Is it time for a cultural revolution when it comes to health behavior?

“Culture: the beliefs, customs of a particular society, group, place, or time…a way of thinking, behaving, or working that exists in a place or organization.”

By Dennis Archambault

We considered labeling a population health proposal, “Creating a Culture of Health in Detroit.” To some, it seemed like a “me too” concept. After all, Risa Lavizzo-Mourey, MD, CEO of the Robert Wood Johnson Foundation, coined the phrase last year; not quite a cliché, but it’s certainly getting a lot of use. Yet, isn’t repetition part of the rhetorical process leading to acceptance?

I kept thinking about our county, Wayne County, the sickest county in the state, at least as far as the RWJ County Health Rankings go. I’m sick of looking at the indicators. Yes, we’re sick for many reasons, including the social determinants that have such a heavy influence on health. But it’s more than something in the water. To a large extent, we permit, even encourage sick behavior. It’s part of our way of thinking, behaving, working.

We’ve learned through the extensive smoking campaign, traffic safety, and drinking/driving campaigns that it’s not until we can motivate peer influence, and social engineering, that positive change occurs on a major scale. We have learned to work smarter, more safely, and not accept workplace injuries as a natural part of doing business. Why can’t we take that next big step and creating an American manifesto: We will be well…?

Of course, there is plenty of cold reality to deal with beginning with an economic system that still rewards sick care, while primary care and prevention services struggle to be heard in budget deliberations. Investments for programs that create or promote health are even less prominent in budget debates.

We can keep working at the poor health indicators incrementally, struggling for grant funding for programs. But until we have collectively decided that we will have a healthy society we won’t achieve the massive change that’s needed in health status. Just as the three martini lunch is no longer acceptable in our culture, we need to become intolerant of other behaviors that contribute to an erosion of health and the need for health care services.

Of course, in our society we struggle between the societal imposed public health standards and the “right” of individuals to live as they choose. But American society evolves and despite our political polarization we manage to establish norms.

Dr. Lavizzo-Mourey’s description for creating a culture of health is less prescriptive and more visionary: “It means a society in which each person has the opportunity to lead a healthy life, with adequate housing, educational opportunities, safety from violence, healthy food options, exercise, and of course, affordable, quality health care. A desire for a culture of health is already emerging across the nation.”

Imagine if one of the questions we ask each other routinely is “Did you get your exercise in today?” And if not, you respond with regret. “No, not enough time or energy, but definitely tomorrow.” Or neighborhood conversation about the meal you’re cooking or planning to eat at a restaurant? Or looking forward to your next physical exam as an opportunity for improving your life, rather than a dreaded appointment your provider to evaluate BMI, cholesterol, and other disease indicators.

The point here is that we accept the fact that we live in a culture of sick and harmful reinforcement. We may laugh about skipping meals and grabbing junk food at the gas station, rushing through to the end of the day. We may willfully drive haphazardly in order to get there. Why don’t we have enough personal and social discipline to say, “This is crazy?!”

Dennis Archambault is director of Public Affairs for the Detroit Wayne County Health Authority.