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To your health – its more complicated than you might think

“To your health” is the toast we’re likely to hear during this season of festive rejoicing.

"To your health" is the toast we're likely to hear during this season of festive rejoicing. Most of us would put living a long and healthy life before money and fame. Achieving and maintaining this goal is a challenge, especially for some people. It's also something we can't do alone.

When it comes to taking control of our health we tend to focus on the wrong things. Even the doctors, nurses and other health professionals I teach at the Jefferson University School of Population Health are surprised to learn that, according to one estimate, health care accounts for only 10% of the many factors that help us live to a ripe old age. The rest are things like good genes (30%), social circumstances (15%) and healthy habits (40%).

While we can't do anything—so far—about picking the right parents for better genes, there is much we can do to stack the lifetime lottery in our favor. We could take a more active role in our own health by eating less and better, or exercising more. This can work, but despite the best of intentions health is much harder for some people to achieve when they are swimming against an unhealthy tide.

The sad reality is that zip code often matters more than genetic code. Where we live and our social situation loom large in health outcomes. According to the Philadelphia Department of Public Health, male life expectancy by neighborhood varied by as much as 12 years in 2010 (65 vs. 77 years).  Community factors such as housing quality, violence, income, employment, and access to healthy food impact health outcomes. However, moving to a "healthier" neighborhood may not be enough to erase these differences. Other factors such as discrimination, stigma, lack of social support and the stress these conditions cause can literally make us sick.

Unfortunately, our political and policy-making institutions often fail to address these concerns. Telling people that they should take better care of themselves is not controversial. Despite the debate over Obamacare, politicians of all stripes generally agree that access to high-quality health care is a good thing. However, promoting public policies that raise wages so people don't have the stress of living hand to mouth is considered a political act. Raising taxes on certain junk foods—shown to decrease calorie consumption—is derided as an attack on American free choice. Earnest discussions about the health impacts of racism and other forms of bias often devolve into petty partisan debates and victim blaming. We must find a way to depoliticize these issues.

Policy interventions that improve health are not just a moral imperative. Poor health outcomes result in higher premiums, lost worker productivity and increasing taxes. Even if you believe that people have ultimate responsibility for their own health, helping them achieve it makes economic sense.

All of us and our political leaders must acknowledge that health is determined by many factors—some of which are beyond an individual's control. We must identify and apply proven policies to ensure everyone has equal access to social, environmental and economic conditions that promote rather than harm health.


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