Tuesday, February 3, 2009

Health Care Reform and Well Being

Were it not for the constraints of time, this could be a longer post. The topic of health care reform in the United States prompts many passionate reactions from citizens. Abroad, people must wonder how we have tolerated the system we have for this long anyway? In the midst of economic chaos in the United States, the issue has been temporarily put on the back burner. Yet, President Obama knows very well that the costs of inaction, in human terms and in dollars saved, are greater than the cost of reform—and growing every day.

The irony is that attempts at national reform in the United States have been tried several times during the past century. For example, most people don't appreciate that President Harry Truman tried valiantly to reform the system, without success. Then there are the better known efforts of President Kennedy (leading to the compromise that became Medicare and Medicaid), and the failed Clinton effort. In each case, the complexity of the issue, special interest groups protecting their "rice bowls", and an effective disinformation campaign by the health insurance companies linking a national approach to "socialism" or socialized medicine, were able to derail the efforts. Meanwhile, like a patient in critical condition, the system is in need of urgent life support and getting worse.

So, what does this have to do with "Doing Life Well"? It's simple, really. Important requirements for doing life well include being informed about issues, making wise choices, and advocating for conditions in our communities that support our ability to participate in activities that contribute to our health. Former HHS Secretary nominee Tom Daschle has advocated for a compromise solution that would create a Federal Health Board and unify both private and public systems, requiring everyone to have insurance. Personally, I think the best system is a single payer system that enables choice and limits profits that are based on human illness or suffering. Why profit from services that people have no choice but to accept? Isn't that a grand perversion of monopoly? But, the important thing is to make progress in reforming the system. Whatever we do, however, we must have as a principle of reform that lifestyle-related prevention and health promotion initiatives and funding are part of the solution. The value of such efforts is unmistakable, and can save millions (not to mention the advantages of helping people feel better about themselves and making them happier and more productive). Most people would rather live their lives well and be active and engaged than to have health care money spent on keeping them "alive" at the end of life, hooked to tubes and merely surviving rather than flourishing.

Albert Einstein, a wise and learned man, once observed that not everything that can be measured counts, and not everything that counts can be measured. The dialogue about health care must include a discussion of issues not easily measured, like value. There is a wide difference between the meanings of cost and value. We must ask the question: How is the system to support efforts that address people's quality of life?

Thursday, January 29, 2009

Optimism and its global Importance — Especially Now

A recent article describing Sir David Tang's observations about optimism as the cure for the global economic meltdown is one of the most important messages delivered in the past three months. You can read it in its entirety here. It deserves far more exposure, in my opinion.

Sir David makes several wise observations, including the need to distinguish value and cost, to recognize that size and importance are not the same thing, and to appreciate that productive work is one the most important "assets" we have. Notice that productive work is not the same as making money. People who trade paper derivatives on wall street make money, but their work is not productive in the sense that it adds much value to the world.

There are not more educated people as a result of trading derivatives, no new houses, roads or labor saving products as a result of the work of those financiers, and no entertaining poems, or beautiful planted trees to decorate the landscape. Nor, indeed, are there well made clothes, shoes, or cars that provide useful benefits to society as a result of such work. If work is done only to make money, no real tangible wealth is created. It's just paper that can be traded for products and services that represent real work. Often, this wealth comes at another person's expense.

Work that produces something of value for the world is work that gives the doer a sense of contribution and pride. When that work goes away, people lose meaning and become depressed. People without productive work are among the unhappiest people in the world, not because they lack money, but because they lack the work itself. As a result, they can lose hope and become pessimists.

Sir David Tang notes that pessimists have a way of creating more pessimism. And when people are pessimistic, they often create a self-fulfilling prophecy. If they believe there is no future, they begin to act in ways that creates that dismal outcome. On the other hand, laughter and optimism are equally contagious and inspire hope and actions that create better futures. Humans in groups have the power to create optimism or pessimism.

