Op-Ed: An Equal Opportunity For Health?

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In a column for The Chicago Tribune, Mary Schmich argues that taking personal responsibility for your health isn't as simple as everyone makes it out to be. Schmich reminds readers that many Americans do not live in walkable neighborhoods and cannot afford healthy food.

NEAL CONAN, host:

Now, the TALK OF THE NATION Opinion Page.

When Louisiana Congressman Charles Boustany, a heart surgeon, provided the Republican response to President Obama's address to Congress last week, he raised an issue that keeps bubbling up in the health care debate: personal responsibility. I operated on too many people who could have avoided surgery, he said, if they'd simply made healthier choices earlier in life.

And indeed, conventional wisdom holds that if we just exercise, put out that cigarette and lay off the fries, we can all be healthier and stay out of the doctor's office.

But Mary Schmich, a columnist for The Chicago Tribune, argues that the answer to our health care dilemma isn't really that simple.

So, are you living the healthiest life you can? What stops you from having the lifestyle you know you should? Give us a call: 800-989-8255. Email: talk@npr.org. You can also join the conversation on our Web site at npr.org. Click on TALK OF THE NATION.

Mary Schmich joins us today from WGN Radio in Chicago.

Thanks very much for being with us.

Ms. MARY SCHMICH (Columnist, The Chicago Tribune): Hey, Neal. You're having a big Chicago Tribune day today on TALK OF THE NATION.

CONAN: Indeed, we are. Yes, indeed.

(Soundbite of laughter)

CONAN: And enjoying some Wrigley gum, too.

But isn't it our responsibility to take care of our own health? Those of us who do not end up costing everybody, the taxpayers.

Ms. SCHMICH: Well, you know, I do find this a vexing question, and I started thinking about the - this part of the argument in the health care debate about when John Mackey wrote a controversial op-ed piece in the Wall Street Journal a couple of weeks ago in which he really made a plug for personal responsibility instead of government intervention on behalf of…

CONAN: This is Mr. Whole Foods.

Ms. SCHMICH: Yes. Yes. He's a CEO of Whole Foods. And, you know, he wrote that, you know, rather than increasing government spending and control, we need to address the root causes of poor health.

Can't argue with that. I mean, can't argue with we need to address the root causes of poor health. And then he said this begins with the realization that every American adult is responsible for his or her own health.

You know, and then he went on to say that, you know, that most of what's killing us is preventable through proper diet, exercise and not smoking, minimal alcohol consumption and other healthy lifestyle choices.

Well, healthy lifestyle choices, I think, is a term that's usually used by people who have lifestyle choices. And when, you know - I'm all for personal responsibility. It's really hard to argue against personal responsibility. But I think in matters of health that we aren't all offered the same set of opportunities to be personally responsible.

CONAN: And some of those choices are limited for us by genetics, but those are not the ones you're talking about.

Ms. SCHMICH: No. You know, I'm talking about the difficulty that many people have of getting access to good food, of finding the time to eat correctly, especially people who are, say, working the night shift, working two jobs.

There was a really good article in Time Magazine last week about a study of people that showed that a lot of people, especially working parents, are just too busy to eat right. And that sounds like an excuse, you know? But the truth is, if you're working the night shift and the company cafeteria is closed down, you're going to eat out of the vending machine. And, you know, maybe you're so organized in addition to getting the kids to school and doing all that that, you know, you packed your lunch.

(Soundbite of laughter)

CONAN: Yeah.

Ms. SCHMICH: But, you know, there's another level of difficulty on top of the regular difficulties and responsibilities of life that gets added when we start, you know, just clucking and tut-tutting at people, you know, just be personally responsible for your health.

CONAN: Yet we all do know people who set the crock pot before they leave for work and bring in a sandwich and an apple.

Ms. SCHMICH: Do you, Neal?

CONAN: No.

(Soundbite of laughter)

Ms. SCHMICH: We do. And you know what? I really admire those people. And I think we should be cultivating these behaviors in people. But the idea that we would punish them when people are already working against so many odds to keep their lives together just seems wrong to me.

CONAN: Nevertheless, you know, I don't bring in my sandwich and apple every day, but nevertheless - nor set the crock pot. I don't have a crock pot, for that matter. But for - you know, I do try to take the responsibility to take the time to exercise, and I do work long hours. And I think that's important.

Ms. SCHMICH: Well, and I do, too. You know, I like to think I'm somebody who takes a fair amount of personal responsibility for my own health. But you and I live, even if we work long hours, you know, we make a decent salary. We are not working the night shift. We have a lot of privileges, I think, that allow us to have a wider set of choices.

CONAN: So what is it, we're asking our callers today, that prevents you from living a healthier lifestyle? Give us a call, 800-989-8255. E-mail us, talk@npr.org.

We'll start with Doug(ph). Doug calling us from San Francisco.

DOUG (Caller): Hi, there.

CONAN: Hi, Doug.

