Key Story Summary:
- It’s easier to change your environment than your behaviors.
- To change the health of society, we need to first create a health-promoting environment within the healthcare system.
- Some examples of a healthier environment in the academic setting may include eliminating soda machines and incorporating health behavior counseling into each patient-clinician role modeling case.
Parlez vous francais? If you don’t happen to speak fluent French, it may because you never immersed yourself in the culture. Similarly, if you don’t understand “health” it’s probably because you never were fully surrounded by it.
The American society prides itself in its traits of personal responsibility, and to achieve your dreams and ideal body figure, all you need is more willpower and determination. But when we look at the explosion of obesity in this country, can we honestly say within two decades that our willpower has eroded, making us susceptible to poor health choices? Is it our own personal faults?
When I’m hungry and see a cookie, I’ll likely eat it. When I’m tired and see an elevator, I’ll likely take it. Giving into these urges isn’t necessarily a lack of willpower, but instead a natural primitive response to acquire and conserve energy. If cookies and elevators surrounded me daily, I may no longer be The Healthy Pharmacist, instead transforming into some type of less-jolly Santa Claus. By doing one simple thing though, The Healthy Pharmacist will remain.
New York Times bestselling author David Brooks stated in The Social Animal, “It’s easier to change your environment than to change your insides. Change your environment and then let the new [cues and unconscious influences] do the work.”
In today’s modern world, our instincts to seek out high calorie, pleasurable foods and rest to conserve our precious energy stores work against us as we live in an environment where calories are abundant and exercise is avoidable.
To combat this on a personal level, we need to surround ourselves in an environment where healthy behaviors come easy. By only storing fresh foods in the house, for example, you can redirect cravings and “let the new cues do the work” to reinforce better nutrition. But while upholding individual responsibility to maintain personal diet and exercise habits is a must, we should at least have systems and policies in place that allow these behaviors to be easily achieved, or at least not outlandishly difficult.
To become a healthier society, a shift in thinking needs to occur that no longer blames the individual for their health status but rather the system that allowed our communities to become a toxic trap of unhealthy options. As described by Dr. Dariush Mozaffarian, Dean of the Friedman Tufts School of Nutrition Science & Policy, there is no one cause of our current problems. It’s not our personal attachment to soda, or gluten, or physical inactivity. Instead, it is the compounded effects within the environment we have created and in which we continue to surround ourselves.
Attacking all the causes of the current unhealthy environment is a daunting and unrealistic task, so instead I’ll single out a problem I believe to be key.
At a minimum, the healthcare system should be a role model for society to live healthier. When health systems and health professionals fail to act in a manner that promotes healthy living, we cannot expect policy makers and the public to act differently and to prioritize preventative behaviors.
Health systems fail to devote training on and monitoring of health behaviors which leads to clinicians lacking the confidence and knowledge to effectively provide patients such education. For this, I fault the schools and accrediting bodies that teach and license these influencers-of-health.
The messages health professional students receive and the habits they make while in school will perpetuate throughout their career. To set them up for a lifetime of health advocacy, the power of health and wellness needs to be ingrained during these formative years.
Disappointingly, such behaviors were not a part of the environment of my professional education. Highlighting my frustrations, I remember one particular professor saying, “As long as we still have a Big Mac, we’ll need to keep prescribing statins (a drug to reduce cardiovascular disease),” which was met with a few chuckles throughout the class. Knowing now the significant link between diet and disease, no longer can we accept comments like these as the norm. To continue this pattern of thinking, health professionals would be doing an enormous (and almost unethical) disservice to those who suffer with disease and disability.
To make health professionals role models of health, the culture of education needs to change. Students need to be keenly aware of and personally experienced in the forces that keep us healthy–including food, exercise, mental wellness, and sleep. By establishing these ideas as truths in the minds of health professionals, schools will reinvent the academic culture of health.
While not comprehensive, below are some actionable ideas to improve the educational environment.
- Remove sugary beverage machines and increase free water fountains
- Encourage stair use with increased stairwell space and inspirational artistry decorating the walls
- Subsidize the costs of healthier-option foods when catering or dining
- Prevent prolonged classroom sitting with engaging activities or standing desks
- Incorporate health behavior counseling into each patient-clinician role modeling case. Listing patient reported health habits should be just as important as drugs and dosages. Proving tangible behavioral changes is paramount.
- Create a “Wellness Support” department within each school that regularly updates students on local, wellness activities and resources
- Encourage consistent sleep patterns by curtailing electronic course work (emails, etc.) past a nightly curfew
- Instead of bake sales, welcome mini farmers’ market produce
- Mandate nutrition courses into curricula and reinforce the knowledge with application through hands-on cooking and gardening courses
The idea is to make healthy habits second nature and effortless. If these tasks become burdensome, the objective will be missed and behaviors will not change.
Just as it is difficult to learn a new language in a classroom setting, so to is it for health. Instead, health professionals need to immerse themselves in a culture of health to be the best role models for their patients.
If you have other ideas to create a healthier environment in any setting, I encourage you to leave a comment.
The Healthy Pharmacist 
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