When was the last time you went to your healthcare provider and you walked away with nothing to do?
Chances are even if you were the epitome of “good health,” your provider likely encouraged you to “keep eating healthy” or “keep up with that exercise.” There was likely a behavior attached somewhere to the visit.
There is good reason for this.
What we do, our health behaviors, not only have an impact on our own lives but also an impact on others.
In one of the most telling studies the past decade, Mokdad et al. found that 40% of all premature deaths have to do with health behaviors. Specifically, ” the leading causes of death in 2000 were tobacco (435 000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (400 000 deaths; 16.6%), and alcohol consumption (85 000 deaths; 3.5%). Other actual causes of death were microbial agents (75 000), toxic agents (55 000), motor vehicle crashes (43 000), incidents involving firearms (29 000), sexual behaviors (20 000), and illicit use of drugs (17 000).”
As the graph shows, we are dying way too young because of what we do. Even our genetics and socioeconomic status pale in comparison to our behavior.
What we decide to do with our health truly does have the most substantial impact on our overall health and why we live or die.
When we start to look at some of the trends emerging in our society, it becomes clear that we are less active. In a great article by Katzmarzyk:
“Modern humans in the Western world have relatively low levels of physical activity compared with contemporary hunter-gatherers. Recent work among Old Order Amish living a traditional agricultural lifestyle indicates that this population engages in more daily movement than contemporary Americans. The average number of steps per day taken by Amish men and women were 18,425 steps per day and 14,196 steps per day, respectively. These values are considerably higher than recent estimates for contemporary U.S. adults (as seen in the figure below).” 
And remember, these choices have an impact on the overall healthcare system. Consider the total economic cost of obesity now in the range of $300 billion per year. It doesn’t take much to begin to connect the economic costs of a particular health condition back to rising healthcare costs. Once individuals begin experiencing the health problems secondary to their health behaviors (obesity in this case), their decisions on what to do (or not do) when sick can also be a driver of healthcare cost. When estimates come in that “healthcare costs for chronic disease treatment account for over 75% of national health expenditures”, we might have a bit of a problem.
If behavior accounts for so much with our health, why don’t we just change?
Well, changing health behaviors can be hard.
Think about it. We often know what we need to change:
Eat less;
Exercise more;
Stop smoking;
etc.our
However, knowing what we need to change and actually changing that behavior can be as different as night and day. Thankfully there has been some excellent research done that can guide those interested in making a behavior change.
First, make your change specific. One of the pitfalls with health behavior change is that people hear “you need to eat better, exercise more, etc.” but don’t come up with a specific goal (e.g., “I will smoke three cigarettes less per week” vs. “I am going to quit smoking”).
Second, recognize that change does not happen in one day but rather takes time. Too often we think we have failed if we do not make our change as soon as the provider tells us that we need to change. There is a vast amount of research that has gone into identifying various “stages” people go through when deciding to make a change.
Third, be persistent. Sometimes setting goals and working with your healthcare team takes time to achieve the goal you want for your health behavior change. Changing a behavior may not always work the way you want it to the first time, but sticking with it and being persistent is critical for long term change.
In healthcare, we must not lose sight of the role of behavior. We should examine policies that allow for our providers to work with their patients on making these changes. We already know that providers are stretched thin with their time, and addressing health behavior change can be time consuming (remember, it is hard), but what could be more important for long term health? According to the data, not much.
Dr. Miller has his doctorate in clinical psychology and is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. His core task is to integrate mental health across all three of the department’s core mission areas: clinical, education, and research. Opinions expressed here are his own and not those of his employer.
