Episode 163: Diving into the complexity of factors that determine someone's health and why some people have such an easy time while others have seemingly every obstacle stacked against them.
Welcome back to Real Health Radio. Today’s episode has been in the works for over a year. I’m diving into the topic of the complexity of health. I cover the myriad factors that contribute to someone’s health status, what we get wrong about it as a society, and the problem with dealing with health at a population level.
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00:04:15
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Links
00:00:00
Chris Sandel: Welcome to episode 163 of Real Health Radio. You can find the links talked about as part of this episode at the show notes, which is www.seven, so the word, all spelt out, S-E-V-E-N, -health.com/163.
A couple of weeks ago, I mentioned that I’d reopened my practice to new clients. I do this twice a year and client work is the core of my business and the thing I actually enjoy the most. And after working with clients for the last decade, I feel confident in saying I’m very good at what I do.
And when I reflect on all the clients I’ve worked with over the last couple years, there’s a handful of areas that come up the most. So one of the biggest is helping women get their period back. So recovery from hypothalamic amenorrhea, or HA, and this is often a result of under-eating and over-exercising, and is almost always coupled with body dissatisfaction and a fear of weight gain.
So the work with these kinds of clients, as with really all clients, is a mix of understanding physiology and how to support the body, but also being compassionate and understanding psychology and uncovering the whys behind these clients’ behavior and figuring out how to change this. I’ve had clients regain their periods after being absent for 20 years, even after they’ve been told it would never happen.
I also work with clients who are disordered eaters or have previously been diagnosed with an eating disorder. And with these clients, there are symptoms that are commonly occurring, so things like water retention, poor digestion, always cold, peeing all the time, especially at night. No periods or bad PMS symptoms, low energy, poor sleep, low thyroid. There’s also common mental and emotional symptoms. So compulsion to exercise, fear of certain foods. So fear of carbs, or fear of bread. Anxiety, low mood or depression, poor body image or a fear of weight gain.
And with these clients, again, it’s using that mix of understanding science and compassion to help them recover. And I know that full recovery is possible and I’ve had many clients who’ve had multiple stays at inpatient facilities, where nothing worked, where they then got to a place where they are now fully recovered.
The final area is helping clients transition out of dieting and learning how to listen to their body. They’ve had years or even decades of dieting and nothing works. They know it’s a failed endeavor, but they struggle to figure out how to eat without dieting. How do you listen to your body? What should they eat? They’re just confused.
And with this work, it’s often a combination of intuitive eating and non-diet approach, my nutrition understanding, and being able to guide clients towards being able to listen to their body, that helps them then be able to put this behind them once and for all, and truly know how to look after and to nourish their body.
So it’s these kinds of clients that make up the bulk of my practice. And I’m very good at helping these people get to the place with their food and their body, and with their life that they think is impossible. So if any of these scenarios sound like you, then I’d love to be able to help and please get in contact. You can head over to www.seven-health.com/help. So H-E-L-P, and you can read there about how I work with clients, and you can apply for a free initial chat.
At the time of recording this intro, I have two slots left. And I’d imagine that these will be all booked up by the end of the week, or early next week. After this, I won’t be taking on clients again until the start of 2020. So if you are interested, please get in contact. The address again is www.seven-health.com/help, and I’ll also include a link in the show notes.
00:04:15
Hey, welcome to another episode of Real Health Radio. So this week, I’m back with a solo episode, and this has been an incredibly long time coming. So when I look at the Word document that has all my notes in it for this, it was first created back in April 2018. And I’d been thinking about doing this episode even before then. It’s all about the complexity of health.
And I made reference to working on this podcast during my episode on life expectancy, and that came out back in August of last year. And if you haven’t listened to that one, then I’d suggest you check it out. It’s not a prerequisite. Both of these shows are standalone episodes. But if you enjoy this one, then you should enjoy the other one as well.
And the reason that it’s taken me so long for this episode to see the light of day is because it’s such a big topic. There’s so many influences and ideas that I want to touch on, that I’ve just struggled to reconcile how to make it work. It became this sort of tangent ridden mess that I was struggling to prune back and to have, feel like one cohesive idea.
