why medicine is not a science and health care is not health

MicroscopeHere’s something I read recently in a blog post (The Limits of (Neuro)science at Neuroskeptic) that started me thinking:

Will science ever understand the brain? …

The notion that humans are complex and hard, while nature is easy, is an illusion created (ironically) by the successes of reductionist science. Some of the biggest questions facing mankind for eons have [been] answered so well, that we don’t even see them as questions. Why do people get sick? Bacteria and viruses. Why does the sun shine? Nuclear fusion. Easy.

I started to write a simple reply, but it grew into the following.

Medicine is an applied science, not a pure science

It may be true that understanding the human brain is only an order of magnitude more difficult than understanding any other aspect of human biology. I’m uneasy, however, about putting ‘why people get sick’ in the same category as ‘nuclear fusion.’ Particle physics is a science. Questions can be asked and (usually) answered under the controlled conditions required by the objectivity that characterizes science.

Medicine is the application of certain sciences (molecular biology, biochemistry, medical physics, histology, cytology, genetics, pharmacology, neuroscience) to – ultimately — individuals. Each individual is the product of a unique, lifelong sequence of social, cultural, economic, and psychological (as well as physical, chemical, biological, and genetic) influences. To this day, we don’t really know why some people get sick and others do not. To my mind, that makes medicine an application of science – like engineering – not a science in itself. Read more

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Guest post: Guilt-edged

Bananas with the Globe and MailToday was in need of humor. Here is another guest post from Kate Gilderdale (the original can be found here), who blogs at The Jaundiced View.

I found a website that lists (in a most unfortunate typeface) 29 types of humor. I’d say Kate’s writing combines – not always in the same post — wit, irony, understatement, repartee, satire, and that je ne sais quoi that can only be acquired by growing up in the British Isles. The word urbane also comes to mind. At any rate, I find that Kate’s posts brighten my days.

Guilt-edged

I know you can have Catholic guilt and Jewish guilt but you really don’t need religion to make you feel that whatever goes wrong is somehow your fault.

I feel guilty when I go through customs even though I am scrupulous about not bringing in anything illegal. I feel guilty when I go the dentist in case I haven’t flossed in the approved manner. I feel guilty when I try to defend my decision not to be tested for a disease I haven’t got, or don’t know I’ve got, or might have because at some point I’ll have to die of something – simply because I’d rather not know.

Now The Globe and Mail Life section reveals I could be guilty of hastening my demise by eating fruit. See The New Enemy in today’s paper, which warns that bananas are the arch enemy of the serious dieter and “that the high fructose content makes grapes and cherries as unhealthy as a plate of cookies.” Or not. Depending on which ‘experts’ you believe. Read more

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Guest post: A sound mind in a disintegrating body

Mens sana in corpore sanoIn an attempt to balance my very serious attitude towards the subject of healthism – the idea that individuals should be held personally responsible for their health; an idea promoted at a time of rising health care costs in the “Great Society” seventies, appealing to residual American sentiments of self-reliance and individualism, conveniently distracting attention from social and environmental determinants of health …

I could go on, but as I was saying, in an attempt to provide balance, I offer this guest post by Kate Gilderdale, a writer who valiantly resists healthism propaganda and whose approach to any subject is always liberally laced with humor. Kate blogs at The Jaundiced View (where this post first appeared), and I highly recommend a daily visit (laughter being the best medicine and all).

Mens sana in corpore sano is today’s mantra for many people, but a lot of us only manage to fulfil half the equation at best.

In order to attain the corpore sano required by today’s fanatical health and hotness community you have to devote two or three hours a day to honing the body beautiful so that it contains no lumps, bra overhang or bits that have to be sucked in when you walk past a mirror. This involves lunges, squats, curls, lat pulldowns, pushups, bench presses and eventual death from exhaustion unless you are of that rare elite who are truly in The Zone.

The rest of us get by by avoiding spandex and investing in Spanx, whilst using those three hours not spent at the gym to fill our brains with stuff that we hope will make us appear erudite without being unforgivably elitist.

When it comes to physical exertion, Joan Rivers said it best. “I don’t exercise. If God wanted me to bend over, he would have put diamonds on the floor.”

Any deviations from Americanized spelling (“fulfil”) may be attributed to Kate’s proper British education.