There is abundant research in the psychological literature that demonstates the value of optimism. Few if any of these studies discuss optimism and economic outlook, but many show that optimistic people are more resilient, live longer, and are able to influence their own healing. Studies show that optimists make the best salespeople. While their mood probably makes them seem more approachable or engaging, their belief in making the sale also makes them more engaged and persistent. Sales success requires persistence.

Besides, optimists are more fun to be around. Economic stimulus packages that create jobs double the return on their investment. Why? Because the result can not only be people with the ability to earn money for rent, food and clothes, but more importantly people who feel better about themselves and their futures because they are doing productive work.

Monday, January 26, 2009

A Post on Karma as "Doing"

This post is different than recent offerings. For one thing, it is (slightly) shorter. Another difference is that it pertains not to traditional "Western" ways of living, but the culture of Asia. A third difference concerns its topic area, which pertains to spirituality.

Note that on this blogsite, being spiritual does not necessarily equate with being religious. When we are spiritual, we contemplate ideas that are beyond this world, such as "Why do I exist?" or "What happens when people die?" Often, we contemplate these ideas within the context of formal religions. A religion can be described as a formal, organized way for thinking about spiritual matters. But many spiritual people don't adopt or govern their lives according to the "rules" of organized religions. In other words, according to this view, it is possible to be spiritual without being religious.

Karma, a word from Sanscrit associated with Buddhism, can be translated into English as "doing." In Buddhism, and Hinduism, there is a belief that the sum total of one's "doings" in the physical life (or previous lives) determines their destiny, or what happens to them in future lives.

Without getting into a discussion about religion, the notion of how our acts today determine our fate or destiny tomorrow (or in the future) seems common to many formal religions in cultures around the world. The late Joseph Campbell observed this in his writings on myth contained in "The Hero with a Thousand Faces."

But when you think about it, there is another point of view that deserves mention here. That is, we can create the lives we want (and thereby influence our futures) by acting in certain ways now that may not have anything to do with spiritual or religious teachings. Some people "seize the day" and create their opportunities. They believe they can influence what happens to them by organizing and directing their actions in purposeful ways. To me, there seems to be a certain logic to this. Perhaps this is what the sports apparel maker Nike suggests when it uses the advertising slogan "Just do it!"

So, the fact that the word Karma translates into "doing" invites many interesting thoughts from this blogger. I'd be interested in reading yours also!

Saturday, January 24, 2009

Obesity and Lifestyle Change - Thinking About Activities

In previous posts we have discussed how people use time, their patterns of activity, and how these relate to their well being. These discussions have focused a great deal on how activities influence mood, or how they can serve to reduce stress. Less has been said about how activity influences our heart, lungs, nervous system, bones and muscles and other physiological systems.

I hasten to point out that this is not a post about exercise and physical fitness. The body is a complex system, with many individual subsystems working together to explain that complexity. Ordinarily, we think of the brain as the control center. But we seldom think of the back office systems that influence how the brain works. One of these back office systems is the endocrine system. This system regulates the chemicals in our bloodstream that carry messages to the nervous system. It influences metabolism, tissue growth, development and mood. Scientific discussions about how stress harms the body focus directly on this system of alerting or message sending through hormones. This brings us to the main topic of this post—obesity

Obesity is a significant health problem and it can be described as a kind of banner or symbolic indicator of how activity and lifestyle in the 21st century can influence health in both beneficial and harmful ways. Obesity is an epidemic, and if you visit the website of the Centers for Disease Control (CDC), you will see a dramatic illustration of how the incidence of obesity has spread across the country over the past two decades. The data clearly suggest that obesity is not just a regional phenomenon, nor a socio-economic phenomenon. It is a lifestyle phenomenon that is related to how people spend time to consume and expend energy. If you notice in the CDC chart how the prevalence of obesity has spread, states where there are more outdoor opportunities for hiking, skiing and kayaking, or more farming and ranching— seem to be the last places where the obesity epidemic arrived. That suggests environment (and activity opportunity) influences obesity. But we are getting ahead of ourselves here. There is another important factor related to weight gain—hormones. Especially hormones resulting from living stressful lifestyles.

