I was recently reading the “Book of Predictions.” Written in the early ’80s as an offshoot of the popular “Book of Lists,” it documented experts in various fields’ thoughts on where we would be years in the future.

Health experts generally believed major illnesses like obesity and heart disease would decline as people realized the perils of unhealthy diets. While realization of the perils has become true, an increase rather than decline has occurred.

We know it’s bad, but embrace rather than reject unhealthy lifestyles. The ease, cost and pleasure of junk food is so culturally, socially and industrially ingrained that it creates far more incentive to be unhealthy. The experts didn’t see that coming.

But how did it end up that way? Health is a systemic problem, not just in the sense of health-care policy, but the big picture (think real big picture).

A McDonald’s Quarter Pounder. The reason why so many people are unhealthy is because of the bad choices they make.

Flickr: rob_rob2001

Go all the way out to agriculture policy, specifically corn crop subsidies. The argument is that this keeps farmers afloat. What it really keeps afloat is what the vast majority of corn is used for: not corn for consumers, but livestock feed and high fructose corn syrup. We literally feed and kill billions of cows, pigs and chickens every year, which literally turn into heart disease and obesity.

High-fructose corn syrup is key to literally every sugary and processed food, literally turning into diabetes and obesity. We are systematically subsidizing disease epidemics.

When Smoking Was Cool

So while on the surface we tout the importance of healthy lifestyles, realistically we’re promoting quite the opposite. There are many other examples of this hypocrisy evidenced in various documentaries but the point is that there is big (very big) business in keeping people unhealthy. This spans whole sectors of industry and the economy with well funded lobbies and entrenched support.

In retrospect it’s much like the smoking industry was 50 years ago. Smoking was not only cool; it was the cultural norm. The crazy thing was that tobacco companies put out studies showing that smoking was actually healthy and all of it was believable at the time.

Obviously now, the dangers of smoking are well known, but that wasn’t the force that decreased smoking habits. Just like unhealthy diets, people understood it was bad but continued to smoke anyway.

The major factors that have turned the tide have been through legislation: bans on smoking in public places, increasing cigarette taxes, not allowing companies to advertise to kids and increasing the purchasing age have all created the biggest effects. This pressure has made smoking “uncool,” decreasing its visibility in TV, movies and culture in general.

Legislating Health

The question becomes, how do you better legislate health?

First off, the whole Obamacare vs. socialized medicine vs. whatever other plan is moot because it does not address the core issue of better intervention at the point of prevention. (The point is not the little Dutch boy deciding which hole in the dike to put his finger in; it’s about decreasing the water behind the dike.)

How do you better legislate healthy lifestyle policy? Awareness programs, better labeling, fast-food zoning restrictions, school lunch nutrition standards; these are all well intentioned, but merely drops in the bucket.

One of the most innovative efforts was the soda tax and ban on large cup sizes. Why not extend that idea to all junk food?

Again, using the smoking model, why not prohibit advertising of junk food to kids? Why not restrict junk food distribution in public places like parks and arenas? Why not require junk food packaging to prominently feature grisly photos of the effects of heart disease and diabetes like cigarette packs do?

Leaving health care up to the individual doesn’t work, in large part, because individuals aren’t made accountable.

Alas, there will be blowback arguing the intrusiveness of government and civil rights, but how else do you enact real behavior change?

Leaving it up to the individual doesn’t work, in large part, because individuals aren’t made accountable. If you want more real change, I would advocate more radical (and controversial) ideas that hold individuals accountable.

If you choose to eat unhealthily, you should bear the consequences. Health insurance should not just incentivize healthy behavior (decreasing your rate if you lose weight or your blood pressure and blood sugar numbers are controlled) but also penalize unhealthy behavior (increase your rate for weight gain and uncontrolled numbers).

I would advocate the same accountability for smoking: Feel free to smoke, but you understand the risk and waive the right for insurance covering any future smoking-related health problems. Car insurance discriminates against bad drivers. Life insurance discriminates against older people. Why can’t health insurance discriminate against unhealthy people? That’s accountability.

Alright now, don’t get all upset. I’m just throwing ideas out there to start a conversation.

The point is we need to think outside of the box. Yes, it will rub a lot of people the wrong way, but change is uncomfortable. The problem is, being unhealthy is what’s become too comfortable.

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