08/27/2009 05:12 am ET Updated May 25, 2011

A Healthier America

President Obama spoke about a healthier America on Wednesday night. I am very aware that our very important debate about health care is focused on the medical profession and how much it costs us to go to the doctor, be referred to specialists, endure a battery of tests and machines, and if necessary have advanced procedures and surgeries where things are taken out of our bodies and other things are put in. But medicine and health are not necessarily the same thing. Part of the turn-around has got to be to de medicalize America.

I watched the President's remarks (and the muffled seeming questions from the press) while in Big Sur, California. This is a stunning part of the country. The California coast line here is magnificent. Cars pull over all along the road and people from around the world stand in awe at this part of the Pacific Ocean. The histories here are diverse, and there's a convergence of cultures: black leathered bikers (that is motorcyclists -- you'd have to be out of your mind to ride a regular bike around these curves on Highway 1), hikers, campers, fishers, rich folks who can afford the Post Ranch Inn (2K a night and more for some rooms -- what bad economy? ), people on horse back the closer you get to the actual sand of the beach. There are diverse histories here -- the Esalen Indians are said to have been among the first. I asked my guide today, a member of the historical society, if there were any Native Americans around now -- he said, "I think there's one of em." There were miners here. Japanese concentration camps. Jack Kerouac and the beat writers were here. Kerouac's house is still under the Bixby Bridge. Then the people into the human consciousness movement -- exemplified by the Esalen Institute, which sits on a magnificent cliff with it's nude baths even now. Up the hill a monastery. And story after story of decadence, as you breathe in some very healthy air: "You used to be able to go into the bar and bar tender'd hand you a beer and a tab of acid". Maybe not so healthy. The point is, part of a healthy America is the vibrance of cultures and imagination set in action. And part of a healthy America is the vast diversity and beauty of the land.

I hiked today with Bill, who has lived in Big Sur since 1963. At 67 years old, he is vital, strong, and weathered. He "was around all those people" -- Joan Baez, Kerouac, Ginsburg -- everybody it seemed who had passed through here. I doubt if Jack Kerouac was very healthy given the amounts of alcohol he and the literati of the time -- the beat writers and poets -- were said to have consumed. But in those days it was not about being healthy.

Bill took me over a river, up a mountain and down the other with a vista of the sea, pointing out all the mountain lion droppings as we walked. "Oh, don't be scared, they don't come out til dusk." We stopped at a large redwood tree and he put his hands on it and dropped into total silence for a few moments. He then humbly reported, "The Indians could feel the spirit in the tree. I can't feel it much. Just a little." He shook his head, as if he'd been trying to feel that spirit since he arrived in '63. He told me bits of history and marveled at how the young kids -- the ones making current history -- have come back to the earth: "They're growing their own food and raising their own goats. They got these mushrooms that suck the oil out of the earth." I thought about one of the "young kids" I'd met in a bakery by the Big Sur River, Tommy, a tall lanky white guy and a drummer, who is into anthropological recordings of African music. I was downing espresso, as the bakery has the only decent coffee for fifty miles or so along the coast. He told me he didn't drink coffee. I said, "Well what do you do when you need to stay awake?" He said, "Oh for me it's just water and intention." Okay, no wonder Tommy looks so healthy. Water and intention. I'll have to try that.

As Bill and I were coming to the end of our hike, we peeked through a heavy wooded area of redwoods, to see if any of the high school kids were down there fishing. He said the river was where some high school kids fished and got their dinner and where with this recession some people who'd lost their homes were living. I said well at least the land welcomes them, and started playing around with word land -- lord. Who owns the land? Who owns our ability to move on the land? Who owns our ability to grow on the land?

I would have liked to swim in the river but it's too low. When Bill, the guide and I waded across the Big Sur river, we barely had to roll our pants legs up. "Global warming," he yelled out in exasperation.