Kitten with barbell

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Why do we feel bad about the way we look?

Laurie Essig’s new book, American Plastic: Boob Jobs, Credit Cards, and the Quest for Perfection, includes a chapter on how we learn to want cosmetic surgery. She quotes Joan Rivers, from her book Men Are Stupid . . . And They Like Big Boobs: A Woman’s Guide to Beauty Through Plastic Surgery:

My abiding life philosophy is plain: In our appearance-centric society, beauty is a huge factor in everyone’s professional and emotional success—for good or ill, it’s the way things are; accept it or go live under a rock.

Heidi Montag cultural texts promoting cosmetic surgery

Essig comments:

But Rivers is a TV star. TV and movie stars have always utilized the miracles of cosmetic surgery to look good in the two-dimensional spaces they inhabit. How did the rest of us learn to desire a perfectly plastic body? How did ordinary women and men with ordinary lives and ordinary bodies learn that they need plastic? The answer: the plastic ideological complex, a set of cultural texts that are both highly contested and yet tightly on message. It is itself so ubiquitous that it might even be described as hegemonic. In other words, the “need” for cosmetic procedures is impossible to avoid. Through advertising and TV shows, movies and magazines, we learn to want cosmetic intervention in our aging faces and imperfect bodies. This need is now so firmly implanted in our cultural psyche that it has become “common sense” to embrace cosmetic procedures. Why wouldn’t we want to look more beautiful, younger, thinner, more feminine, better? The question is no longer will you have plastic surgery, but when.

Accept plastic beauty or go live under a rock. Rivers isn’t just joking; she’s also doing the serious work of enacting the ideology of plastic, an ideology that we can no longer avoid. Even if we did live under a rock, whenever we crawled out from underneath it, we would be assaulted by images of perfectly plastic beauty on billboards and the sides of buses and on TV and in movies and even the nightly news. And then there are those damn magazine racks, an unavoidable gauntlet of Dos! and Don’ts! that must be passed through each and every time we buy our food.

A conspiracy of capital to make us feel bad

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The duty to be happy

Pascal Bbruckner Perpetual EuphoriaThe French intellectual Pascal Bruckner casts a critical eye on happiness in his newly translated book, Perpetual Euphoria: On the Duty to Be Happy. Much of what he has to say about happiness applies equally to health.

In the first post on this blog I asked: How did health, which used to be something we were born with, become something we believe we can personally control. Today most people in developed countries assume they can avoid certain diseases and prolong their lives by practicing a “healthy lifestyle.” How did this happen? When did the change occur? What does it mean that – unlike earlier generations — we’re so preoccupied with our health?

Attitudes towards both health and happiness changed in the sixties. In an interview in The Guardian, Bruckner comments: (emphasis added)

After the 60s, there is no more distance between one’s happiness and oneself. … One becomes one’s own main obstacle. To overcome this obstacle a huge market opened: medicine to modify your mood, surgery to modify your body, and it also includes the spread of therapy and new or reformed religions. So Jesus is no longer this transcendent God, but a life coach who helps you overcome addiction and so on. …

We should wonder why depression has become a disease. It is a disease of a society that is looking desperately for happiness, which we cannot catch. And so people collapse into themselves. …

[P]eople are very unhappy when they try hard and fail. We have a lot of power in our lives but not the power to be happy. Happiness is more like a moment of grace.

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The complex signaling function of hair

Complex signaling function of hairHere is the abstract from a paper with the title “The Currency of White Women’s Hair in a Down Economy.” (emphasis added)

This short essay is a reflection on the relationship between the economy and women’s hair. I suggest that examining women’s spending on hair care products during uncertain financial conditions provides insight into the gendered aspects of the economy. As the economy has declined, sales of home hair-care products targeted toward white women have increased. Major news outlets report on salon customers trying to stretch out the time between their regular $250 hair salon treatments. Certain women turn to home hair dyes to maintain conforming appearances. In popular culture, to have white skin and gray hair is to be old (unemployable and unattractive) or menopausal (unproductive and unsexual). An attempt to retain their hair color (natural or chosen) is, for certain women, an attempt to retain a currency of employability, utility and desirability.

