Health at Any Wage: Follow-Up From 'The Takeaway's' DIY Checkup

The role of personal responsibility in health is one that's hotly debated around these parts. And while there's no doubt that genetic factors, environmental influence, and public policy play large roles in shaping one's susceptibility to disease, propensity for obesity, and general wellness, there's always room for people to make changes within those parameters--up to 70 percent of chronic illnesses, after all, can be influenced by personal behavior.

And yet, the language that doctors and journalists often use to talk about personal health often leaves many people out. As part of a 10-part series, DIY Checkup, running throughout the summer on Public Radio International's The Takeaway, we're investigating what all people can do to live better, no matter their genetics, history, or economic status. This week, we discussed long-term goals, and determined that four basic behaviors--eating five servings of fruits and vegetables, exercising 150 minutes a week, and quitting smoking--offer near universal benefits. (For more on the fourth "behavior," and why it's not listed here, visit The Takeaway's blog).

When interviewing doctors about this behavior, the same narratives came through--narratives familiar to anyone who's read health journalism over the past five years: people need to get to the gym because they spend all day behind a desk or on the couch. There's truth to this: videogames, the Internet, desk-jockey jobs find Americans less active than before. But to generalize that people spend all day trapped in a chair (and to prescribe exercise as a cure for that) automatically excludes people who spend the majority of the day on their feet: janitors, sanitation workers, nursery-school aides, construction workers.

Of those workers, only a few probably get aerobic benefits on the job comparable to those gained from 30 minutes of heart-pounding, sweat-inducing cardio. All would likely feel better and have more energy for those jobs were they to fit in a little personal fitness each day (a new study shows that just 10 minutes at a time can have lasting benefits). But by defining the need for a workout as something endemic to white-collar workers, those who work on their feet may never get the message.

Then there's fruits and vegetables. On this morning's episode of The Takeaway, host Celeste Hedley mentioned that when it comes to getting your five fruits and vegetable servings, fresh is best. That's the conventional wisdom (and one I agreed with at the time), but a UC Davis study shows that canned, frozen, and fresh produce all have similar nutritional values (the link opens a PDF). That's an important point to make: many communities are stranded in so called "food deserts", places that have no real access to fresh produce. (Next month, NEWSWEEK's Claudia Kalb will have more on the issues of food deserts, available nutritious foods, and plans by nonprofits and the Obama administration to make fresh food more available.)

But what's the big deal? If everyone benefits from exercise and fruit and vegetable consumption, why does the language doctors use to convey that importance need to be so specific?

It's because making those healthy changes are hard. Even for people with both money and access to gyms and organic groceries often find themselves skipping their workout for a night on the town, or leaving expensive produce to rot in the fridge while they order takeout for the third night in a row.

The Takeaway series is about making healthy life decision as easy as possible. It's about making very small changes for maximum health benefits. When faced with too many obstacles--or really, any good excuse--people tend to take the path of least resistance. If they think they're excluded from the target group (as with exercise), they won't listen. If they think the health goals are too far out of their reach (as with asking people to eat five servings of fruits and vegetables) they see no reason to even try.

There are many, many obstacles that keep low income and working class citizens from obtaining better health. But unfairly and unknowingly excluding them from health advice shouldn't be one of them.