You can disagree with the doctor \u201d\u201d you can even be offended \u201d\u201d and still come to see that there is a larger point behind his tough-love approach. The debate over health care reform has so far revolved around how insurers, drug companies, doctors, nurses and government technocrats might be persuaded to change their behavior. And for the sake of the economy and the federal budget, they do need to change their behavior. But there has been far less discussion about how the rest of us might also change our behavior. It\u2019s as if we have little responsibility for our own health. We instead outsource it to something called the health care system.<\/p>\n
The promise of that system is undeniably alluring: whatever your ailment, a pill or a procedure will fix it. Yet the promise hasn\u2019t been kept. For all the miracles that modern medicine really does perform, it is not the primary determinant of most people\u2019s health. J. Michael McGinnis, a senior scholar at the Institute of Medicine, has estimated that only 10 percent of early deaths are the result of substandard medical care. About 20 percent stem from social and physical environments, and 30 percent from genetics. The biggest contributor, at 40 percent, is behavior.<\/p>\n
Today, the great American public-health problem is indeed obesity. The statistics have become rote, but consider that people in their 50s are about 20 pounds heavier on average than 50-somethings were in the late 1970s. As a convenient point of reference, a typical car tire weighs 20 pounds.<\/p>\n