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Some Kill with a Six Gun, Others with a Frying Pan: We Must Take Better Care of Ourselves

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Apologies to Woody Guthrie for that one....

I was rushing home late from work last night, and I ducked into a Subway to grab something for the train home. The guy behind me ordered a foot-long cheese steak. He watched the gobs of meat and melted provolone crackling on the grill. With obvious satisfaction, he pronounced: "That one's got heart attack written all over it." It did, and it looked damned good.

Much has been written and said about Tim Russert's tragic death. At 58, at the height of his abilities and his profession, with so much to live for, he was way too young. There was something about his vivid humanity that made him a welcome presence in millions of homes. The day he died, my mother called me at work. She wanted to tell me that I am a good father and a good son. By all accounts, Tim Russert was both. That's not easy, especially for such a driven and public person.

It's not fair to make Tim Russert the poster child for unhealthy living. He tried to take good care of himself. Like many people including me, I suspect he was trying to undo the effects of several decades' worth of bad habits. He was on medication, exercising, trying to lose weight. Maybe his doctors should have been more aggressive. It's always easy to second-guess. You can never completely guard against the effects of bad genes and bad luck.

Upon hearing Russert's news, an acquaintance emailed that everyone who can afford it should have an advanced heart scan. I'm not convinced. The track record of shot-in-the-dark imaging isn't good. It leads to many unnecessary, costly, and sometimes dangerous interventions whereby some surgeon cracks your chest open with too little reason.

What we all must do is much harder than buying an $800 scan. We need to adopt more healthy lives and help our family, friends, and neighbors do the same. That's counter-cultural these days. We live in a toxic society and economy that discourages proper nutrition, exercise, and other forms of healthy living. We see this most dramatically among children, too many of whom marinate in a pop culture dominated by seductive commercials and undemanding video entertainment. High-calorie food is cheap and tasty. We can sit on our butts and TiVo 150 channels of HDTV while texting our friends. My daughters attend a public junior high school in the Chicago southland. If you wait by the front door, an astonishing number of overweight kids come running out at the end of every school day.

The offerings in their school cafeteria don't help. When my oldest started sixth grade, I examined the September menu. Out of 23 meals listed, I found three of vague nutritional value. Other offerings included double and bacon cheeseburgers, three days with hot dogs, seven days of pizza. September 21 simply listed "curly fries," with optional cheese topping. Other items remain mysterious, such as the one called "Bosco Stix." Everything, of course, can be purchased with the requisite complements of chips and soda.

Childhood obesity captures public attention. By far the most widely-cited article of my academic career was an almost trivially simple paper with Richard Strauss in the Journal of the American Medical Association showing exploding rates of child overweight between 1986 and 1998. A college junior could have written our paper. The facts spoke for themselves in one or two graphs. If you ask why this happened, we noted many factors: changes in the relative price of fruits and vegetables compared with junk food, declining physical activity in everything from bike riding to less time spent in middle-school gym, more enjoyable sedentary entertainment, parental fears about what might happen to children playing outside in dangerous neighborhoods. Much research has been done to nail down these factors. It's like that old movie, "Murder on the Orient Express." There are many suspects, all guilty.

What's happening to our kids mostly reflects what is happening among adults. We are becoming too fat and too sedentary, with large and growing gaps along predictable lines of race, income, and schooling. The National Center for Health Statistics reports that African-Americans in their fifties suffer twice the cardiovascular mortality rate of other Americans. I would have guessed that the gap is even greater.

My day job is to conduct public health research, often in low-income communities of color. Every community in which I have worked is experiencing rampant hypertension, obesity, type II diabetes, and more. Cardiovascular disease is a much larger contributor to race/ethnic health disparities than is homicide, AIDS, infant mortality, or other public health problems we associate with the inner-city. What happened to Tim Russert quietly happens every day to countless people of color across the country. I remember once talking on the phone with a friend and mentor. "I feel dizzy," he siad suddenly. The next thing I knew, he was hospitalized with a stroke. I know many others with similar stories.

Of course, these problems are not confined to any particular community. There is an ongoing farcical debate about whether smoking or obesity is the greater killer. Apparently smoking is still leading. Both cause much death and illness that does not have to be. I recently spent a long time at a hospital caring for a loved one. I saw many, many tense relatives relieving the stress and boredom of the cardiac ICU waiting room wandering down to the cafeteria for a dollop of fatty food.

We must change that. It won't be easy. The things we eat, the amount we eat, the occasions we eat -- these are so basic to our lives and the way we relate to other people. Food is a reliable source of pleasure. It provides an opportunity to relieve stress, pass the time, comfort ourselves, care for other people, remember loved ones, honor family and religious traditions.

Tim Russert's mega-seller Big Russ and me has a poignant chapter, simply titled "Food." It describes how the Russert family gloried in hot dogs, steak, chicken soup ("Jewish penicillin"), fruits and vegetables, too. "You gotta eat," Big Russ taught his children, as my parents taught me with many of the same foods. Indeed we do, but most of us have to eat better food in smaller portions. We must teach our children this, too.

We must talk about this at every dinner table. The conversation belongs on the campaign trail, as well. I co-chair an advisory group on public health issues. I'm not telling tales out of school to say the obvious: It's hard to get population health -- as distinct from health services -- onto the political agenda. Almost all of the "health reform" debate concerns insurance coverage and the delivery and of personal health services. It's much easier to get people excited about ensuring broad access to high-tech surgery and heart scans than it is to drum up interest in less glamorous, more difficult preventive measures that are often more reliable and cost-effective. For the cogniscenti, Bob Schoeni, Jim House, George Kaplan, and I just co-edited a brilliant academic tome on this very subject.

Don't get me wrong. We absolutely need better medical care and universal coverage. Yet we must look beyond these issues to other public policies that promote health, and to the personal choices we make every day to care for our bodies and minds that no one else can make for us.

Reporters have been ribbing Barack Obama over his apparent reluctance to eat fatty foods. Michelle Malkin asserts that anyone afraid of a cheesesteak isn't ready for Bin Laden. In his apparent fastidiousness, Obama realizes something the reporters don't. The campaign may look like a sprint, but he wants to stick around for what promises to be an exhilarating long-distance run. Me too.