The hair-care spending of African-American women (of all socio-economic classes), in contrast, appears to be less susceptible to economic cycles. African-American legal scholars have given voice to the complex role that hair can play in the personal, professional, social and legal lives of black women. I argue that only in a down economy do some white women grapple with their hair’s complex signaling function, including its link to race and privilege.

Hat tip to Tyler Cowen at Marginal Revolution, who thanks www.bookforum.com. Read more

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Imagine a future without cosmetic surgery

American Plastic Laurie EssigA less pithy title – and what I really mean – would be “Imagine a future where aesthetic cosmetic surgery wasn’t motivated by the images of celebrities/advertising/porn and by the dissatisfaction with normal bodies that these images create.”

In the concluding chapter of her new book, American Plastic: Boob Jobs, Credit Cards, and the Quest for Perfection, Laurie Essig suggests we might try using reality-check groups before going under the knife. We could weigh our decision, benefit from the input of friends, then opt for lipo if we were still determined to pursue perfect beauty relentlessly at any cost.

The purpose of such groups would not be to dissuade members from getting cosmetic surgery. It would simply introduce some objectivity. You might decide you really should get that facelift or breast augmentation, but “you will at least be making a far more informed and realistic choice than if you sit at home alone and watch plastic surgery shows while you try to pay your bills and fantasize that if only you looked better you’d have more money because your career would suddenly take off or Prince Charming would finally show up, haul you up onto the back of his horse, and ride off with you.”

The beauty solution

As part of her research for the book, Essig attended a number of conferences for plastic surgeons. One of them was in East Berlin, a meeting of the International Confederation for Plastic, Reconstructive, and Aesthetic Surgery.

The secretary-general of that organization, Dr. Eisenmann-Klein, delivered a speech on the future of cosmetic surgery. She quoted William Mayo (of Mayo Clinic fame) on “the divine right of man to look human.” She cited scientific studies that show the brain is hardwired for the “survival of the prettiest.” Currently 87.5% of cosmetic surgery clients are female, but – according to the good doctor – “the good news is that men in industrialized countries were becoming less satisfied with their bodies.” Read more

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Love and marriage in China

Chinese weddingPrevious articles on the “second wives” of well-to-do Chinese men have focused on how unfair it is that mistresses of corrupt officials become exorbitantly wealthy. Or on the government’s foot-dragging in putting marriage databases online. But in an article ostensibly about the branding of luxury goods, Tom Doctoroff, a leading authority on marketing in China, offers a cultural analysis of the phenomenon. (emphasis added)

Because China has never had a humanist revolution, sex and marriage have always been relatively divorced. That is why many Asian cultures have an immensely commercialised and categorised [sex industry]. … [I]f a husband is a man of means, and has a significant income, then he can take on a second wife without violating his obligation to his first wife. …

Second Wife culture is just one part of a much bigger and more interesting area which is the difference between love and marriage in China and the West. Marriage in the west is rooted in romantic passion, and although that passion evolves over time we basically assume that if it’s is [sic] gone from marriage it’s a shallow marriage. Yes, there are other concerns that surround it – children, money – but it’s not the core of the relationship.

In China it’s fundamentally true that a marriage is not between two individuals, it’s between two clans. Marriage is a way that people connect into a broader society in which the individual is not the basic productive unit. This has always been the case.

In China, a romance is not ideal unless it is also accompanied by commitment. In Chinese, when we translate “a diamond is forever”, we don’t mean that passion lasts forever. It translates as “he will do anything for you, forever”. And that’s why people buy a lot of things for their mistresses – that affection needs to be demonstrated, too. Read more

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Guest post: A fat lot of good

Slow bicycleToday’s post is a guest column by writer and editor Kate Gilderdale. It’s on a subject close to my heart – the promotion of personal responsibility for healthy lifestyles. Unlike me, Kate has a highly developed sense of humor, and I really enjoyed what she had to say.

