Health Focus: Individual Responsibility In Health Care

The importance of taking charge of one's health.

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.

Patchogue Patch encourages our readers, writers, political officials and anyone in the Patchogue-Medford area to submit their personal views on current events and issues as articles for our Opinion section. Articles submitted should not exceed 500 words, and all submissions will be considered. Please note that these pieces are not necessarily representative of the opinions of Patchogue Patch and represent that of the author. Submissions should be sent via email to michael@patch.com

Jean Phillips April 26, 2011 at 11:20 PM
We need to take on a more active role in leading a healthy lifestyle regardless of employer incentives. Howeve, I do believe there is an appropriate role in incentives by insurance companies and employers. Just the way the auto insurance and life insurance industries charge premiums based on an assigned risk, there is a place in healthcare. We just need to determine where it is.
Dain Alaia April 26, 2011 at 11:22 PM
I think it is everyone's individual responsibility to take ownership of their own health care and well being, but at the same time I am not opposed to offering incentives or issuing penalties. This is done in many organizations. For example , my company pays a higher commission rate once a piece of business reaches a determined level. This is the basic business practice, but we also offer prizes and rewards for it. This is another way to motivate the sales people. Different people are motivated by different things. While paying someone to take care of themselves is not a fool proof practice by any means, it is at least a start and provides another reason for people to care for themselves. They could in theory use that monetary incentive to purchase the healthier foods which are more expensive than junk foods. I also think that wellness is something that needs to be promoted in the local schools. Focusing on today's youth can help in multiple ways...helping the younger generation and also informing them of the risks that the older generation faces by not changing their habits. An example of this is kids being the driving force behind their parents quitting smoking. The children wouldn't know the risks if they weren't taught them in school. If we start the learning process young, it can help on multiple levels!
david Blume April 26, 2011 at 11:25 PM
While this all sounds great, taking personal responsibility and all, it seems to me that so far it has not worked out real well. Today people want instant gratification, not depriving themselves of junk food or over indulgence. Rewards for good behavior sound good, but often dissolve into punishing the bad behavior. Our culture will protect the bad behavior even granting disability status to protect groups from bad behavior. So, while this all sounds great, the reality is a tuogh sell.
Thomas Murphy April 26, 2011 at 11:29 PM
I agree that most of our health care problems are self inflicted and I think that providing incentives for positive behavior and penalizing for negative could work. When money is involved I think that most people would think twice before making a decision. In addition to this, for true success, I think that a comprehensive wellness and education program would be critical for a healthy population. Give the people the information + incentivise them and I think you have a recipe for success.
kate costante April 26, 2011 at 11:30 PM
I believe its a great idea for individuals to take some responsibility for their own health. This will not happen quickly however. All Americans will have to change their mindsets about health care delivery and buy into a new way of handling health care. Employees who are offering incentives for a healthier lifestyle are on the right path, but they don't have any way of measuring the compliance issues that coincide with the incentives. We as parents must buddy up with the educational system in this country to teach our children a healthlier way of life early on. This will aslo take time but we need to start somewhere. With perserverance it can happen!!
Althea Williams April 26, 2011 at 11:41 PM
I was at that same panel discussion and also agree that individuals and family must take responsibility for their health. Additionally, I believe this is easier said then done. It takes effort and willpower and probably incentives. Look how long it took the smoking cessation programs to have some impact on health outcomes. Still there are people smoking and the cigarette industry is not going out of business. Impacting the wallet of Americans seems to be the only language that may get some response - negative or positive - but some response. As a society we are self indulgent, self absorbed, and want what we want, when we want it, without liimitations. We need those limitations and incentives may be the only to achieve better health outcomes in the long term.