I remembered that Monterey, about an hour away, had a unique and well appointed -- "Monterey Sports Center." I'd been to Monterey a couple years before, to a conference, and as is my practice when I get to a new town, I had hunted around for a swimming pool. Sometimes I have to deal with a small over chlorinated hotel pool. Sometimes I luck out. In Monterey I lucked out. I think the community -- note the word community -- pool must have at least 15 lanes. I was amazed, and remain amazed at the facility of which the pool is a part. It was a civic enterprise -- it took three cities or more coming together (Monterey, Carmel, and Pacific Grove) to build it, and a lot of support from business -- as signs along the walls attest. It's state of the art -- significantly better than most private clubs I have been to. (Some of these have become exorbitant in terms of fees -- obviously it's a privilege to stay fit: one of my favorite Washington DC "clubs" now charges 6K a year, and really doesn't want new members, I was told.)

The pool here in Monterey has water slides for kids, plenty of room for water aerobics classes, with an abundance of lanes left for swimming lessons and lap swimmers. A far cry from a memorable swim I had in New York City: At prime time, 6:30am, there were so many swimmers that we had to reluctantly succumb to what city folk would know as "the circle swim." That means a line of swimmers follow each other up one lane and down another -- kind of like on a highway. Faster swimmers pull out to pass slower ones. I bumped into a well-built type-A guy. He stopped me and announced, "If you bump into me again, I'll drown you." That would not be very healthy.

The basketball court at the Monterey Sports Center is very large -- the cardio and weight rooms are up to standard of anything you 'd find in one of the major commercial gyms. The place is spotlessly clean, well maintained and well lit.

I loved the physical attributes of the place, but what I marveled at most was the diversity of the people on the machines, on the basketball court, in the pool. They pull in 3,000 people a day. There were -- the super fit (they offer triathlon training), people rehabilitating, people who clearly had not moved very much in their lives, very senior citizens, and youth of all ages. I saw an Asian American woman who looked to be in her sixties doing chin ups.

Most of the "clubs" I go to, and even some Y's, are filled with middle class whites. Not so here. Though most of the over people over 45 were white, the kids represented a wide variety of races. It's probably the most ethnically diverse sports center I have ever visited. Here's a perfect image to describe what I mean: A white haired woman in a walker with a daughter or grand-daughter, or perhaps a great grand, at her side -- and young Latino kid with a basketball crossing in the hallway.

And people who pass you actually say hello (very different from the studied absence of recognition of other human that I experience, again, in private clubs all over this country). It's probably very good for the national health for us to learn to speak to one another. And I have noticed, that the healthier people seem to be physically spiritually, and intellectually, the more they speak to those who pass by. We are all a member of the human race. There's nothing I enjoy more than being in a strange town and sharing a greeting with someone coming from or going to their workout "Morning!" "The water is fantastic today!" "Have a good one!"

A guide I had while visiting townships outside Johannesburg, South Africa put it better. After being with me for a week, and noticing that I had the American habit of not speaking to strangers, he said to me quietly and in a cautionary tone, "African people like greeting." And so I learned to nod and acknowledge the people I passed. Greeting the humans we pass is a form of national (and international) health.

Even the military has something to teach us about a healthier America. I visited Landstuhl Army Hospital in Germany. Everyone was fit! They were stunning! Staffers walked around full of energy and purpose in a pristine clean environment. I compared it in my mind to the often lethargic hospital workers I've come in contact with in our civilian hospitals. Why? The army required a certain number of hours of physical fitness per week. Employers I hope are thinking as much about putting money and incentives into getting a fit work force as they are in thinking about insurance costs. And schools...need I say more? It is a disgrace that we have taken sports, dance, physical Ed and healthy eating out of public schools. (I wonder if schools even still have a school nurse.) I had all of the above in what was for all intents and purposes a segregated school in my youth.

