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David Katz, M.D.

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The Missing Link

Posted: 12/20/2012 8:13 am

As those here have abundant cause to know, I have lots to say. I strive for it all to be well-reasoned and reasonable, evidence-based and defensible, educational and entertaining, and ever in the service of epidemiology over ideology. I leave you to judge.

But whatever my successes or failures, I do have opinions to share. So I was delighted when LinkedIn invited me to join its inaugural group of 150 "Influencers," and blog directly to their network of 175 million or so. When I saw the company I was in -- from Barack Obama, to Richard Branson, to our own Arianna Huffington -- I was pretty sure they had made a mistake, but I wasn't about to tell them! I would ask that you not tell them, either.

LinkedIn asked us all recently to share our "big idea" for the upcoming year and beyond. As fate would have it, my big idea was all about something "linking in" is ideally suited to help fix. My big idea was about the next big thing in health promotion, and at present, all too often a missing link.

My big idea was: family.

The basic functional unit of our society is not the lone individual. We are social creatures, to our pith and marrow. The basic functional unit of our society is family. Family comes in many forms, of course, but any variation on the theme will do. However we define family, we know our own -- and that's what matters.

There was a time, in fact, when the irreducible unit of human culture was larger than the family. It was the clan or tribe or village. And at times, perhaps, it still is. But the diasporic forces that predominate in the modern world tend to disperse such larger aggregations, down to the level of the so-called "nuclear" family, itself a modern contrivance. Family used to be what is now called the "extended" family, and traversed several generations.

But family does persevere, and is the smallest unit of social cohesion at which culture is achievable. And it is culture that will determine the road we take to the future of our health; it is culture that will make all the difference.

Yet family has been routinely neglected in efforts to confront the salient human health threats of our time. This might be shocking, but it may be symptomatic of a larger trend in health care: oversight, born of expertise. So much attention to the parts, that we fail to see the proverbial elephant in the room.

Adults address the challenge of weight loss and control by going on diets that leave spouses and children behind. Employers implement wellness programming to lower disease-care costs, but don't extend the programming to the children of employees as a matter of routine. Schools strive to implement health promotion programming for kids despite want of resources, and when they do manage it, often leave out parents.

So, my opinion is that the next big thing in health promotion will be a rediscovery, and reaffirmation, of the family. Because children and parents shape one another's culture. Because adults and kids will get to health together, or probably not at all. Because in unity, there is strength.

Before continuing as I intended, I am obligated to note that news of the appalling calamity in Newtown, Conn. -- a town I have visited often and know well -- broke while I was working on this column. As a parent, I confess I am selfishly trying not to imagine the agony of those most intimately affected. My thoughts and deepest sympathies nonetheless bind me to them, and that pain.

I can't begin to know what malignant dysfunction led a son to kill his mother and more than two dozen innocents. I can't begin to guess what the ingredients were in this toxic, volatile mix beyond alienation, ammunition, and access to the vulnerable. And so I have no idea what might have prevented it.

But a culture that is more consistently about "us" and less about "me," let alone "them," could only be a good thing. The family at the center of this story was clearly torn apart, with appalling collateral damage. Perhaps prioritizing the solidarity of families might spare some of us, some day, a repetition of such tragedy.

The reaffirmation of family must involve more than philosophy, of course -- it should engender novel public health interventions. Businesses, for instance, long accustomed to adopting stretches of interstate highways, could start adopting schools, and sponsoring complementary wellness programming for the children of their employees. Health promotion programming delivered in schools could be designed to reach parents as well as children. Weight management programs for adults could be family-friendly by design.

Children could be engaged in the processes of health promotion, rather than having its products simply imposed on them. The right medium could be selected to reach every age group -- so that we are all part of the common solution, and none of us is left a part of the problem, alone, adrift.

John Donne told us centuries ago that "no man is an island" -- that we are, in fact, all links in a common chain. The future of health promotion will owe much to looking back at the words of Donne, and then moving forward. The missing link is that ineluctable link -- to one another.

-fin

Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org

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