DOUG: I am an interventional radiologist. I'm a physician. And I hope you will start this conversation with maybe an interesting twist on what you're looking for, because the single greatest thing that keeps me from leading a healthier lifestyle is having to take care of patients at all hours of the day and night, who are living lives of self-abuse and self-neglect.

CONAN: So you're busy because you're really, really busy?

DOUG: Well, busy is a neutral way to put it. Yeah, I'm busy, but I'm doing lots of things that ought not to be done just as the cardiothoracic surgeon mentioned during his Republican rebuttal to the president's speech. And…

CONAN: So you're seeing plenty of evidence that Americans are not taking care of themselves.

DOUG: Yeah. But - well, I'm happy to discuss that, but I don't want to get off point because you're talking about - I think, you're - you want to discuss how an individual can or should change his or her lifestyle to live a healthier life. But if you want to talk about…

CONAN: No, that is indeed - you're directly on point, Doug.

(Soundbite of laughter)

DOUG: Okay. So, I just - you know, there are lots of people in the health care profession - millions, of course, around the country, nurses, physicians, technicians of one sort or another - who live very stressful lifestyles, but are trying to work out and take care of themselves simply because they choose to care for millions of people who are not taking care of themselves. And, you know, it's a significant problem. It's stressful in so many ways. It's not just in sleep deprivation, it's the tragedies that take their emotional toll on us, too, when someone who is dying from something that could have been prevented or at least never would have become as severe as it did as a consequence of their irresponsible behavior.

And I say irresponsible, I don't really mean in any pejorative or - sense and I suppose it's judgmental, but I'm really trying to state the fact that there are so many people who, whether they were born with certain risk factors that, you know, on a genetic basis or not, could have and should have taken care of themselves and they didn't - made aware of these issues and they still refused to do so. And, you know…

Ms. SCHMICH: So, Doug, are you saying that you feel that you aren't taking good care of yourself?

DOUG: Well, it's a struggle, because there's a dedication to what I do and someone's sick, and, you know, I'm doing some sort of procedure that takes longer than it might have or that is more difficult and anxiety producing for everyone than it might have been. I can't say, sorry, I have to go swim and -or go running right now because it's time to work out. And I need to take lunch, I can't skip lunch because it's not healthy. (Unintelligible) all the time.

Ms. SCHMICH: I mean, this is a really interesting example, though, because I think many people, even though they're not doing the job that you're doing, they feel - their own set of stresses, their own urgencies that prevent them from doing the things that they know they should do.

DOUG: (unintelligible) that's right.

Ms. SCHMICH: And so, the - I mean, you know, the researcher in this Time magazine article said something, you know, the structure of our lives is keeping us from doing the things we know we ought to do. So the question is, how do we get around that? There really are these societal systemic structures that I think go beyond individual personal responsibility, even though I'm all for personal responsibility.

DOUG: Fair enough.

CONAN: All right.

DOUG: I agree. Thanks. I just wanted to share that with you.

CONAN: And, Doug…

Ms. SCHMICH: Yeah, very interesting.

CONAN: …we thank you for being there when our errors add up and put us in a situation where we need your services.

DOUG: Well, thank you for saying that. You're welcome.

CONAN: Bye-bye. Here's an e-mail we have from Marian(ph) in Massachusetts. I always have done everything I can do to live a healthy lifestyle and still do. I guess that's why my case of multiple sclerosis is so mild, but we really can't be sure of that since it's an incurable, unpredictable illness that doesn't have a known cause. Please don't tell me to eat right, exercise, et cetera. I do, but I still use a wheeled walker and work part-time, flex-time to deal with MS fatigue.

And, again, I think Mary Schmich was talking about people who are not in the situation of Marian, but people - or people who have genetic difficulties - but genetically caused problems. But people (unintelligible)…

Ms. SCHMICH: No, but I - you know, I…

CONAN: …among other situations.

Ms. SCHMICH: …I think that her case illustrates another difficulty in just telling people to be personally responsible is that, you know, a lot of people are, and then they get sick anyway. I think it's hard to tease out the causes of diseases, even though, yes, we know that things can be prevented. You know, it's pretty clear that cigarette smoking leads to lung cancer. You should stop smoking cigarettes. That, you know, drinking soda pop all the time leads to obesity. I mean, there are causes and effects, but I think if you look at any individual sick person, it gets really difficult to tease out why that person is sick.

CONAN: And that's the argument that we're having in Congress and elsewhere. It's the line between individual responsibility and collective responsibility.

Ms. SCHMICH: Right. And, you know, and I would say that we are collectively responsible for each other. Yes, we are.

CONAN: Yeah. Yes, we are. All right. So…

(Soundbite of laughter)

Ms. SCHMICH: On the other hand, I - you know, I get really ticked off when I see people complaining that they can't lose weight and then I see them eating a whole box of Pringles, you know?

CONAN: Well, this goes to the motorcycle helmet law. Oh, I want the freedom to ride with the wind blowing through my hair and when I get in a catastrophic accident you taxpayers could pay for it.