Without going into too much detail or repeating information available widely on the Internet, most diets (the usual approach to battling weight gain) fail. Why? Because hormones signal our body to store energy (or calories) so that we can survive famine conditions. These systems are ancient, biological survival mechanisms that evolved over millions of years when humans were hunters or gatherers. Animals in the wild have the same systems, but they spend their awake hours in a quest to find food just as humans once did. They may go for days in their quest for meals, burning more calories than they are able to replenish. Contrast this with the modern life of humans in the U.S. and other developed nations: Going for hours without a meal is often viewed as a starvation diet!

Thus, animal species (including humans) are biologically wired to store calories and resist efforts to expend them. All dieters know that as soon as they begin reducing their food intake, their body reacts by increasing its efforts to hold on to those life sustaining calories. That's what makes dieting so difficult. But food intake is only half of the equation.

The other part is energy expenditure. As modern conveniences are developed, technology becomes our enemy. We move less, watch TV or surf the Internet more, and there is little calorie burning to offset our increased consumption. Moreover, eating itself is an activity, and a pleasurable one. Generally, people would rather eat than work out on the treadmill. Eating is also typically a social activity. When people get together to enjoy themselves and each other, food is often involved.The result is increased body weight. Exercise intentions expressed in New Year resolutions are, well— well intended. But habits and routines are hard to break. People need stimulating reasons to live their lives differently. They need to be motivated to move more and eat less.

But the story doesn't end there. Stress (and there is a lot of that around lately!) produces hormones that signal the body to conserve energy. So metabolism (calorie burning) slows as a result of stress too. Some scientists attribute the obesity epidemic as much to increased levels of stress (and the influence of stress hormones on slowing metabolism) as they do to lifestyle patterns that are characterized by sedentary activities and increased food consumption.

So, at long last, we get to the point of this post about obesity. Obesity is more than weight gain. It is a condition of lifestyle that is affected by factors that have nothing to do with eating. The interesting thing is, these factors involve human activities, and the most natural solutions have to do with the activities people do as they live their everyday lives. If those activities help people burn more calories and eat less, so much the better. But if they give pleasure, reduce stress, and stop signaling the body to store energy, they provide a double benefit. The bottom line: Activity is more than exercise!

Wednesday, January 21, 2009

Use of Leisure Time - Implications for Health and Well Being

The American Time Use Survey, reports from which are featured on the Bureau of Labor Statistics website, reveal some interesting data about how people spend time. Of particular interest here are two activities, television and Internet usage, that consume significant portions of available leisure time. For example, watching TV accounted for half of the leisure time available to men and women (2.62 and 2.88 hours per day on average). As might be expected, young people from 15-19 spend more leisure time on computers than people of other ages. The average for this age group was around 50 minutes per day. In contrast, leisure activity involving sports, exercise or other types of recreation averaged slightly less than 30 minutes per day.

The implications of these statistics for health should be apparent. Sedentary activities may be interesting, but they don't provide the kind of movement necessary for maintaining fitness, including strength, endurance, and proper body mass index (percentage of fat) to avoid risk of obesity, heart disease and other chronic conditions. Movement burns calories, and regular exercise coupled with moderate and appropriate food intake helps to maintain weight within healthy limits.

How people use time, obviously, not only has significant consequences for physical fitness, but it also influences other types of "psychological fitness", such as how interested or bored they are, and how challenged or motivated they may be to participate in activities that lead to skill development, accomplishment, and improvements in self-esteem or self confidence. Research shows that when people are successful in new activities or projects, they are more inclined to undertake additional challenges. These cumulative successes create the sense of meaning that we need to live our lives with energy and purpose .

