by Quinn O'Neill
Making the rounds on facebook and twitter is this anonymous quotation: “True health care reform starts in your kitchen, not in Washington.” Where I've seen it posted on facebook, it’s accompanied by a photo of fresh fruits and vegetables and garners enthusiastic and positive responses.
It seems to be widely understood that you can ensure your own good health by eating fresh fruits and vegetables, avoiding junk food, exercising regularly, and not smoking. It’s an empowering idea that places the individual in charge of his own health, but there’s a flip side: if good health is attributable to the healthy choices that we make as individuals, then poor health must also be a choice.
This kind of thinking shapes our views on health care reform. If people choose to smoke, be sedentary, and consume an unhealthy diet, then why should the rest of us be expected to pay for their treatment when they end up with poor health? They made bad choices and so they should suffer the consequences.
The problem with this reasoning is that none of us makes decisions independently of our living conditions, and we have limited control over these conditions. We can’t blame children for learning unhealthy eating habits from their parents and we can’t blame a teenager who starts smoking as a result of peer pressure for being so desperate to fit in. Nor can we blame them for becoming unhealthy adults as a result of this early experience.
The most powerful influences on our health are not a matter of personal choice. They are well known to health care professionals as the “social determinants of health” and, unfortunately, they seem to be a well kept secret. “Health care” continues to be framed in public disourse as a system for providing medical services rather than a system for optimizing health within our society. If we care about health, we ought to be as interested in preventing illness as in treating it.