Anthony April 26, 2011 at 11:42 PM
I agree that Americans should take a proactive approach when it comes to our health. Additional efforts to infuse public health issues into the community will get more Americans involved. If healthy lifestyle information was advertised as much as fast food, prescription drugs and video games, we might be amazed with the results. My employer currently offers health pledges that offer financial incentives to those that meet the requirements for smoking cessation, annual physical and health assessment. I think that it is a great idea. I have also heard of other companies offering lower premiums for patients that meet certain benchmarks, like weight loss.
Lisa Tine April 26, 2011 at 11:49 PM
I think it is important for people to be accountable for their own health. If this can be done by giving incentives and disincentives than so be it. People need a wake up call and realize that their lifestyle is a major contributing factor to many illnesses. It must start with the parents, then the children will learn by following their foot steps. I also think that the educational system should teach children about healthy food choices. Education is crucial for a healthier generation.
Tiffany Nendza April 27, 2011 at 12:01 AM
I am a believer that it is our responsibility for our own health. But I also think that as a society we tend to put the blame on everyone else. Such as it is the government responsibly or our employer to help us quiet smoking. I don't agree with the incentives, I understand why they are doing it, to motivate with money. I think educating ourselves, parents, and other what a healthy lifestyle is. How can we achieve it in these economy hardships.
Heather Reynolds April 27, 2011 at 02:14 AM
I agree education is a critical component, however ,the food and entertainment industry as well as the media and marketing companies need to address their social responsibility in this matter. Our society is suffering from over stimulation and over saturation of the mind and body. Offer incentives to businesses to promote health and wellness, motivate our youth with scholarships for health innovation, and create more open space in our communities for outdoor exercise. We need to develop community forums for people of all ages from all walks of life so they can engage in conversation about this issue. Helping and supporting each other to make healthy lifestyle choices should not fall solely on the individual. The American society can and should take a stand on this issue and make it the responsibility of all . History proves collectively we have the will and strength to overcome many obstacles. We need to stop talking about it and just do it!!!!
ann iuliano April 27, 2011 at 02:32 AM
I do believe that individuals should be responsible for their own well being and their health. It can be very difficult to change old habits and lifestyles, but we need to start somewhere. We all need to take care of ourselves in order to stay free of preventable chronic disease and out of the acute health care settings. But tracking the effort that people do make may prove to be difficult, as lack of success would most likey be the method of choice. But is not being successful really an indication of not trying to live a better life? Our society is also not geared to make these changes. We work long hours in order to make ends meet leaving little time and energy to do all the right things. Physicians don't always offer flexible appointments and most employers perfer you don't take time off work to take care of personal appointments. So the change needs be all encompassing .It amazes me that health insurance plans will readily cover the cost of bariatric surgical interventions for obesity but do not cover (or some may minimally cover) non-surgical interventions such as weight watchers and/or gym membership that can be very successful in preventing or treating obesity. Our society needs to change along with our individual attitudes toward self care.
James Kiefer April 27, 2011 at 02:41 AM
Education is the key I believe. There also needs to be a sense of individual responsibility. There is no magic bullet for obesity, despite what the media says. It comes down to being responsible for what you eat and how you excercise. Instead of taking a pill for everything, often times it is possible to avoid complications or at least minimize them, by taking a common sense approach. As far as children being obese, it is a real shame that children are not encouraged to be active and eat healthy. A a parent, there is no greater responsibility than to do all you possibly can for the betterment of your child. If it takes incentives, than so be it.
ethelglisson279 April 27, 2011 at 07:18 AM
Companies do give out samples. They are looking to put their products in potential consumers' hands. They wouldn't do it if it didn't work one of the place that always worked is "123 Get Samples" search online
Katheryn Metzger April 27, 2011 at 11:27 AM
I agree that americans need to take more responsibility for their health. I also think that the PCPs need to make more of a commitment to their patients by taking the time to educate and actually have a conversation about the patient's wellness goals, not just the current ailment. Education on weight loss needs to be explicit. It may require uncomfortable conversations about the patient's life style.