Unfortunately, time use surveys have not yet begun to gather data on qualitative factors, such as the feelings one might have that are associated with doing a particular activity. Part of those feelings, of course, are based on the context in which an activity is done ( that is, who is with us, what motivated us, what need will be served, etc.); but time use scientists generally feel that the opportunity exists for gathering more qualitative data in such surveys.

As time use science evolves, there will be more objective evidence to provide guidance to people on how to design their lives for optimal health and happiness. This is just another part of the interdisciplinary science of everyday living.

Tuesday, January 20, 2009

Seratonin and Mood: Evidence that Activity and Happiness are Connected

Serotonin, a hormone, is known to be an important chemical messenger that influences brain activity related to a wide range of functions, emotions and behaviors. These include circadian rhythms, moods, and thought. Disorders related to seratonin have been linked with impulsive violence, anxiety, and depression.

Higher levels of seratonin are associated with feelings of happiness and well-being. Too little seratonin is implicated in depression. But too much seratonin can be toxic and fatal. What is needed, it seems, is efficient regulation, which relates to having the right levels of seratonin and the right number of brain structures to use it appropriately. Current treatment approaches typically involve drugs that attempt to increase or decrease seratonin levels or improve its processing in order to achieve a satisfactory balance and the proper mood.

Because depression is a growing worldwide public health issue, new approaches to understanding this brain-mood-behavior phenomenon is in everyone's interest. That's why a recent editorial by the editor of the Journal of Psychiatry and Neuroscience is of interest here. The editorial, by Simon Young, suggests that new evidence supports the use of non-drug interventions in mood disorders related to seratonin.

Without going into the highly technical specifics of the science here, what Dr. Young suggests is that exposure to light, exercise, diet, and activities that lead to improved mood may all be examples of lifestyle- related strategies that can be used to address seratonin imbalances and prevent depression and its consequences. His article cited several promising studies that provide evidence for his "non drug intervention" proposal. I like this line of thinking, because it shows again that through lifestyle related interventions, people can influence their health and well-being. More emphasis on population-based approaches to preventing or treating health related disorders through lifestyle change must be a part of health care reform. Population based lifestyle intervention is smart, synergistic, humanistic, and economical.


Monday, January 19, 2009

Aligning Believing and Doing - Another Feature of Balanced Lifestyles?

A recent story on the NPR series called "This I Believe" featured an essay by a seven year old (Tarak McClain) of Austin, Texas. Tarak shortened his original list of 100 beliefs into a radio-ready list of 30, which he read on the air.

Aside from the remarkable fact that this very young man was thoughtful and wise enough to compose this list, (and poised enough to do an exemplary job of recording his interview), the notable feature of his story relates to his acting in ways that are consistent with his beliefs. Tarak has a commendable list of service projects to his credit already. This made me think about my recent posts on life balance, and one of the papers given at the life balance symposium I attended. This particular paper was about life balance as acting in accordance with personal values.

Values and beliefs are closely related. But few of us always stop to think (except on Sundays if we are church going Christians, or on other days if we practice other faiths) about how our actions align with what we profess to believe. For example, I believe in sustainability and conserving energy so that future generations will enjoy a high quality of life. But when I think about the actual things I am doing that are in alignment with this belief, I am embarrassed that the list is shorter than I would like. Perhaps this is why the phrase, "talk is cheap", was coined.

Tarak and I share some significant beliefs, and I suspect, that given the way 7 year old young men come to form their beliefs, that his parents have similar sentiments about community, peace, service to others, living in harmony and other values. But in the end, when it comes to making our communities and world better places, when actions and beliefs are aligned, we create the world we imagine. As Gandhi said "We must be the change we hope to see in the world."

I invite you to share your beliefs about living life well on this post, and to comment on the actions that reflect those beliefs.

On Meaning and Well Being

I'm back. For the past three years (has it been that long?) I have been distracted by my long distance commuting job, writing book chapt...