But recently, there was a campaign in the UK by Cancer Research UK, and the campaign was telling people that obesity is a cause of cancer. And to really hit home, the ad had the slogan on the front of cigarette packets, in the same place that cigarette packets have their health warnings. They were trying to say that from a cancer perspective, smoking and obesity have the same effects.
Laura Thomas, who I’ve had on the podcast before actually wrote an open letter on medium to Cancer Research UK. And that was signed by many prominent doctors and professionals and nutritionists and dietitians and psychologists and others in the health field. She also set up a petition on change.org. And I’ll link to both of these in the show notes.
And there’s many issues that I have with this campaign, and generally, how we think and talk about health. And so I want this episode to show the complexity of factors that impact on someone’s health, and why some people have an exceptionally easy time, while others have basically every obstacle stacked against them.
00:06:40
So why do I think this is important? Well, there’s a number of reasons. I mean, I would say that the bulk of nutritionists, dietitians, MDs, who have more a food and lifestyle focus, and others working in the health field come from a well to do, or affluent background. And this isn’t true of the whole field, it’s definitely true of those who are at the top and have the most prominent voices.
And these people have typically led a healthy life. Many are type A personalities, when they learn what is healthy and what they should do, they just get on with it, and they do it. And I also know that many people who get into this work do so because of their own health struggles at some point in their life.
But even when this is the case, if someone is rising to prominence, and are able to overcome this, I would say they typically have more resources than the average person to turn things around. And this lived experience can color how these people see the world. It can seem that just making some simple choices and changing some habits lead people to better health and that this is a fairly straightforward process.
And for a certain segment of the population, this is true. They have the means, they have the ability to make changes easily and they do see the results. But this isn’t true for the vast majority of people. And when we assume that it is, it becomes this very black and white thing, that we all have the information available to us, and if some people are just choosing to ignore it, then that is on them.
I’d also argue that even within the segments of the population who can make a change, this doesn’t always work out so well. So I tend to see a lot of the after results of those with the resources to improve their health, who end up with disordered eating and eating disorders and exercise addiction. And this isn’t everyone who goes down that path, but it’s probably a higher percentage than most probably imagine. So for many of the people who are lumped into the success category, in terms of improving their health, in real health terms and behind closed doors, maybe they aren’t so successful.
00:08:50
And I was watching a debate or part of a debate on political correctness. And the debate itself is irrelevant, but there was something that was said that really stuck with me and resonated with what I want to do as part of this episode. And one of the panelists was the British actor, comedian, writer, Stephen Fry. And he said, one of the greatest human failings is preferring to be right, rather than effective.
And if we’re talking about trying to improve health at the population level, the goal should be to genuinely help people. Not to provide them what we think people need, like more knowledge. And if they then don’t do it, or that doesn’t do the trick, we just throw our hands up and say, well, some people just don’t want to help themselves.
For example, like eating more vegetables is generally going to increase someone’s health and longevity. But if we take 100 people, simply telling them this fact, might only help 10% of them. Like most people already know this information. It’s not like they haven’t heard it before.
But let’s say there’s some small percentage, that being reminded of this information is what actually helped them to implement the change. But for other people, what they need isn’t more information, but rather support in other ways. So for one segment of the population, say, providing an after school club for their children, might be the thing that allows them to eat more vegetables.
For some other group, it’s providing nursing support for their elderly parent, or their disabled child. For some other group, it’s providing them with cooking skills, so they know how to make vegetables that they actually enjoy eating.
Now, it’s easy to say that just because there’s no after school club, or there’s no nursing support, that doesn’t stop people eating vegetables. Or, if they can’t cook, you can just go and look up some recipes or go on YouTube. But this is where you need to make the distinction between what we think should work, i.e. being right, versus figuring out what levers really do make a difference in people’s lives, i.e. being effective. We need to meet people where they’re at, rather than just looking at it through the lens of what would work for us and assuming that everyone else lives up to these standards.
00:11:10
And this is the real problem with dealing with health at the population level. We’re using a model that is about giving people more information, assuming that it’s people simply not knowing. And then if they knew, they would behave differently, like there’s just this information deficit.
