don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

Last week, I gave a talk in Delaware to health educators. I reluctantly confessed that experience has led me to believe most folks will NEVER achieve anything remotely like a wellness lifestyle -- unless we can get THEM to cast off THEIR metaphorical burkas (customs, beliefs and conditions supportive of mediocrity.) I outlined seven propositions to stimulate discussion of new strategies for SUSTAINED behavior change. I have been promising to summarize these propositions -- and finally got around to it.

While a few heroic, talented, courageous and/or fortunate citizens among us sustain healthy behaviors, most fail. What makes the difference is a strong sense that wellness is worth the trouble. How can we convince the suffering masses that it makes sense to work at the kind of behavior change called wellness, or self-management for lifestyle artistry?

Here are the seven propositions I offered for conference participants to ponder and discuss. The idea was that these might stimulate discussions about new strategies for success in raising the value of behavior change.

Proposition One:

It is unkind to promote wellness to most Americans. Under existing conditions, doing so is unintentionally cruel and, what's more, you should take care not to display too obviously your own wellness lifestyle if you are among society's lifestyle elite. Going on about how wonderful you feel just makes the average, "normal" citizen feel even worse. Maybe we can't, as true believers, help ourselves, that is, refrain from whooping it up about how great it feels to be fit and all that. Just the same, we should at least attach warning labels to our enticements for wellness behaviors: "Caution: Attempts at healthy lifestyles could lead to serious backsliding" or something along these lines. Let's warn people about the high failure rate of any attempts to sustain healthy lifestyles.

Dr. Judd Allen, head of the Human Resources Institute that seeks to create healthy cultures, responded to a draft of this proposition by pointing out that while "it is true that almost all lifestyle change efforts fail, the best alternative is not to shy way from these issues, but rather to help people go about their change efforts systematically and with supportive environments. The challenge at this point is to make such an approach fun and workable." This situation reminds me of some unknown comedian's remark: "If you can't be a good example, at least be a horrible warning."

Proposition Two:

If you think medical care is expensive now, hold your hat -- or pocketbook. It's going to get even worse. Absent the advent of major reforms in the existing system, I predict that, by July 18, 2007, only fifty Americans will be able to afford health insurance. If your picture has not appeared in Fortune Magazine in recent years in connection with the listing of the world's richest men and women, you almost surely will not be one of them. Due to rising costs, some people will initiate behavior changes, but fear of illness or financial ruin is not likely to motivate behavior change, let alone sustain such changes over a period of time sufficient to enable health and life status advances.

Proposition Three:

If you want to increase public awareness of the importance of behavior changes, run for public office. Do so on a platform that promotes wellness values, mindsets and principles, in addition to whatever other local issues you choose to embrace. No need to make this decision anytime soon -- just consider the option for a later stage in your life. Never forget that you do not have to gain the most votes to "win" big time. You will "win" by knowing that you have reached large numbers of people who otherwise might not have heard about wellness values. You will also shape the debates about a wide range of policy issues from a perspective that otherwise would not arise during the campaign. In short, you will win friends and influence people for wellness, self-managing values that tend to sustain healthy behaviors.

Proposition Four:

Challenge those who express ludicrous ideas! Do this in a charming, pleasant way, of course. Question perspectives and viewpoints you think are bizarre, dysfunctional, dangerous or simply jejune. Doing so will be a service to others and society, and an expression of your own integrity. An example might be a cliché such as, "I believe there is a reason for everything." How many times have you heard that? By challenging such assertions, you will contribute to the "smarting up," not the continued "dumbing down" of society. The point is not to convert others to your point of view; rather, the objective is simply to offer a rational perspective that others, including bystanders, might mull and ponder, over time.

Proposition Five:

America desperately needs a reformed health or sickness care system. I favor a national health insurance scheme that provides catastrophic coverage for all, but with costs tied to positive wellness incentives. For example, if a taxpayer completes a wellness assessment (which, of course, must be defined to assess positive health indicators, not just signs of illness, disease and risk factors), a substantial tax credit or co-pay reduction would be allowed. Even more important would be a set of incentives for further cost savings and/or service entitlements based on evidence of personal responsibility initiatives consistent with and supportive of health status advances.

I recognize not everyone is enthusiastic about a federal role in organizing the medical system. Maybe with Homeland Security and everything else, the national government is not the best manager for a reformed system that covers everyone. I can't forget what P. J. O'Rourke said on this topic: "If you think health care is expensive now, wait till you see what it costs when it's free!"

Proposition Six:

Humans need to evolve more effectively. Why should changes come about so slowly? How about some experiments designed to speed up the process, and shape things in ways that enable our successors to turn out a bit better? At present, so many of us seem pain driven. That is, we will not make changes until the pain of changing is less than the pain of staying the same. As long as the pain of staying the same is less than the pain of change (or is PERCEIVED as such), we don't make changes. This is no formula for sustaining behavior change, is it? However, it surely does account to some extent for the sorry state of American health. What do YOU think? Would an administration that opposes cloning also block conscious evolution -- even if only for wellness purposes?

Proposition Seven:

For better results, sustained behavior change might be tied to the quest for the meaning of life. OK, maybe not THE meaning of life, for after all there may be no overall single meaning applicable to all. There certainly does not seem to be one that we humans worldwide or even in America are likely to agree on. Right? So, how about promoting a quest for a process of seeking more meaning, a part of which could be the search for happiness, or at least more of it? I propose we encourage people to think of meaning, purpose and happiness in four structured parts:

A. The ground floor of meaning, that is, subsistence/safety and security seeking. For most, perhaps, this is the orientation that gets attention throughout life. It means your job, career, and all that connects with securing the means to get by, preferably in a little style and comfort.

B. Meaning at the leisure level. This entails some concern for living wisely, agreeably and well (a phrase attributed to John Maynard Keynes.) Maslow called this level "belongingness" in his famous "hierarchy of needs" construct.

C. Meaning found in the development, refinement and expression of talents, gifts and uniqueness. It entails self-fulfillment and earned self-esteem.

D. Meaning from reaching out and being of service. This could entail meeting needs of others, or the pursuit of knowledge for the betterment of society.

At the conference, a discussion of these propositions was followed by twelve suggested areas that would, in my opinion, give the best results in terms of wellness advances.

At about the same time as I spoke in Newark, DE, the HHS Secretary Tommy Thompson announced a $15 million grant to promote "Healthy Communities," which will be increased to $125 million next year. Thompson noted that 7 of 10 deaths and the vast majority of serious illness, disability and health care costs are caused by chronic diseases, such as obesity, asthma, diabetes, heart disease/ stroke and cancer. How do these diseases come about? Thompson listed "risk factors," such as poor nutrition, lack of physical activity and tobacco use and exposure. If people were wellness enthusiasts, that is, pursuing and sustaining positive lives because they are their own reward, would these risks exist? I doubt it. That is not really a vast sum for such an ambitious undertaking, I know, but it's a welcome if modest start. After all, the healthy communities endeavor is about health-enrichment, not disease treatment. This kind of funding might do some good for the goal of promoting sustained changes for healthy behaviors.

My speech was much longer, but the propositions noted above were at the heart of the matter. Think of how much time you saved by reading all this, instead of listening to it! Be well and look on the bright side.

(Note: This essay will be filed in the archives in the MENTAL DOMAIN under the skill area of mental health. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

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