Health Focus: Individual Responsibility In Health Care

At a recent panel that I moderated a prominent local health care executive commented that we have an excellent medical system but a poor health care system. In general I agree with this assessment, especially when it comes to taking individual responsibility for the health of ourselves and our family.

Consider this sobering conclusion from a recent study - If the level of obesity continues the current generation may have a shorter life expectancy then their parents. Even more troubling is if we don’t change, one in three babies born today will develop diabetes in their lifetime. Every American should be alarmed and frankly embarrassed that we are so adversely affecting not only the length but the quality of our children’s future health.

But the obesity epidemic is also sweeping through the adult population, this same study also projects that by 2020 81 percent of men and 78 percent of women will be overweight or obese. While most of us know the strong link between being overweight and high blood pressure, heart attacks, stroke and diabetes, the American Cancer Institute warns that increased weight also leads to a heightened risk of cancer.

Our lifestyle choices like overeating and smoking tend to accelerate the prevalence of chronic diseases such as diabetes, heart disease, and lung cancer which have become a huge financial burden. Today three of every four dollars spent in the U.S. health care system is for treatment of chronic disease and for those of us who have one or more chronic conditions the expense is five times greater than for someone without any chronic disease.

But changing lifestyle choices is difficult, even physicians have only a 10 percent success rate when they advise patients about altering their habits. This resistance to change can be readily seen as the ‘quit rates’ for smokers linger around 2 to 3 perent a year and despite a surfeit of best-selling diet books our waistlines continue to expand.

Wellness programs and financial incentives are now being tried to encourage lifestyle changes. In the health care reform legislation, the Affordable Care Act (ACA), there is a provision that allows employers to offer employees ‘up to 30 percent of the cost of coverage for participating in a wellness program and meeting certain health-related standards’. Unfortunately this doesn’t take effect until January 2014.

Researchers are gaining a better understanding of how positive incentives (payment for good behavior) and negative (fines for bad behavior) can lead to change. For example, positive reinforcement is linked to one-time good behavior like showing up for disease screening, while it is believed that negative reinforcement may be longer lasting and more powerful, significant proof is elusive.

As we look for our employers to incent us, researchers to discover better ways to motivate us and lawmakers to craft programs to help us change our lifestyles, let’s keep in mind our role as parents and grandparents; that this is a battle where our children are at risk and we have an obligation to become active participants in ensuring that they have a long and healthy future.

John Sardelis is an Associate Professor of Health Administration at 's Long Island campus in Patchogue.

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