jhscdood:

heavyweightheart:

Y’all know that individual health behaviors – choices around nutrition, exercise, smoking, etc. – only account for about 25% of a person’s health status? The determinants of health are largely social: income and education level, the safety of one’s physical environment (e.g. working conditions, clean water), and degree of social support. Trauma is far worse for health than fast food.

It’s tempting to subscribe to a just world theory, where good things happen to good people (or people who make good decisions), and problems befall problem people, but that just isn’t the world we live in.

Most sick people have spent their lives fighting against oppressive circumstances. They don’t invite illness and hardship with their bad decisions, they are miracles of survival in a sociopolitical environment that’s hostile to their very existence.

(oh look it’s my grad program in a nutshell!)

Yes, this!

People talk a lot about health behaviors – what you choose to eat, whether you exercise, whether you drink/smoke – because they’re believed to be modifiable risk factors that you can change in order to improve your health. You can control how much you exercise, but you can’t control your genes, so let’s talk about exercise! That kind of thing.

But there is a LOT that goes into whether or not a person CAN modify those seemingly-modifiable risk factors. If a person is working two jobs for 18 hours a day and lives in a neighborhood with no sidewalks or streetlights and high crime rates, then as much as they may WANT to exercise to improve their health, they do not have the ABILITY to do so. They know they need to. They know it’s important. But it is literally impossible. 

Similarly, if someone lives in an area with no nearby supermarkets, where fresh food is expensive, when they don’t have time (or supplies, or a kitchen) to cook it, then as much as they may WANT to eat healthy homemade meals, they do not have the ABILITY to do so.

In America, we’re all about individualism. We like to think we have All The Choices, and that we can choose to be happy/sad, rich/poor, good/bad, and it’s that easy. But it’s not. Because the ethos of individualism ignores the fact that we live in a society, that we live in a specific context, and that that society and context has far more of an impact on us than it wants to admit. 

Example: As individuals, we can all choose to take shorter showers and save a few gallons of water. But commercial organizations, factories, etc waste thousands upon thousands of gallons of water every day. Individuals making the choice every day to save water will have very little impact on the water supply. Regulations forcing companies to save water? GIANT impact.

How this works when it comes to health: We can talk and talk and talk about individuals choosing to change their modifiable risk factors (nutrition, exercise, smoking) until we’re blue in the face, and it’s going to have very little impact on health. There just aren’t a lot of gallons there. People are already doing the best they can within the context of our society.

But if we change that context? Anything goes. ANYTHING GOES.

If we change regulations: Require municipalities to clean up their drinking water. Install sidewalks and streetlights. Ban toxic substances from agricultural, commercial, individual, and all other use. Increase the minimum wage so that people only have to work one full-time job to survive. Subsidize grocery stores in food deserts. Subsidize fresh food in food deserts. 

Or if we change access: Provide health insurance for everyone. Improve the quality of health care provided. Provide preventative care. 

Or if we change society: Improve our education system. Increase equity. Eliminate discrimination. 

….then health will automatically improve. It will automatically improve, on a population level. And individuals? Will automatically engage in those modifiable health behaviors that improve their health status. Because there will be nothing – access, ability, time, and 100 other things – to stand in their way.