In Baltimore, Maryland, Blacks, Jews, Poles, and Italians all lived separately. As a girl -- the Negro YMCA had a swimming pool, swimming lessons, and summer camp. As a teen I changed my perspective on the world, largely due to a YWCA that was integrated and that somehow -- without what we now call "diversity programs" -- managed to integrate the place and to put young women from all kinds of backgrounds in contact with each other, while we swam, hiked, taught theater, learned to dance, taught crafts, learned about leadership and learned about civic responsibility.

There's so much about our health that never should have been medicalized. I think we gave up on our own wit to solve problems, and have given it over to medicine. And with the flooding of pharmaceuticals into our daily lives, this will get worse. I think the President's aspirations for a repaired health system will come to fruition. His resolve and commitment are palpable and I think they will prevail -- we have to turn a lot back around. But even if, and especially if, a new improved era in health care comes to pass, we will need to reclaim our bodies back from medicine. We need to revise not just health care but our relationship to it.

Ask a doctor about nutrition -- that is, about what you choose to put in your mouth -- and you won't hear a lot that's appealing. Even though they eat, just as we do, they seldom talk about food with imagination. I think you have to go to the people who've been thinking about alternative ways to cultivate, distribute and prepare food to start to redo your relationship to food. Or talk to athletes! They are motivated to win and know some things about how nutrition works to get the most out of your body.

And God help you if you're stuck in a hospital without a friend to bring in decent food. Even with the attention to national obesity, I guarantee you; it's a rare doctor who is going to say anything that's significantly different than what they may have said twenty years ago. Ask one about weight control, and you're lucky if you get them to look you in the face. They're usually scribbling something on a soon to be antiquated chart, and mumbling or grunting out a few overused sentences like "Move more eat less." "Calories in, calories out."

Doctors in Commedia Dell Arte were a source of comedy. The Italians, years ago saw their flaws. We, in modern times, in this country began to look at doctors as Gods, saviors. Well -- I can't help resisting a plug for a television show I'm in, Nurse Jackie, that enjoys the flaws in the system.

Doctoring brings sobriety to our consciousness in part because we live under the umbrella of the big scare -- cancer -- any one of us could get it and we don't know why. The best we think we can do is show up for yearly inquisitions the machines -- the machines that look and could possibly see. The machine does all the looking. We just sit there, or lie there, or endure the pokes and thundering screaming noises. We dread what they might see: diseases that we fear will take our lives or the lives of the people we love -- in spite of all the technology. Diseases that we fear will turn our lives upside down, put us in the clutches of insurance companies, and debt and all of the other horrors that a more organized more cost effective universal health care is meant to revise. Diseases that will ultimately take our lives and those of the ones we love. And then a deep silence. We have a culture that does not speak much about mortality.

One thing is certain. This new era of health care will require more responsibility on our parts. We simply will not be able to plant ourselves at the doctor's doorstep like laundry to be cleaned and returned the next day. There's a lot of discussion of what this will cost us financially and not enough discussion about other sacrifices we will need to make. Will all of us be able to get everything we need when we think we need it? Will there be new kinds of ethical considerations? To prepare ourselves for what may be tough questions we need to be stronger, as consumers and as citizens. I was concerned that the press at the President's press conference sounded so timid. Was it because the President's microphone was stronger? Was it because the press who stood to ask questions often did not hold their own mikes close enough to their mouths? Are their upper arm muscles weak? They sounded very faint in comparison to the President. From as far back as Jefferson, who was ambivalent about the press, but acknowledged their importance, we've known that we need a healthy relationship of press to President to have a healthy America.

There's a lot we need to do to get our health on track and to get it to the level as is often said of "other developed countries". We all have to start someplace. For me, I think it starts as communities getting healthier together on all levels. I've never seen anything like what they are doing in Monterey. A real community center. For the last 15 years, I'd always research the town I was going to for a private "health club" where I could swim and work out. The "health" I'm looking for happens outside of "clubs". I am beginning to think exclusivity, is in fact, not so good for a healthy country. I'm looking for more well funded, impeccably conceived, high spirited, robust places like the Monterey community center. In my opinion, that's where a healthier America would start.

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