Let’s Kick the Can Down the Road Again. Or Not!

We’re all familiar with them, each a bestseller: “Who Moved My Cheese,” “Seven Habits of Highly Effective People,” “Good to Great,” and so many others.  Popular books that highlighted a simple business lesson for success:  Don’t put off till tomorrow what must be today’s pressing and important priority.  Savvy leaders recognize that problems staring you in the face don’t simply vanish if ignored.  The bad only gets worse.  Sadly, today avoidance seems to be all too common. 

Elected officials quickly point fingers and prefer debating settled science for fear of antagonizing their base.  All in the interest of self-preservation or self-interest.  When it comes to public health, we need a bolus dose of radical purpose and a stiff shot of courage. We seem overwhelmed by health and ecohealth problems.  Yes, engaging and solving the endless list of issues appears impossible.  However, avoiding these “big three” – obesity, mental health, and plastics – only compounds the significant societal and business woes we’re already facing.

“Let’s start at the very beginning, a very good place to start…” as Julie Andrews sang Rodgers and Hammerstein’s uplifting Do-Re-Mi in The Sound of Music. It’s time we begin to rally to the beat of three public health priorities where investment of time and money will deliver outcomes:

Weight

1. America’s Expanding Waistline: Some 40% of American adults aged 20 and older are considered obese. The domino effect of obesity-related conditions includes heart disease, stroke, type 2 diabetes, and some cancers. These are leading non-communicable causes of costly, premature death. According to the Centers for Disease Control, the estimated medical cost of obesity in the US reached $173 billion in 2019. Medical expenses for obese adults annually are almost $2,000 higher than medical costs for people with a healthy weight.

It’s simple to point the finger at the fast-food industry as a leading cause of the nation’s obesity problem. It’s also popular to blame overweight people for inflicting the problem upon themselves.  That’s not a good use of time or effort. It’s not even accurate,  Five contributors tip the scales: 

• Caloric intake
• Poor diet
• Lack of exercise
• Stigma
• Access to expert care

Social determinants of health influence obesity rates among adults and children. Poverty, racism, geography, and lack of access to preventive and expert medical care contribute to our ever-expanding waistlines.  Structural racism is baked into our institutions, policies and practices—from defining where people (are often forced to) live to how food is produced and priced. 

We also need to take obesity seriously as a medical condition.  Physicians such as Katherine Saunders, MD, and Louis Aronne, MD, at Weil Cornell are at the forefront of this emerging discipline. But fewer than 6,000 physicians like Saunders and Aronne are certified in Obesity Medicine.  The millions of people confronting obesity need continued medical intervention and support beyond losing pounds.

Marshaling public health and medical expertise to address obesity – access to care, greater public education, access to healthier, affordable food options and reinvestment in primary and secondary school physical exercise programs will produce results that slow the obesity-related non-communicable disease cascade, sustain lives and reduce costs.

Mental Health

• Mental Health is Health: We must stop ignoring the realities and stressors of life that contribute to other health problems.  “You’ll get over it,” is not a curative response. There is universal acceptance that the pandemic unleashed the mental health problem. It merely made mental health an inescapable issue.  Removed from distractions and living, learning, and working in isolation from others, what was beneath the surface quickly bubbled up to the visible top.

It’s time we face the music and accept that depression and other mental illnesses are manageable medical conditions when diagnosed promptly and treated. Likely the biggest obstacle to care is societal bias and stigma.  In recent years, rates have shown a marked increase in reported cases.  Young adults aged 18-25 years have the highest prevalence of serious mental illness (9.7%) compared to adults aged 26-49 years (6.9%) and aged 50 and older (3.4%).

“As more of us share our experiences, then the stigma starts to reduce, as we understand that this is a shared experience, and this is what is part of being human,” said John McPhee, CEO of the JED Foundation.

Worse than the statistics around mental health-related conditions are deaths by suicide and the endless trauma survivors – parents, partners and children endure.  Globally, one person every 40 seconds takes their life. The World Health Organization and the Global Burden of Disease study estimate that almost 800,000 people die from suicide annually. With timely, proven intervention, many suicides can be prevented.

According to the JED Foundation, mental health in teens and young adults is pressing. More than half of college students will go through a period of high anxiety and one-third of college students will experience some level of depression. The data are frightening.  Suicide ranks the second leading cause of death among ages 15 to 24.

Public and self-stigma is the primary disease we must overcome to set the groundwork to better assist people with mental health needs.  Along with expected basic vitals tracked during a primary-care check-up, health professionals can make a difference by conducting mental health screens and conversations.  Remove the embarrassing obstacles to diagnosis and treatment so that more people step forward to ask for and receive care.  It’s a start that likely will save lives.

Plastics

• Plastics – Reduce Use in Healthcare Settings: Microplastics have been detected in human breast milk for the first time, according to a new study published in Polymers and shared in WebMD. The researchers shared that they are worried about the potential health effects on babies. Shouldn’t elected officials share that concern? Shouldn’t the global medical community? Most definitely expectant parents!

US hospitals produce more than 5.9 million tons of waste yearly.  There is no escaping the reality that the planet’s health and our own are joined, and the medical community must work closely with environmental affairs experts on what must be done to keep the planet sustainable.

World Health Organization Director-General Tedros Adhanom Ghebreyesus, Ph.D., wrote in the Healthcare Without Harm report, “Places of healing should be leading the way, not contribute to the burden of disease.”  The health industry can start by using alternative plant-based packaging and products whenever possible rather than plastics. It’s an essential start to supporting clean innovation.

Is this even possible?  Absolutely! There are market leaders that are role models and sharing sustainability data. Kaiser Permanente, the nation’s most extensive integrated, nonprofit health system, reports its efforts to prioritize environmental health and patient care have enabled it to become the first health system in the US to achieve carbon-neutral status. Mega not-for-profit health systems such as CommonSpirit are partnering with vendors to reduce the use of plastics in operating rooms. These efforts must become a social impact metric that defines the business sector that commands almost 20% of the national GDP and is dedicated to sustaining our health. 

Health standard bearers such as Kaiser and CommonSpirit have proven that change is possible.  These centers of healthcare excellence – caring for people and the planet – lay the groundwork for Federal and state policies that can protect our short- and long-term well-being.

The clock is ticking.  These problems cannot be wished away.  Weight, mental health and plastics are three priority health concerns contributing to a deadly domino effect where one crisis leads to another.  Of course, these are not the only public health issues of import we face.  At the foundation of these problems are poverty, racism and economic systems rooted in an unsustainable status quo.  Eventually, there will be no choice but to engage and change.  By then, what will the state of people’s health be?  I’d prefer we commit to taking the necessary action sooner to spare us from having to face that bleak future.