Jill Snelders April 27, 2011 at 11:48 AM
We should take personal responsibility for our own health however, every organization should institute healthy lifestyle programs as incentives to encourage all (especially children) to make better choices. For instance schools should not cancel recesses at the drop of a hat and should have kids out walking on cooler days (dressed appropriately). After school daycare programs should have fitness incentive programs to encourage kids to be active while at daycare. Schools should have weekly fitness logs along with reading logs that kids should have to complete and submit each week. Food choices at school, home and at restaurants should be portion controlled and reasonably priced. We have to pay too high a price for healthier choices. More coupon incentives should be offered for healthier food options. The incentives offered thus far are only a drop in the bucket. Obesity has to be a nationally recognized initiative that challenges everyone to help break down the barriers so that choosing a healthier lifestyle is an option for all.
Reese Nolan O'Hanlon April 27, 2011 at 01:55 PM
Wellness is not a destination; it is a practice that each of us must implement in our individual lives. Wellness is an essential endowment that each person must give to himself/herself, as well as his/her loved ones. Everyone must make a conscious effort to practice wellness. Wellness is not something you do; it is something you are. PPACA established the National Prevention, Health Promotion and Public Health Council to coordinate federal prevention, wellness, and public health activities. Wellness can be practiced at any stage in one's life, regardless of an individual's health status. Each time a person makes a wellness choice, he/she reaps the bounty of a consequence that moves the person toward better health. Examples of wellness implementation are weight reduction, the cessation of smoking, and the integration of exercise into one's life style. In essence, the person who makes a conscious effort to implement wellness gives his/her life the integration of physical, mental, and emotional harmony. Each person's wellness story is unique and evolving. Practicing wellness is an individual responsibility that changes over the stages of one's life. As the Nike shibboleth says, "Just do it"!
Kate Fenton April 27, 2011 at 02:26 PM
After attending the mentioned panel discussion and reading many articles about healthcare reform and the obesity epidemic I must say all responses thus far have been on target. As a professional working in pediatrics and a parent it has been my goal always to assist children in adapting healthy lifestyles. The schools have started many proactive programs, including changing menus, including children and families in decision making efforts concerning healthy diets and habits, and providing activity programs and events that no longer center around food, but shared experience. These small steps are presently threatened by cuts in school budgets as I type, so they must stay vigilant not to lose ground. In the hospital, children and families are refered to a nutritionist for education about nutritional changes that can assist the child with recovery and adapt lifestyle changes that can proactively prevent some chronic illness. Support groups and education sessions are conducted for children, families, educators and coaches to help affect habit changes. So much more can be done and the information must get out there for people to take advantage of these programs. That being said, as an adult who struggles with weight loss, it is not an easy task to individually address this issue, no less nationally. Positive reinforcement will probably work best, physicians, educators and counselors can reinforce healthy adaptations to assist the individual in health care responsibility.
Lorraine Mercado April 27, 2011 at 03:36 PM
I believe we are part to blame for the obesity issue in our country but the media is also to blame for our health too. When I was growing up once in a while we had fast food, which was a hamberger or a Nathan's hot dog. Now everything is fast. I hear new moms getting take out on the way home and not cooking any more. All this nutritoin is gone. The media is a powerful element in our lives. it plants seeds so the thought grows in to laziness. Do you see kids outside riding a bike or playing hopschotch? Electonic devices also contributes to everyone sitting in front of these devices and not expelling any movement or excercise. I believe starting from the homes to instill proper health habits would be a start. May be in the schools have a parent class which includes this topic. Lorraine Mercado
Patricia Butera April 27, 2011 at 04:59 PM
Health and Wellness are the responsibility of the individual. Obesity is on the rise for a multitude of reasons which include but are not limited to: Exercise and dietary habits from birth, costs of fruits and vegetables and eating well, accessibility and media advertisement of fast food, knowledge deficit related to physicians not educating their patients appropriately on losing weight. Even the school systems are not on board with exercise and nutrition as what programs do they cut when the budgets fail? They cut gym, after school sports and bring in many carb loaded lunches to feed the masses. We are not structured as a society to aspire to wellness. We don't need incentives, we need a life change which begins with the ACA funding education NOW and not incentivizing health and wellness in 2014. By 2014 we will have added another large group of individuals who are obese and suffering from the associated illnesses. We need the government to work on reducing gas prices, grocery prices and the cost of living so that individuals can be taught nutritional and exercise guidelines but can afford to be part of the teaching. If there's money to give incentives in the future why not invest in the future, with today's dollars, now and show credibility and allegiance to our nation's health and wellness TODAY? We can't talk about it anymore we need action and this should be the priority of health care reform and it's far reaching tenets.