But alongside this, it’s framing the problem as an individual issue, that it’s simply down to the individual to make the right choices. That if someone has poor health, or people are dying younger because of lifestyle causes or lifestyle components, that this is because of their choices, and they’ve only got themselves to blame.
It’s that kind of bootstrapping, American ideal that everyone can do anything if they just put their mind to it. And if you don’t do it, well, that was just your choice. And personally, I don’t believe this is true. And there’s an incredibly long list of factors that impact on our health and why people do what they do. And the idea of choice is a lot messier than most people think, when they hear that word choice.
And I also want to say from the outset that I don’t actually have a solution to solve health problems for everyone at a population level. And I imagine it’s never going to be completely solvable. Because no matter what we do, there’s going to be disparities and people are going to get sick.
But I want to reach a point that if we are having a conversation about improving health across the board, that we include all of these factors. Not just looking at it through the lens of someone who has means and someone who has privileges to make changes in their life easily, and framing it from a position of choice.
00:13:00
So a great example or analogy here is the famous study called the Marshmallow Experiment. And I referred to this in my podcast before on goal setting. So this experiment was originally done in the 1960s at Stanford University. But since then, it’s been done many, many times. And it’s created a huge array of research off the back of it, especially in the field of childhood development and social psychology.
So the original experiment was done with hundreds of four and five-year-old children. And it starts with bringing the child into a private room on their own, where they’re sat down in a chair at a table and have a marshmallow placed in front of them.
Researchers then offered the child a deal. So the researcher was going to leave the room but promised the child that when they come back, they would give them a second marshmallow. But this would only happen if they could hold off eating the first one. So they can either eat one marshmallow now, or they can wait and get two marshmallows in a little time.
So the researchers then leave the room and I think it was for about 15 minutes. And as I said, this experiment has been repeated many times. So there’s lots of footage on YouTube of various children sitting in front of marshmallows. So if you want to have a laugh, go check that out. I’ll put a link in the show notes.
Some of the kids ate marshmallows as soon as the researchers left the room. Others tried to kind of pick at it, just have little bits. Others sort of wriggled as they sat in their chair, tried to sit on their hands, tried to restrain themselves. And I mean, the look on the kids’ faces is priceless. But actually, a few of them managed to wait the whole time.
The interesting part of the experiment isn’t what happened in the room with the marshmallow. It’s what happens years and decades after. Because with many of the studies, the researchers actually continued to check in on the children as they grew into adults. And what they found was the children who are able and willing to wait for the 15 minutes and receive that second marshmallow, ended up having lots of advantages later in life. So they ended up having higher SAT scores, they had lower levels of substance abuse, lower likelihood of obesity, better responses to stress, better social skills, and generally better scores in a range of other life’s measures.
And some researchers actually followed the children for over 40 years. And basically, in all areas of life, those who were able to wait for longer were more successful in whatever was being measured.
And so out of this research came the idea of delayed gratification being a good thing. That if we can simply teach children to wait and abstain in the short term, then it’s this that will improve so many areas of life. And so schools and parents were taught that they need to teach kids how to delay gratification.
But what’s interesting, and this is what has come to light more in recent years, is that delayed gratification is actually a symptom of something much bigger. While the kids in the original experiment did well, because they could delay gratification, it wasn’t because they learned this one skill.
And when they looked at the kids who were able to delay gratification, they found that they had typically grown up in well-organized and structured homes, where things happened in a consistent pattern, where if they were told something was going to happen, then it actually did happen. And in comparison, those who struggled with the delayed gratification often lived in environments that were more erratic and chaotic. They were less likely to be able to see the link between action and consequences, outside of the realm of immediate impulse.
So someone’s home environment mattered hugely with results. And the biggest determinant of this was socioeconomic status. If you had a higher socioeconomic status, the learning of delayed gratification was a byproduct of your everyday life. You weren’t explicitly taught to delay gratification, you weren’t like doing the marshmallow test multiple times throughout your life. It just happened.
And this happened along with a long list of other skills, that just naturally occur because of the environment you’re in. So those with the higher SAT scores, the lower levels of substance abuse, and all the rest of the improvements that were correlated with waiting for the marshmallow for longer, didn’t happen solely because of delayed gratification.