Ms. SCHMICH: Right.

CONAN: Yeah. All right. We're talking with Mary Schmich, a columnist for the Chicago Tribune on the Opinion Page. You're listening to TALK OF THE NATION from NPR News.

Let's go next to Todd(ph). Todd with us from Wooster in Ohio.

TODD (Caller): Hey. How are you doing?

CONAN: Very well. Thanks.

TODD: Hey, I agree 100 percent with personal responsibility. And I work in manufacturing and I work a night shift. I actually work swing shift. I work different shifts depending on the situation. Anyway, I cycle to work when I can. I use a light, a high-powered light in the evenings. I pack - I make my food on Sundays. I pack my food everyday. I always have an apple or banana with every meal. I never use the vending machines here at work because our cafeteria is indeed closed. And I think that people just need to make - helping - they need to make their health a priority in their life.

CONAN: So, even those of us forced to work at night like you, Todd, can make healthy choices, you're saying?

TODD: That's right. You can. There - you know, you may not be - have the time to workout that you want, but you always have the time to eat right and to avoid eating fast food or to avoid eating out of vending machines or any sort of packaged processed garbage. You just should not eat like that, you know? And everybody knows that. And you know, nobody - everybody would just say, well, I don't have the time to work out. I have a busy life. I guarantee you those people have the time to go on social networking Web sites, they have a time to watch TV. If you have time to do those things, you have time to take care of yourself.

And what scares me - because I think we do need health care reform and I would like to see a public option. I would like to see government health care. But I'm afraid that there's going to be so many people that are - due to their own devices are going to the weigh the system down and it's going to cost people like me who - I never have to use the doctor, I go get my regular cholesterol check-ups…

CONAN: Todd…

TODD: …once a year.

CONAN: …I'm - I suspect I'm much older than you, but never say never. One day will come.

(Soundbite of laughter)

TODD: But I'm doing all I can to prevent…

CONAN: I'm sure you are and I'm not being, you know, but never say never. The system's got to be there for you one day, too.

TODD: That's true. That's true.

Ms. SCHMICH: Well, and I think it's great that Todd is doing what he does. And in a perfect world, more people - way more people - would live the way Todd lives. But I don't think it's that simple, you know? There are those of us who have been trained to think this way, to live this way, who don't have say, alcoholic tendency. You know, there's just so much more psychological situational complexity in making these choices I think than just, you know, because I live a good lifestyle then I think it's easy for everyone else to.

CONAN: Todd, thanks very much. Appreciate it.

TODD: Thank you.

CONAN: Bye-bye.

Let's see if we can go next to Andy(ph). Andy with us from Spring Hill, Tennessee.

ANDY (Caller): Hi, Neal. Thanks for taking my call.

CONAN: Sure. Go ahead.

ANDY: You know, one of the things that people seem to forget is that with a rotten economy a lot more people are out of work, which tends to send a lot more people to places like food banks. And food banks, like the one in my town, are, you know, their roles have doubled since last year. And food bank food, as anybody who has ever donated to a food bank knows, isn't particularly healthy stuff because it has to be non-perishable. So, you know, we're looking at people who are forced into poverty by the bad economy, they eat rotten food from a food bank and it doesn't improve their health. My wife and I planted a large garden next to our local food bank just so that they could have fresh produce…

Ms. SCHMICH: Good for you.

ANDY: …because they can't afford otherwise.

CONAN: And indeed that's a solution that many people are turning to, but again not available to everybody, Andy. And you're right. The options in a food bank are extremely limited.

ANDY: Yes.

CONAN: So, thanks very much for the call. We appreciate it.

ANDY: Thank you.

Ms. SCHMICH: We…

CONAN: Go ahead, Mary. I'm sorry.

Ms. SCHMICH: But, you know, we have this issue in Chicago and a lot of cities, big cities, especially, have, too, and this issue are food deserts. There are big swaths of Chicago where it's really difficult to get to a decent grocery store.

CONAN: Indeed. Washington, D.C. as well and other cities, too - a decent grocery store other than the corner bodega where prices are high and choices are extremely limited, they're just not available in a lot of places.

Ms. SCHMICH: Right. Right.

CONAN: All right. And I assume that you're going to be leaving the WGN studios there on your high heels to buy a pack of cigarettes and go for a…

(Soundbite of laughter)

Ms. SCHMICH: Oh, you know me so well, Neal.

CONAN: …a three Martini lunch.

(Soundbite of laughter)

CONAN: Mary Schmich, it's been a pleasure to have you with us today.

Ms. SCHMICH: Thank you, Neal.

CONAN: Mary Schmich is a columnist for the Chicago Tribune. And as we mentioned, she joined us today from the studios of WGN Radio in Chicago.

Tomorrow, Google scanned nearly 100 years of written material into a giant virtual library. It could change the way all of us read books. What happens as books go digital? Plus, actress Jasmine Guy will join us next time on TALK OF THE NATION from NPR News.

I'm Neal Conan in Washington

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