Jeffrey Thompson April 27, 2011 at 05:57 PM
Surgery anyone? Gastric Bypass; Lap-Band; both surgical procedures to treat obesity. The lap band is like putting a rubber band around your stomach to make it smaller, therefore eat less. The gastric bypass literally bypasses the small intestine working on the premise of malabsorbtion. Why do we need surgical procedures? Probably because as a culture, we eat a lot of processed foods that have a lot of calories with little nutritional value. People who are obese think surgery is an easy fix, but it is really a money maker for the physicians and hospitals. Yet, food is something we all need and it can be expensive. So once again, it comes down to personal choice and what YOU decide to put in your own stomach. Go ahead.... have that Big Mac and super-size it while you are at it. I will be eating my protien bar and taking a vitamin supplement (both processed).
Bonnie Morales April 27, 2011 at 07:33 PM
Bonnie Morales This epidemic of obesity did not happen over night. It was a slow process that sadly has taken until now to become a "problem". Along with the health care system that needs to be fixed, there will also need to be a cultural change in society's way of thinking about health and the obesity epidemic that continues to grow. As a society, there needs to be a collaborative effort which includes parents, doctors, schools, businesses and government, to educate all individuals on the importance of health and develop programs that allow us ALL to "walk the walk, not just talk the talk". We all need to be responsible and accountable for our health. Why does it always come down to money and the need to have positive or negative monetary incentives for an individual to be healthy?
michelle cheslak April 27, 2011 at 10:30 PM
I believe in incentives for hospitals to pay for performance but I don't believe the the government should be giving incentives for people to stay healthy. It is an insult to our society. We should worry about educating our children and providing classes to promote healthy living
Denise Bongiorno April 28, 2011 at 12:33 AM
Obesity did not happen overnight and for anyone who has ever tried losing weight, it will not reverse overnight either. Americans feel entitled to their way of life and good luck to anyone (insurance companies, govt., employer) who tries to tell someone that they "have to" lose weight. It must begin with education--from our schools, physicians and parents. However, the people teaching it must also be demonstrating it. No one buys into "do as I say, not as I do". The true incentive for losing weight is not money, it is the joy of true health and all the blessings that come with it.
Through the Looking Glass April 28, 2011 at 11:16 AM
I am appalled at the size of so many people I see. I see obese children being lead around by their obese mothers who are accompanying their obese mothers. I am not going to profess being textbook perfect in my shape and size but I have no compassion when those around me are waddling because they can't walk properly. When the size 24 mother is buying her preteen children sugary foods and stuffing sweetened drinks in their faces how can we expect people to have some from of fitness? Those of us who can remember when McDonalds was a novelty can also recall that most people of that era were relatively trim and what we considered fat was probably nothing larger than a size 14. (Sorry if my size relativity picks on women. I don't mean to be chauvinistic here) Today I believe that seeing a size 14 is generally the "slim" woman, not the heavy one. And how many beer bellies do you see on men? Legs the size of chests are not uncommon. Heart disease is rampant in both sexes. Diabetes is rising faster than the national debt and unfortunately there's also too many pills available to mask the the problems associated with the diseases. Children are waddling into their preschool classes while their overweight mothers give them prepackaged foods that are essentially dripping with sugar. When the suggestion is made to give them a bag of grapes or something with no added sugars the mothers give blank stares and come in the next day with store bought buttered bagels with 1/4 of butter on them!
christine diah April 28, 2011 at 04:15 PM
The facts are sobering, An inspiration for me to do better selfcare. This information should be made available to schools at every grade level and to people in lower income neighborhoods. People in lower income neighborhoods tend not to pay attention to nutrition and have the highest incidence of obesity, high blood pressure and high cholesterols.