Kate lives in Stouffville, Ontario (a suburb of Toronto), where she is an editor of the Stouffville Free Press. The Canadian Lalonde report of 1974 was one of the first government documents to emphasize lifestyles and the role of individual behavior in health. So I’m not surprised that Canadians are subjected to the same health injunctions as Americans. Other columns by Kate are available here, and she blogs at The Jaundiced View. Read more

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Buffness and beauty are arbitrary fashions

Exercising at the gymA nice essay in the New York Times on the cult of physical fitness, past and present, occasioned by the death of Jack LaLanne. (emphasis added)

That sense of failure you feel when you haven’t exercised in days? That conviction that if you could pull off better push-ups, you’d be a better person through and through? These, too, are his [LaLanne’s] doing, at least in part. What he left behind when he died last week, at the toned old age of 96, was not only a sweaty culture of relentless crunching and spinning but also the notion that fitness equals character, and that self-actualization begins with the self-discipline to get and stay in shape. In the post-LaLanne landscape, it’s not the eyes but the abdominals that are windows to the soul. …

There’s a bullying strain to the modern fitness ethos, a blurred line between cheerleading and hectoring. And it’s hard not to wonder whether that kind of intimidation — in addition to the social and economic realities of diet and exercise — helps explain the paradox that for all the newfangled aerobic machines and reduced-rate January gym memberships, Americans aren’t noticeably haler and healthier.

When exercise comes wrapped in value judgments, does it wind up entangled in an anxiety that threatens the very resolve to get fit? As Mr. LaLanne was siring new methods for shaping up, he was fathering something else, too: a potent, and in some cases immobilizing, strain of contemporary guilt.

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Old age and the limitations of a healthy lifestyle

Old age and Alzheimer'sA nice op-ed in the NY Times touches on our belief that living a healthy lifestyle guarantees a long and able-bodied life. The author, Susan Jacoby, speaks specifically to the issue of dementia and Alzheimer’s.

Members of the “forever young” generation — who, unless a social catastrophe intervenes, will live even longer than their parents — prefer to think about aging as a controllable experience. …

Contrary to what the baby boom generation prefers to believe, there is almost no scientifically reliable evidence that “living right” — whether that means exercising, eating a nutritious diet or continuing to work hard — significantly delays or prevents Alzheimer’s. …

Good health habits and strenuous intellectual effort are beneficial in themselves, but they will not protect us from a silent, genetically influenced disaster that might already be unfolding in our brains.

Jacoby cites a review of knowledge about Alzheimer’s sponsored by the National Institute of Health. (emphasis added) Read more

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The problem is you

The problem is youA post I wrote earlier this month — Character, personality, and cosmetic surgery — reminds me very much of something I wrote 30 years ago. It was a chapter called “The Problem Is You” in a book I published in 1981. Today I write about personal responsibility for health. In the 1980s my phrase to identify that emerging phenomenon was “the problem is you.”

The 1980s saw significant shifts in medicine and health care, among them a shift away from focused attention on disease and chronic illness to an emphasis on individual risk factors, the need for greater self-surveillance, and the promotion of personal responsibility for health.

Health includes psychological well being, and one of the areas where blaming yourself was most apparent was the self-help industry. What I wrote 30 years ago was prompted by Wayne Dyer’s book, Your Erroneous Zones, first published in 1976 and now available from Amazon in 17 different formats. Dyer’s message: responsibility for emotional dissatisfaction lies with the individual. The problem is you.

The dark side of positivity

The message from the self-help industry (you control your own destiny and have no one to blame but yourself) was also popular in the business community (successful positive thinking is essential if you want to impress employers, customers, and co-workers). It was eventually adopted by the health care industry (you are personally responsible for living a healthy lifestyle).

There is a dark side to positive thinking, however, as Barbara Ehrenreich describes in her recent book Bright-sided: How the Relentless Promotion of Positive Thinking Has Undermined America. Read more

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Healthy lifestyles serve political interests

Runner healthy lifestylesThe practice of western medicine remained virtually unchanged from the time of the ancient Greeks to the mid-19th century. This is a testament to medicine’s basically conservative nature: Let’s not risk human life with something brand new.

Dramatic changes occurred, however, once medicine became a science. By the mid-20th century, medicine was experiencing a Golden Age: Life-saving drugs, miraculous medical breakthroughs, new diagnostic technologies, and a profession held in high public regard.

By the 1970s the Golden Age had ended. Medicine, along with other professions and institutions, fell victim to the anti-establishment sentiments of the 1960s. It was criticized harshly by consumers, journalists, and scholars. Medicine — it was alleged — was no longer concerned with the needs of patients, but with the ambitions of doctors.

