09/24/2014 06:21 pm ET Updated Nov 24, 2014

Why Some People Can Fly and Others are Healthy: of Science, Sense and Skillpower

david katz

This column might be catalogued as a tale of two books, one destination, and two ways to get there from here.

The destination is health.

The first book is a public health classic, Why Some People are Healthy and Others are Not. By authors including Yale colleague Ted Marmor, the book explores the profound ramifications of the social determinants of health. Those linkages are of undeniable importance, and fully support the contention that your health is likely to have more to do with your zip code than your genetic code. For some of us, the best way to be healthy lies along a road not only less traveled, but in a state of inaccessible disrepair. In such circumstances, the body politic needs to step up, and pave a passable way.

But on the other hand, few of us can afford to wait on the world to change when our own health and that of our loved ones is on the line. We need to do the best we can with what we've got. And that's what the second book, my own Disease-Proof, is about. The book, newly available in paperback, reaffirms what the body politic can and should do, but focuses principally on what each of us can do, and how, to tend to the health of our own bodies in the meantime.

We can do a lot. We can slash our lifetime risk of all major chronic disease by a stunning 80 percent, a figure reaffirmed in yet another study this very week. We can add years to life and life to years; enjoy terrific vitality; and share these luminous benefits with those we love. We can even fly.

OK, I take back the one about flying. But we can at least fall with panache.

Pilots, on the other hand, can fly. As it turns out, whether the destination is health, or a city at the far end of a flight plan, the means of getting there from here are basically the same: science, sense, and skillpower.

Flying a plane begins with the sciences of aviation and engineering, otherwise there would be no plane. Similarly, achieving health is informed by the biomedical sciences that provide our definitions of health, our assessments of it, and the reliable means to the desired ends. The science need not be perfect to be very useful. We know enough.

Flying a plane requires sense, because engineering only takes us so far. We all feel better thinking the folks in the cockpit have good judgment, and will respond sensibly and capably to the vagaries of weather and circumstance not pre-calibrated into the autopilot. Science is not a substitute for sense; they go well together.

And finally, flying a plane very clearly requires a specific skill set. Pilots can fly planes not because they are better people than we are, but because they learned a set of skills most of us don't have. We could get those skills, too; and some of us do. But most of us are plenty busy doing what we do, and are content to let the pilots fly us where we need to go.

And that is where health and aviation diverge, because when it comes to your health -- no one else will fly you there. You fly yourself there, or you don't get there at all.

When health is the destination, the relevant science pertains to lifestyle as medicine, and it is copious, consistent, and compelling. Believe it or not, even the part about diet. I've said it before: we are NOT clueless about the basic care and feeding of Homo sapiens, much as those with the next great fad diet book in the queue might like to contend we are.

The sense is just the same sense you apply to everything else in your life. The same, sensible people who laugh at get-rich-scheme boondoggles tend to reach for their credit cards whenever a get-thin-quick or get-healthy-quick scheme comes along. That has to stop.

And then comes the skill set, which most people simply don't have -- just as most of us can't fly a plane. I can't fly a plane. But I do have the skill set for getting to health, no matter what. I'm supposed to; I'm a Preventive Medicine specialist, after all. If I didn't, who would?

My five children pester me intermittently to sign up for 'America Ninja Warrior.' Other than the time required, it does actually appeal -- and I am thinking about it. I routinely do a whole lot of chin-ups, so I could probably manage to hang from doorknobs, too. No decision yet, however.

For today's purposes, whether or not I boldly go where Kacy Catanzaro has gone before is moot. Today's point is simply that my health and fitness would allow for it, as a 50-year-old guy with a very hectic schedule, those five kids, and a desk job. The vitality that makes the proposition reasonable is a product of skillpower. It's a direct result of practicing daily for decades what I'm preaching here today.

I hasten to note that the vitality in question does not make me a better person, any more than the ability to fly a plane makes pilots better people than the rest of us. But it does let me do the things I love to do in deep powder, in the saddle, and off the cliffs. Health is not a moral imperative; it's a way to get more out of life. Healthy people have more fun.

Just as those who know how to fly can teach others, I can share the skill set on which I rely every day to be healthy, lean, and vital. That's exactly what populates the pages of Disease-Proof. The book details the skill set, and skillpower, on which I rely personally, every day.

Before bringing this in for a landing, there are three important caveats.

1) The theme of healthful living is exactly that: a theme. The variations on that theme allow you to choose a way to get there from here that works best for you and your family. The science/sense/skillpower formula for vitality is a dogma-free formula. We are all bounded by the theme, but within the theme -- you are the boss.

2) There is no guarantee. Despite everything, planes do crash. And despite taking the best care of ourselves, none of us can get a 100-percent guarantee of a long life of perfect health. Like the captains of old, we can control ship and sail -- but not wind and wave. The application of skillpower shifts the probability of a long, vital life massively in your favor. But it falls short of a guarantee. Stuff, alas, happens.

3) The body politic really ought to make this easier! If our culture did to aviation what it does to health, we would be hurling objects into the atmosphere to make flight as challenging and perilous as possible. Instead, we have air traffic control doing all it can to make it as smooth, and safe as possible. For losing weight and finding health, too, there is a role for the body politic -- rather like the role of air traffic control. Nothing we do collectively would eliminate the need for personal responsibility, but it could empower us all to take responsibility. The choices we make are, after all, subordinate, to the choices we have -- and our culture goes out of its way to tempt us with bad choices. This needs to change.

But you and I, and those we love, can't really afford to wait on the world to change, can we? Not when years of life and life in years are at stake, right now.

One other similarity between health and aviation is germane. We care about experience. We like our pilots to have a lot of miles. Similarly, I think it's reasonable to expect that those who are passing along advice are preaching what they have practiced successfully. I recommend nothing I have not applied to myself for 40 years, nothing I have not successfully shared with family, friends, and patients. Skillpower proven to work is meant to be paid forward. That's the mission here.

The route to health should be a path of lesser resistance than it is, free of turbulence and traffic. But it is what it is for now, and we need to rise above it.

No, we can't fly to health. But with the right blend of science, sense, and skillpower, we can get there from here just the same.


Praise for Disease-Proof:

  • "The best damn book I've ever read, except, of course, my own." Dr. Katz' anonymous colleague
  • "The best damn book I've ever read, since my son's last." Dr. Katz' mother
  • "Not bad." Dr. Katz' father
  • "Did you say something, Dad?" Dr. Katz' son, with Beats by Dre on his head

With endorsements like that- what are you waiting for? Get yours today from these fine retailers (just duck when the drones swoop in):

Photo: The author diving off the cliff in Ka'anapali, Maui/Catherine Katz