Joan O'Rourke April 29, 2011 at 03:55 PM
I don't agree that employers or the goverment (our tax dollars) should have to give us incentives to stay healthy. It has to be every indivduals responsibility to want to be healthy. Education has to be provided so everyone is given the opportunity to understand and make healthier choices but after that the individual needs do the right thing. Yes I agree changing your habits is very difficult but when it interferes with life or death the individual has to get onboard no one can make them change.
anthonia onyemem April 30, 2011 at 04:20 AM
I think it’s our individual responsibility to take care of ourselves. Americans are not concerned with their eating patterns and the damage it does to their health. For example, the people who you see obese are the same ones you see always patronizing fast food restaurants. Healthy choices are not even on their agenda probably because of the addictive nature of these foods. I think providing incentives to people to take care of their health is a good idea because it will help reduce some of this health problems related to our eating habits and also be a cost saving strategy for the federal government since healthcare inflation is on the rising.
Louanne Charles April 30, 2011 at 10:40 AM
Though it is every individual's responsibility to take appropriate measures to ensure that they live healthy lifestyles and maintain good habits to promote longevity, it is a difficult struggle for some to accomplish, and may seem easier said than done. In every aspect of life, there are people who are stronger than others and need help and motivation from others to help them along the way. Although there are services provided to help individuals, not everyone has the courage to seek out help on their own. I think that ethically, having people on the outside take the initiative to help others before they ask is the type of push we might need to improve the health of the people of this generation, and for generations to come. I'm not sure if financial incentives are the best approach, but I do believe that some type of incentive would be a beneficial drive. As I've mentioned before, if the government is willing to pay physicians to perform, and for meaningful use, they can offer incentives to people who can benefit for healthier lifestyles.
Sandra Boddice May 04, 2011 at 03:14 PM
I agree that individuals are accountable for following healthy dietary practices; however when there is no consensus as to what is a healthy dietary practice it is extremly difficult to stay on track. During the past few years there has been disagreement within the Medical community; beginning in the 1980s the macronutrient 'fat' was demonized and was touted as a major factor in causing heart disease. The American population reduced their fat intake and the statistics show an increase from 1980 to the present day in heart disease. The medical community does agree that eating more fresh fruits/vegetables/lean protein and exercising on a consistent basis is integral to maintaining good health. However the general population is tharted in their attempts at following these guidelines; take a look at the television adverts promoting 'fast processed food' and encouring the consumer to buy double the amount by offering discounts, the film 'Super Size Me' is a wonderful example of this tactic. Have you ever been into a 'poor' neighborhood and looked at the availability of fresh fruits/vegatables/lean protein and whole grains? I have and I can attest that there is a limited availability of this produce. Yes we can continue to be critical of the unhealthly and obese but lets not forget that they are supported and encouraged every day by 'big agro' and in some part by the medical community who let's face it get paid for the number of 'sick' people they care for.
Barbara Hutchens May 06, 2011 at 02:18 AM
Great article. It is about time we start taking some personal responsibilty for our health. As the article stated it is not always an easy task but something we need to continue to work on. I would love to see lower copayments for people who are compliant and striving to improve their health. NSLIJ has been working toward improving employee health. This year they are offering financial incentives to employees who don't not smoke, those who go for an annual check up and those that take a health risk screen which creates an EMR for the employee. We need more employers to get on board and provide wellness programs. Not only does it decrease employee sick time it reduces the insurance rates.


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