So if you took some kid from a disadvantaged background, who grew up in a chaotic household, and you simply told them to wait longer for a marshmallow, this alone wasn’t going to move the needle very much, if at all, in terms of their later life outcomes that I talked about being connected to just waiting longer.
00:17:50
And this is where I see people getting the complexity around health wrong. They’re trying to teach something that is a symptom of something much bigger but mistaking that thing for what really makes a difference.
So for example, more vegetables are better for your health. I totally agree with this. But if you’ve just seen your mother die of an opiate overdose, and since you were a child, you were molested by an uncle, eating broccoli is going to make a small dent. And the absence of eating broccoli isn’t going to be the thing that leads to you dying 10 or 20 years earlier than someone else.
And I know that that is an extreme example, and it is probably at the far end of the spectrum. But what we’re often paying attention to as the reason for poor health or the reason for dying younger is typically a symptom of something much larger. And if we only focus on that surface level of the outcome, just more vegetables or eating more fruit, but not at what’s driving this, we’re going to miss the real issue.
00:18:55
And what’s driving this isn’t just one thing. So Steven Pinker talks about the problem with root cause-ism. So most of these large scale problems affecting society are so complex and nuanced, that it’s virtually impossible to find one root cause. So instead, the best way to deal with them is finding many ways, that when stacked on top of one another, makes a large shift in the right direction.
Another example that comes to mind here is something I heard about on Tim Ferriss’ podcast. So he, along with some others, went into a maximum-security prison. And as part of the intro to that episode, to demonstrate the role of life circumstances, he read an article that talks about an exercise called step to the line.
And they had the prisoners stand in a line and the visitors stand in a line, and I think they’re facing one another, with the prisoners on one side and the visitors on the other side. But basically, in front of the line of where they’re standing is a line marked on the floor.
And then they read out a series of statements. And as the prisoners and the visitors hear the statements, if they were true for them, they then had to step forward to the line. So it was a very obvious, while you were standing there as a prisoner, it was very obvious to see how things stacked up differently, depending on whether you were a visitor or whether you were actually housed in the facility.
And so they would read out statements like I dropped out of high school. I’ve been in a fight to prove myself. I grew up in poverty. My mom and dad have been to prison. At least one of my parents abused drugs or alcohol. I was born to a teenage mother. I became a teenage parent myself. My parents tucked me in into bed and told me I was loved. I grew up in a home with fewer than 25 books. Violence took place in my home growing up. Violence took place against me growing up. When I was 18, I thought I wouldn’t make it to 21, and so on.
And what transpires from this exercise is you see how much life circumstance has an impact on the choices that people make. And if you want to see this in real form, like not this actual exercise, but just how much circumstances can impact on how people end up, I recommend watching the documentary The Work. I mentioned it as part of my year-end roundup last year, as it was one of my favorite documentaries, despite being incredibly tough viewing.
And it clearly demonstrates how life circumstances matter. And the ability to make certain choices is skewed based on these circumstances. So it’s called The Work. It’s filmed in Folsom Prison and is definitely worth a watch.
So I want to actually start to go through some of the factors that can impact on health. And when I was compiling this list or wanting to compile a list, I remembered this huge infographic that I had previously seen. And it was put together by a company called shiftN, whose tagline is clarity and complexity. And so they’re a design company who create different infographics and the title of this one was called obesity systems influence diagram.
And I think it was part of the Foresight report done by the UK government, that found that there are over 100 different factors influencing obesity. And again, I’ll put a link to this in the show notes, both the Foresight report and to the infographic. And as part of that infographic, there’s just all of these factors that are clumped together in different categories. And then it shows how each of the individual items are connected with one another, within these different categories.
And I don’t necessarily equate health with weight. But many of the factors that were saying pointed towards obesity, can also be an issue for health, irrespective of what is happening with someone’s weight. So this infographic could be renamed, factors that impact on health or factors that impact on eating, and it would still make complete sense.
But it does also do a good job of showing that weight isn’t simply a matter of eating less and moving more. There are so many factors that impact on it. And as part of the infographic, they identified a handful of different categories. So the different categories were social psychology, individual psychology, economics, and this is both like individual economics, but also economics as part of a business and say, so businesses producing food. They talk about food environment, physical activity, infrastructure, physiology, and then also medical.
