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Physicians are glib about giving advice about staying healthy; I should know, I am one. Eat healthy, exercise, drink alcohol in moderation, do not smoke, do not use drugs, wear a safety belt - the list could go on for pages. We can elaborate about low glycemic index diets, aerobic exercise, prevention of osteoporosis, risk factors for diabetes. We know a lot; some of us like to educate our patients about what we know. Some like to give orders. Some get very impatient with people who engage in unhealthy behaviors.

While we may know a lot of facts, we know very little about the factors that lead to unhealthy life choices. Why do some people stay thin their whole lives while others gain weight? Why do some stay active and others do not? Which people are more likely to have problems with tobacco and alcohol and what are the barriers to stopping those drugs?

Clearly healthy behaviors involve much more than knowing what to do. It is not a matter of weakness or ignorance. Only rarely have I met someone who is overweight or who uses tobacco, for instance, who wouldn't rather be thin or smoke free. The vast majority of us know the risk factors of our unhealthy behaviors, but there is a huge gap between knowledge and actual behavior change. Lecturing and moralism don't help someone to give up the very things that give their life enjoyment.

Historically, it is a relatively new experience for humans to live as long as we now do. In the past, women died young in childbirth, men died in industrial accidents, children died of scarlet fever and diphtheria. In past eras, an overweight person was thought to be healthy. That was a logical conclusion: that extra weight might better sustain a body through a long illness. A very thin person could be malnourished or tubercular.

In the early twentieth century lung cancer was considered a rare phenomenon. By mid century it had become the leading cause of cancer death. Certainly a rising incidence of tobacco use contributed to this statistic, but so did our lengthening life span. Instead of dying from infectious disease or accidents, we now lived long enough to die from the consequences of our own behaviors.

We human beings have always enjoyed our vices. Many of our most famous philosophers, scientists, scholars, literati were addicted to drugs or alcohol. Opium was a popular drug of choice in the nineteenth century. Alcohol dependence is not a new phenomenon. Is there something intrinsic in humans that leads us to self destruct? Or rather is it that life is difficult, and over eating, drugs, and reckless behavior in general, become an antidote to stress, hopelessness and loneliness? There is comfort in food. There is camaraderie in smoking and drinking with friends. Being scolded by a doctor isn't particularly motivating, nor are guilt and self hatred.

So taking care of one's health goes beyond simply getting that mammogram or colonoscopy and taking your blood pressure medicine. It requires us to think about what gives our lives meaning. To dream about the things we want to live for. And it requires us to find new ways to cope with the stresses of our lives. If we had the money to access alternatives, the education to pursue them, work that gives us satisfaction and family that gives us support, who would need to indulge in vices? But as long as we suffer our own demons, live in emotional and physical isolation, and feel unheard and unvalued, we are at risk of dying young. Health and happiness are not givens in this life, but they are attainable. We just have to want them badly enough.

Learn more about this author, Harriet Squier.
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