The advent of Medicare and Medicaid in the 1960s not only brought government into the health care equation. The American Medical Association’s strenuous opposition to this legislation led the public to associate doctors with small businessmen — avaricious and probably dishonest. The practice of medicine changed from a healing relationship between doctor and patient to a profit-driven business enterprise. Read more

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The politics behind personal responsibility for health

Reagan and Thatcher danceConsumers of cell phones – actually, consumers of any product or service that isn’t essential for health or survival — clearly benefit from the competitive, market-driven economies of today’s modern world.

There are certain goods and services, however, that are essential for the public’s welfare: Drinking water, city sewage systems, financial support in old age, and the administration of things like prisons, schools, and health care. These “public goods” benefit from government influence. That’s because the profit motive needs some restraint in matters essential for basic survival. (Schools are not technically essential, but they’re important for a successful, prosperous society.)

This is only my opinion, of course. Conservatives, libertarians, free market fundamentalists, and members of the Tea Party would disagree vigorously.

Privatization

Privatization is the transfer of responsibility for public interests to the private sector. The PR argument for privatization is that the private sector is more efficient than government. The more basic, underlying motive, however, is that privatization has great potential for private profits. (See my recent post on the privatization of water as the investment opportunity of a lifetime.)

The downside of privatizing public services is that corporations are answerable only to their shareholders, not to the public they serve. We saw this quite clearly during the health care debate, as the dirty linen of the health insurance industry was aired in Congress. Read more

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The tyranny of health then and now

No socialism freedom vs tyrannyWhen we hear the words “tyranny of health” these days, it’s usually a reference to the tyranny of a government imposing unwanted health care on its citizens. It brings to mind images of protesters carrying signs that denounce the “socialism” of Obamacare.

As recently as 1994, however, the tyranny of health had a different meaning. That’s when Dr. Faith T. Fitzgerald published an article in The New England Journal of Medicine with that very title. What tyranny of health referred to – and what Dr. Fitzgerald’s readers readily understood at the time – was the idea that doctors should coerce their patients into being healthy. She objected to this increasingly prevalent attitude that expected the medical profession to be a combination of nanny and big brother.

Healthy lifestyles and the definition of health

The article begins with a reference to the recent emphasis on promoting healthy lifestyles: “Once upon a time people did not have lifestyles; they had lives.” (In 2010, it’s easy to forget that we did not always have “lifestyles.”) Dr. Fitzgerald then reminds readers of the 1946 definition of health from the World Health Organization (WHO): “A state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity.” Read more

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“Tyranny of health” on KevinMD

Cat in windowThat we’re not routinely made seriously ill by this shortfall … is due largely to the fact that most medical interventions and advice don’t address life-and-death situations, but rather aim to leave us marginally healthier or less unhealthy, so we usually neither gain nor risk all that much. Read more

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The tyranny of health

Chocolate cakeA recent commentary in the Journal of the American Medical Association asks: If individuals don’t use preventive services, “what kind of penalty … would be ethically and morally acceptable?” The question wasn’t “How do we account for unhealthy behavior,” but what punishment would be sufficient either to change that behavior or at least to save money by denying these people health care. Read more

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Are married people happier? Are parents?

Happy Family Hugging Each Other

These research findings, of course, fly in the face of our cultural dogma that proclaims it impossible for people to achieve an emotionally fulfilling and healthy life unless they become parents. And that’s a problem, because the vast majority of American men and women eventually have children, yet conditions in our society make it nearly impossible for them to reap all the emotional benefits of doing so.

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Couples who prefer to sleep alone: Your room or mine?

Source: Timeless Lesons In pursuit of a good night’s sleep, an increasing number of couples now choose to sleep alone. Couples who share a bed suffer 50% more sleep disturbances than those who sleep apart, according to recent research by a sleep specialist in Britain. In a separate study, a British sociologist found that when… Read more

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The Spleen in Chinese Medicine

Source: Institute for Traditional Medicine The philosophy that informs Chinese Medicine is very different from the science that determines Western medicine. These two cultures do not start from the same assumptions about what it means to be healthy. Those who dismiss Asian medicine as being of no value fail to take this into account. You… Read more

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