And then under each of these categories, as I said, there’s many, many factors. And often, they are interconnected and they’re overlapping. And so I’ve also gone through this, and I’ve added in my own ideas, and I’ve still kept to the categories that I mentioned before. But then just added in extra ideas for each of them. And this isn’t always so straightforward, because not every reason fits neatly into a category. So I’ve really just picked one category, knowing that there’s going to be downstream impacts and that’s going to flow into other categories as the diagram tries to convey.
And then that leaves me in the difficult position of how to translate this info as part of a podcast. Because at this stage, the list of factors is roughly 130 odd items, and if I sat longer, I could probably come up with more or many more factors. And this has actually been the big stumbling block with me getting this podcast out. I was just unsure of how to put all this information into one episode.
But what I’ve eventually decided to do is just to simply read out these lists in their entirety. And most of the ideas should be fairly self-explanatory, but any that may seem ambiguous or not clear, I’ll add some explanation.
I should also add as well, that what makes this difficult is that different influences matter at different points of our lives. So in the beginning, our habits and health are directly impacted upon by our parents and our home environment. We then get older and we move out and we have a different set of constraints, or factors, like employment levels, or the infrastructure in where we live.
But still, what happened to us as a child can continue to be having an impact. We then have our own children and things like pregnancy and recovery from birth and child care options and the economics of looking after a child all have an impact.
00:25:45
So every item might not be relevant for every person, and some items are specific to certain times in one’s life. And other items will be specific for other times in one’s life. And as I said, this is a long list. And while I don’t want this to be tedious listening, if there is that feeling, it’s probably because this is such a complex idea, and there are so many factors that go into impacting on someone’s health.
So starting with social psychology, so the things that they mentioned were education levels, media availability and consumption, the availability of passive entertainment options, the exposure to food advertising, how much TV someone watches, their newspaper and magazine consumption, their social media consumption, the algorithms of Facebook and Google and Instagram. Not everyone knows this, but what you see when you go on to those places, especially with something like Google, is different to what is shown to someone else. It’s based on what they think you want to see, or what will lead to the most clicks or the most time on page or the most amount of outreach.
So if the algorithm can have an impact on this, you then have the social cultural valuation of food. So how does someone’s cultural background impact on their food choices? You have the importance of the ideal body shape or size. So how important is that, but also, what is the ideal?
So in different areas, you have a different ideal. Do you live somewhere where they value a long neck that is stacked with rings? You have peer pressure, and how much this has an impact on various people can depend on home life and on other factors. You have a lack of time, social beliefs and prevalence of smoking. The importance that is placed on health, and then sort of how is your ethnicity or your class or your identity portrayed in the media?
So that was social psychology. You then have individual psychology, so you have like parental control and parental styling. The child’s control of diet, parental modeling of behaviors. Whether they be healthy behaviors, or not healthy behaviors, learned activity patterns in early childhood. Someone’s self-esteem, how much face-to-face social interaction do they get? Do they live in more of an individualistic versus collectivist culture?
Stress, and how stress then affect someone’s psychology and their thinking? Someone’s desire to resolve tension and resolve stress. Someone’s food literacy, someone’s demand for indulgence or compensation. The use of medication and how this affects someone’s thoughts and feelings. Scientific inconsistencies.
So this can be confusing, like especially with all the mixed messages about what is healthy, what food should someone be eating? You’ve got the perceived danger in someone’s environment. Their parents dieting history or their parents’ relationship with food, happiness in their home life. What’s going on, in terms of drugs, drug crisis within the neighborhood. You’ve got weight bias and weight stigma.
So does this lead to someone dieting or getting into risky food behaviors in the name of weight loss? You’ve got the minority stress response, how stress affects minorities within society. You have adverse childhood experiences or traumas, abusive relationships. You have mood disorders or mental issues, like bipolar or anxiety or depression, that all impact on how someone sees and experiences the world.
00:29:45
You then have physiology. So how our body works. So the health of parents prior to conception, the conditions for you while in utero. The quality and quantity of breast milk and of weaning. Where are you in the birth order? What was your parental attachment style? You have epigenetics, congenital conditions, the appropriateness of your growth as you age. You have endocrine dysregulation. So things like your thyroid or Cushing’s disease or diabetes or PCOS.
