What’s the difference between health prevention, health care, and public health? Health prevention tries to address the causes of health imbalance and disease. Health care treats an individual after symptoms or disease manifests. Public health tries to remove disease contributors— that affect all people. The bottom line is that some health concerns must be addressed through health care and making the right personal health choices. But some disease contributors can only be addressed by modifying societal health choices.

Let’s first clarify the difference between personal and societal health choices— and the connection between them. On the personal level, if my friend, Ralph chooses to regularly over-eat foods known to produce gain weight, his personal decision may drive him towards obesity. On the societal level, if corporate influence, regulations, laws, subsidies, and social policies make fattening foods cheap and available, then these policies will drive Ralph— and millions of others— towards weight gain and obesity.

According to data from the Centers for Disease Control and Prevention (CDC), the American obesity epidemic currently affects “more than one-third of U.S. adults (35.7 percent) and approximately 17 percent (or 12.5 million) of children and adolescents.” Doctors now know that obesity leads to many other illnesses, including diabetes, cardiovascular illness and cancer. The U.S. spends $190 billion a year on obesity-related conditions.

Sixty percent of Americans die from heart disease, cancer, and other diseases related to diet, according to figures compiled by the Physicians Committee for Responsible Medicine. With nearly 68 percent of Americans overweight or obese and incurring annual medical expenses of $147 billion, how did we come to treat healthy food, weight loss, and nutrition as exclusively a matter of individual choice?

Ideally, Ralph should exert personal will. Doctors and nutritional experts regularly urge people like him to alter their food choices. But when over TK 25 million people have trouble acting on that solid medical advice, it shows the limit to defining health promotion solely based on what an individual can do him or herself. Viewed as a kind of unintended scientific experiment, these numbers prove why appeals to individual willpower can’t substitute for grappling with business drivers that oppose health.

Asking people to choose healthy foods in “today’s toxic food environment is like expecting someone being swept up in a tsunami to swim away,” says David Ludwig, MD, Director of the Optimal Weight Loss (OWL) Program at Children’s Hospital Boston, and Associate Professor of Pediatrics at Harvard. Ludwig is a leading obesity researcher and clinician.
There are specific reasons why “swimming away” is an impractical solution. As Michael Moss brilliantly documents in Fat, Salt, and Sugar, Ralph’s willpower is undermined by the food industry. It uses these and other ingredients to make unhealthy foods neurologically addictive. As public and business policies permit the food industry to produce and market foods that make millions of people obese and sick, proposing individual solutions misdirects public attention from the real causes.

As Einstein said, “Madness is doing the same thing and expecting a different result.”

Food and health care are the two most accessible entree points for decisions to either build or neglect health. Healthy nutrition can promote immunity and healthy function while unhealthy food can undo them. According to a meta-review of twenty-seven studies, published in the British Medical Journal, unhealthy food costs about $550 less per person per year, than healthy food. A behavioral study by the Centers for Disease Control and Prevention found that, excluding French fries, there has been little increase in vegetable consumption since 2000, despite health objectives set by the federal government and urged by doctors.

The main problem, these researchers say, is that due to “a complicated stew of government subsidies,” vegetables cost more than junk foods like Doritos. In a September 5, 2010 article Denver Post reporter Karen Auste writes, “the way money is doled out, moves us away from fruits and vegetables and toward meat, dairy products and the sugar- and sodium-loaded processed foods for which crops like corn and wheat serve as the raw ingredients.”

The price difference between healthy and unhealthy food is “very small in comparison to the economic costs of diet-related chronic diseases, which would be dramatically reduced by healthy diets, ” Dr. Dariush Mozaffarian, the study’s senior author and associate professor at Harvard School of Public Health and Harvard Medical School.

Adjusting business and social policies to decrease access to unhealthy foods and increase access to healthier ones would help people like Ralph, and should be considered. It could begin with accounting for the nutritional, health and economic impacts that come from:
• The industry lobbying for subsidies and questionable food ingredients
• The farm subsidies for cheap foods
• The public policies that green-light known obesogenic food ingredients
• The public monies that put them into schools and hospitals, and
• The advertising dollars that get people hooked on them.
• The industry PR that rationalizes our policies through persuading people to believe that eating healthy and organic foods is “elitist.”

Even though theoretically we are allowed to promote health as individuals, there aren’t always available consumer options at prices that everyone can afford.

Here’s another example: there are not always safe and non-toxic choices when we seek to minimize toxic exposure through the personal care products, clothing, cans, or home furnishing or construction ingredients we buy. And what about the toxic exposures that lie beyond individual choice via industrial toxic outputs, like radiation, smog, pollution, and agricultural poisons. Unless you hold your breath or don’t drink the water, these cannot be readily avoided.
There is no doubt that many factors that impact health arise from within us (including fitness, genetics, nutritional status, and attitudes.) Many more factors enter us from without, (such as food, product ingredients, industrial toxins, radiation, and more.) As individuals, we can choose to avoid certain potential health harms. But many exposures occur beyond the zone of individual choice.

Although it is an absolute necessity to both prevent and treat health as an individual, one person at a time cannot compensate for epic health-harming social and business policies. Americans should not be paying the price one-by-one for systemic inattention to health consequences. We must somehow shift our approach.