Illness as Sin

Yesterday, The Times published an article about a program that pays people to take their medicine and, presumably, stay healthier so that they end up costing insurers less money later on. It's also been reported that insurers are giving people breaks on their insurance if the exercise and quit smoking.

Today, there's a debate about getting people to adopt healthy lifestyles. By "healthy lifestyle," they mean keep your weight down and don't smoke, eat at least five fruits and vegetables a day and have a glass or two of wine, and exercise.

These articles send me in two different directions. One has to do with the advertising from Dunkin' Donuts and McDonalds that claims that you can get a healthy breakfast in either establishment.

The other has to do with the fact that I take this stuff personally. Apparently, I don't drink enough, but I do all the other stuff right. But I still have a chronic illness, and it wasn't brought on by bad habits, and getting rid of all the bad habits is never going to make it go away.

Diabetes and heart disease? Yes, clearly affected by diet and exercise. Asthma and cancer, stroke and arthritis? To some extent. Epilepsy and hay fever (one of the five most common chronic conditions, according to this report)? Probably not at all, unless you figure going out and exercising is going to make you sneeze more than staying on the sofa.

(The other items in the top five: sinusitis, arthritis, orthopedic impairments, and hypertension. Stay off the football field, folks.)

The last contributor to the Times' debate, Arthur Caplan, makes me feel a little better. He's a professor of bioethics at UPenn (my alma mater, which also makes me feel a little better), and he writes:

We are in the midst of a cost care explosion in health care and the new zealots of virtue know why — sin. Or more specifically, your sin — be it eating too much, drinking to excess, unprotected sex or smoking. The cure is not the same as that used in the 17th century. You won’t be flogged for dining again and again at the local burger joint.

He adds:

On my drive home I pass by at least 10 fast food franchises. They devote billions in advertising to lure me in to sample their fatty, salty and otherwise unhealthful wares.

The insurance companies want to lower premiums, and this might have as a side effect that some of the insured do, in fact, end up with healthier habits. But chronic disease isn't just a problem of individual perfidy. It's also a problem of social structure.

Food producers want to make more money, and they can do this best by selling lots of cheap food, and cheap food isn't healthy. That they're allowed to use the word "healthy" on the same billboard with a picture of a concoction of fat, refined carbohydrates, and salt or sugar, makes me nuts.

Meanwhile, most of our towns and cities are laid out in ways that discourage walking or cycling, perhaps along with public transit, to get to work, get kids to school, or run errands. So people walk 15 feet out their front door to a parked car, drive to and park at one destination after another, and then drive home.

Don't even get me started on pollution, and the high incidence of asthma among people living in the most polluted places.

So yeah, it's a good idea to encourage people to eat better and exercise more. If those folks could get La Palin to stop glorifying Joe Sixpack and the implied drinking binges, that probably wouldn't do any harm, either.

But at the same time, if people shouldn't be eating junk food, there probably should be laws that prevent the makers of pop tarts from using the word "healthy" on the label. And Congress should divert a major proportion of highway funding toward public transit, sidewalks, and bike paths.

And vilifying the ill as complicit in their illness, failures in some moral way? It's been going on for a long time, as detailed by Susan Sontag in Illness as Metaphor and Aids and Its Metaphors. And it's not doing anyone any good.