You have the degree of GI signaling. Sort of the extent of digestion and absorption. The appropriateness within the body of nutrient petitioning. So how much of what you eat gets used for energy and how much of it is stored for later on? Your tendency to preserve energy. Your resting metabolic rate and level of thermogenesis.
Predisposition for activity. So how much do you have just an innate desire to move? Medications. If you’re on medications and how this can then affect your physiology and the functioning of your body. The pollution levels of the area that you grew up in and continue to live in. Your ability to respond to food cues. You have age-related conditions. So menopause. The sort of environmental or chemical toxicity. Then you have like the effects of having children. So how does this affect the mother? How does this affect the father? You have your sleep ability.
00:31:35
So then the next category is economics, and as I said, this is both individual economics or how someone has the ability to spend or be in employment, et cetera, but also for businesses. So within an area, like you have a level of total employment. You have illness or death of a parent, and how that can then impact on economics. The kind of industry that your parent works in, in terms of job security, like are they working in automation? Are they working in mining? What happens in that situation?
You have societal pressure to consume and to be a consumer, you have pressure on job performance. What’s an individual’s purchasing power or disposable income? Is there a dominance of sedentary employment? Pressure, if we’re talking from sort of a company’s standpoint, what’s the pressure for growth and profitability of a company over the employee’s longevity, or the employee’s benefits or looking after an employee? You have companies with an effort to increase the efficiency of consumption and the efficiency of production and the desire to minimize costs and to maximize volume.
So food companies trying to make the most amount of money for the least amount going into a food. You have cost of ingredients. You have the market price of different food offerings.
00:33:00
You then have the next category, which is food environment. So what’s the food exposure? What’s the food abundance? What foods are in abundance where you live? What is the food variety like? Do you live in an area where there’s food deserts?
I was listening to a really fascinating podcast that looked at, I think they used the census data. Data, data? I never know which one to say. And every seven years, they would look at how areas became either more affluent or became less affluent. And looked then at the offerings, in terms of food and fast food in those various areas. And basically, the more well off an area was, the less fast food offerings they had, the more variety of fresh food and more stuff in supermarkets. And then the poorer an area became, the more you just had fast food outlets.
And it was interesting how they talked about how this would change, depending on how areas changed over those each seven years, that the census was going on. So you then have like demand for convenience food, you have the convenience of food offerings, you have parents’ ability to cook when you’re growing up. You then have your ability to cook in later life.
Alcohol consumption, the palatability of food offerings, the energy density of food offerings. The fiber content of food and drinks, then kind of nutritional quality of food offerings. Portion sizes. You have sort of cultural background impacting on food offerings. Family meals, like did you as a family sit down to eat? Do you do that as a family now? Childcare options. So this can impact on your time and your ability to make food, versus just getting something that’s already pre-prepared.
The next category is physical activity. So your degree of innate activity in childhood. Your opportunity for team-based activity, or for doing sports. How much non-exercise activity thermogenesis was going on or is going on? You have someone’s innate functional fitness, you have degree of physical education, the sociocultural valuation of activity and how important or non-important that is.
Do you have access to opportunities for physical exercise? And so what is the level of recreational activity or domestic activity or occupational activity? How much of there is there a reliance on labor-saving devices? What’s the level of transport activity around? What someone’s relationship with exercise like? What was their natural ability with exercise? So were they the one who was first picked on the team and was really kind of pushed towards exercise because they had a natural ability towards it? Or, was that not the case?
00:36:25
And then there’s two more categories. So one is infrastructure. So what is the sort of safety and opportunity for unmotorized transport? So can someone walk and cycle where they need to go? What’s the walkability of someone’s living environment like? What’s the ambient temperature of where someone lives? Because this can have an impact. What’s the cost of housing? What’s going on in terms of weather? So seasonal affective disorder. What’s the crime rate like within a certain area?
And then the final area is medical. So what’s the level of infections going on? So within a certain area or for an individual, how much of there is a reliance on surgical interventions or reliance on medication? What someone’s scientific literacy like? What’s the hospital funding like in certain areas? Because depending on how close you are to one hospital, versus another, your quality of care could differ greatly.
