Deadliest Disease in America: Bad lifestyle

Over the course of the last 100 years, clean water, vaccines, and antibiotics have doubled our life expectancy. However, a 65 year old today can expect to live only 6 more years than a 65 year old one hundred years ago. We’ve solved the simple acute problems and now we’re left scratching our heads trying to figure out how we can change our culture’s behavior. Unfortunately, the business model of changing behavior for the better is a bit murky. It’s much easier to make money bottling up pills and performing surgeries.

But the future of health in the developed world depends almost exclusively on changing our behavior for the better by eating greener, exercising, and finding happiness. However, the tools we’ve used to solve acute problems in America– public health measures and medical care from doctors–will only sustain our nation’s health, not improve it in a significant way at the population level. Doctors therefore need new tools to tackle “bad lifestyle” if they want to significantly impact health over the next century. Either they stand aside and let behavioral/lifestyle professionals take over prevention and chronic disease management or they take the initiative and become the leaders in the medical/cultural/anthropological space.

And that’s where lessons from a book I just finished, Switch: How to Change Things When Change is Hard, can be applied. It describes the relatively new field of behavior change science. This book should be required reading in the first week of medical school and at least 50% of medical education should focus on behavior change science if the medical profession wants to lead and change health in the 21st Century. Please take the time to read Chapter One ofSwitch. And buy the book. It’s a fascinating read. Most importantly, Switch highlighted the fact that behavior change science is a relatively new field with very few home runs but plenty of anecdotal evidence. Here’s an expert describing the basic concept:

The conventional wisdom in psychology, in fact, is that the brain has two independent systems at work at all times. First, there’s what we called the emotional side. It’s the part of you that is instinctive, that feels pain and pleasure. Second, there’s the rational side, also known as the reflective or conscious system. It’s the part of you that deliberates and analyzes and looks into the future.

Our emotional side is an Elephant and our rational side is its Rider. Perched atop the Elephant, the Rider holds the reins and seems to be the leader. But the Rider’s control is precarious because the Rider is so small relative to the Elephant. Anytime the six-ton Elephant and the Rider disagree about which direction to go, the Rider is going to lose. He’s completely overmatched.

If you want to change things, you’ve got to appeal to both. The Rider provides the planning and direction, and the Elephant provides the energy. So if you reach the Riders of your team but not the Elephants, team members will have understanding without motivation. If you reach their Elephants but not their Riders, they’ll have passion without direction. In both cases, the flaws can be paralyzing. A reluctant Elephant and a wheel-spinning Rider can both ensure that nothing changes. But when Elephants and Riders move together, change can come easily.