So that is it for the list. So I know it’s an incredibly long list, there were some that were probably repeated twice because they were in two different categories. But thank you for sticking with me. This is obviously a non-exhaustive list of possible contributors to someone’s health.
00:37:40
And in my episode on life expectancy, I made reference to the Marmot Review, and this was a review that was published back in 2010, called Fair Society, Healthy Lives. It was paid for by the UK government to look at health inequalities. And what the review found was that the biggest determiner of health was socioeconomics.
It is a 240-page document, so I can’t go through everything mentioned in it. But let me just start by quoting the first paragraph, so quote, people with the highest socioeconomic position in society have a greater array of life chances and more opportunities to lead a flourishing life. They also have better health. The two are linked. The more favored people are socially and economically, the better their health.
This link between social conditions and health is not a footnote to the real concerns with health, healthcare, and unhealthy behaviors. It should be the main focus. Consider one measure of social position, education. People with university degrees have better health and longer lives than those without. For people aged 30 or above, if everyone without a degree had death rate switch to that of people with degrees, there would be to 202,000 fewer premature deaths each year. Surely, this is a goal we’re striving for. End quote.
And the reason I’m reading this out is because when I go through that long list of possible contributors to health that I just went through, the vast majority of things outside of someone’s control. And this is especially true during the developmental years. You don’t get to pick your parents, you don’t get to pick your socioeconomics, you don’t get to pick where you live, your parents’ parenting style, and the way that you’re raised. You don’t get to pick if your mom goes on diets or encourages you go on diets.
What makes us and shapes us is completely out of our control. And now, as an adult, if we find ourselves in a strong socioeconomic position, the potential for changing this stuff is greater. But when this isn’t the case, it’s much more likely that the cycle continues to repeat itself, and you simply do what you were taught and what others are doing around you.
And generally speaking, the more stressed you are, the more you are focused on short-term modulation of emotions and survival, in comparison to long-term health. And this is often directly linked to socioeconomics and social standing. Focusing on health is a luxury that most people don’t feel they have. And if you are 30 years old and don’t know how you’re going to make it through the month, doing things that may prevent diseases that will hit you in your 50s isn’t a priority.
Or, the question from the step to the line exercise. When I was 18, I thought I wouldn’t make it to 21. People’s unhealthy eating, if that’s what’s happening, is a symptom of something much bigger. And if we aren’t addressing those other issues, like more information on the benefits of the Mediterranean diet, or how important sleep is for health, is rarely going to move the dial.
00:41:00
And there’s a thought experiment called the veil of ignorance, and it’s often used to explore social and moral issues. It’s meant to help people become better at being an impartial spectator and to shed their current biases, because of their standing in society.
So as part of the thought experiment, you want to come up with ideas that are best for a society as a whole and for each individual. And so for us, it would be how do we deal with improving health at the population level? But with the veil of ignorance, the caveat is that you have no idea what your ultimate position is going to be in society. So are you going to be well off and affluent, are you going to grow up in abject poverty? Are you going to be someone who has been naturally slim and attractive? Or, are you going to be someone who has been heavy their entire life? And any attempt to remedy this has led to them gaining more weight.
Are you going to be someone with severe mental health issues? Are you going to be someone who had suffered abuse at a young age? And if you are able to think about each of these people, or sort of the infinite number of alternatives, how would you want to be treated by society? What would be a fair response? What would be best for your health, including physical, mental, and emotional health, with each of those different areas? And if you can truly imagine yourself in those different positions within society, then you can have an honest conversation about how to tackle this issue.
But if people simply see the world through their own lived experiences, and make assumptions from this place, then things will just continue on as they are. And this is important because most of the rhetoric around health is terrible at real perspective-taking. Someone in a position of privilege imagines themselves in social or economic deprivation but simply thinks that they would still cook all of their own food, but they’d just use the cheaper ingredients. Or, they’d find gym equipment that’s outside, because they couldn’t afford the gym.
They basically imagine their life with all of the same time, with all of their same skills, all the same beliefs in themselves, but with just less money in a smaller place to live. They forget how the benefits that they’ve had throughout their life, and will continue to have throughout their life, impacts on how they see and experience the world.
And I feel that a retort to my focusing on socioeconomics is that many people don’t fit this bill. That they are dealing with health conditions that are because of lifestyle factors that are in their control, or at least that’s how it’s framed. That they come from a good middle-class background, that they’re not living in poverty, that there was no drug addiction in their family, that they got a great job. Surely, this is them just being lazy or simply just not caring.
But in this situation, there can be many explanations for why this is happening. Maybe for these people, it simply is a matter of changing habits. That they are self-directed and with the right information and some time, they’re able to make changes. They are the kind of bright, shining example that is held up for why information is better, and why making simple changes leads to better health.
00:44:15
But for many people, even if on the surface things appear great, certain life experiences has impacted on their health and their relationship with food. So maybe it dates back to their childhood. They had an aggressive and angry father and they felt that they were conditionally loved. Their mother was on and off diets and it was clear that she didn’t like her body.
Or, they were only allowed healthy foods growing up, because their mom was a nutritionist, who had her own issues around food. Or, they grew up having to eat every last piece of food on their plate, and they now struggle to leave any food and have little sort of internal cues around hunger and fullness.
Or, they were part of the wrestling team and from early teens, were cutting weight and dehydrating themselves for competitions. Or, they dieted since the age of 16. It provides temporary security, it gives them something to bond with their friends on, or with their mother about. Or, they developed an eating disorder in their late teens and they’ve had many hospitals days and are better than they were when they were at their worst, but they still struggle and have disordered beliefs around food and their body and they constantly struggle.
Or, due to a chaotic household, they learned that food was the one thing that could give them comfort and help them numb out. Or, they score high on the ACE score. So the adverse childhood experience score. Or, they are in a relationship that they aren’t enjoying and they have three kids and they feel trapped and they don’t know how to leave.
Or, they’re running a successful company, they’re completely stretched. They have a large mortgage and outgoings and are constantly working. Food is low on the list of priorities, because of other life stressors.
And I’m not trying to create a long list of excuses for why people should abandon helpful behaviors, or not pursue them in the first place. But it’s trying to bring some humanity back into the area of health, that even with supposed privilege, health is still complex. And if you genuinely care about making changes, as opposed to just getting up on a soapbox about how lazy everyone has become, then we need to focus on what actually makes a difference in people’s lives.
00:46:30
And I also want to mention how much health is just about luck. I’ve had friends who’ve come from privileged backgrounds and had many factors in their favor, who in their 20s and in their 30s have got cancer. Or, they were born with a genetic condition that dramatically affects how their kidneys function.
We put food and movement on this huge pedestal, and when something goes wrong with someone’s health, it’s directly related to eating the wrong thing or doing the wrong movement or not enough movement. But apart from the fact that these are just two variables in a multitude of factors that can affect health, often, it’s just shitty luck.
So I trained as a nutritionist. I see the value in food and lifestyle change. But the morality around this stuff is so classist and elitist and just really lacks compassion and understanding. Health is an incredibly complex issue. And when this complexity gets watered down to just eat less and do more exercise, or it’s just about making healthier choices, like this is just moronic. And yes, we can have an influence on our health. But some people have a much easier time than others, and this is largely for systemic reasons.
I started the podcast by making reference to cancer research and their campaign. And while I disagree really strongly with the approach they’ve taken, and I think it is counterproductive, it does seem like, behind the scenes, they’re trying to push for policy changes. And again, while I don’t necessarily agree with the policy changes they’re pushing for, at least they’re trying to do something at this level. Like changes to health at the population level aren’t going to come about by every individual simply taking responsibility. That’s magical thinking by those who have the means. Real change will come about by the changes that are made at the political and the policy level, that pull people out of poverty, that give people real opportunities, that increase employment opportunities.
So that is it for this week’s podcast. This is definitely one I know that I will release and I’ll think of all these other ideas that I wanted to add in, but it has been waiting for a long time for me to actually record this. And so if I want to add more at a later date, then I can do so as a second edition.
As I mentioned at the top of the show, I’m taking on new clients at the moment and have just two spots left. If you’re interested, then get in contact. That’s www.seven-health.com/help. I will be back with another episode next week. Until then, take care.
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