Preventive Medicine Column

Dr. David L. Katz

My two oldest daughters graduated college in the spring.  Both are looking for work.

They are making a bit of money in the interim with part-time jobs, but several months after graduation, they are still looking for the real deal.

My daughters are not lazy, and they aren’t irresponsible.  And they certainly are a long way from stupid.  Oh, no.  Famously, it’s the economy, stupid!

It surely can’t be the fault of my daughters to have graduated college right on schedule, only to be thrown into the worst economy in a century.  We can agree it will nonetheless be their responsibility to do the best they can with what they’ve got.  But if they are, to some degree, victims of circumstances they can’t overcome, it seems a stretch to pin that on them as well.

This is not about my daughters.  In the grand scheme of things, they are children of privilege, as am I.  There are better times and worse times, but our family has never had to worry about the price of bread.  I’ve always had parents of established means willing to back me up when I stumbled.  My daughters are secure in the knowledge of the same (I haven’t changed the locks!).

This is not about my daughters- they are at the very tip of an iceberg of ill-timed disadvantage.  And just as the bulk of an iceberg is submerged while the tip sees daylight, the masses most affected by the dismal economy are drowning in its consequences.

We heard this week that poverty levels in the US have reached a level not seen in decades.  The percent of households relying on SNAP (aka, food stamps) is at a level all but unprecedented.  And in the very midst of the tussle over health care reform, we learn that more Americans now lack health insurance than ever.

There is a bigger message here than the obvious.  The obvious is that a bad economy is bad for people.

The bigger message is that despite the popular railing about bootstraps and personal responsibility, we are subject to forces larger than ourselves.  We have millions more uninsured, unemployed neighbors, friends, and relatives than we had a year or three or five ago.  Do we think these people succumbed to a contagion that siphons off personal responsibility?  Did a virus devour their determination?  Has some new plague agent ravaged will power, self-control, or work ethic?

All nonsense, of course.  Personal responsibility, will power, and work ethic are the same as they ever were.  Human character has not undergone a wholesale metamorphosis in the past year, or three, or five (or, for that matter, 500).  To reiterate: it’s the economy, stupid.  It is a force larger than any individual victim’s control.

We all know that with great power comes great responsibility.  There is an overlooked corollary: we can’t expect people to take responsibility when they are disempowered.

Larger forces can disempower us.  A dismal economy is one such larger force.

So, too, is an obesigenic environment- the topic more intimately tethered to my daily work than economics.

Millions of our fellow citizens would- only too gladly!- be working and solvent in a decent economy who are now unemployed and indigent in this economy.  So, too, would tens of millions who are now overweight or obese be thin and healthier in a world that made it less arduous to get there from here.

You may have heard this from me before: throughout most of human history, calories were relatively scarce and hard to get, and physical activity was unavoidable (it was called survival).  We now find ourselves in a modern world in which physical activity is scarce and hard to get, and calories are all but unavoidable.  We have no native defenses against such forces, and so an overwhelming majority of us are succumbing to them.  No character flaw required.

Just timing.  All that is required is to be a citizen of the modern world.  To live in a world awash in highly processed, hyper-palatable, designed-to-be-irresistible (betcha’ can’t eat just one!) foods.  A world awash in marketing dollars promoting the over-consumption of calories.  A world deluged with devices that do all the things muscles used to do.

And the plot thickens, because the bigger and malevolent forces to which we are subject can intermingle.  Poverty increases the risk of obesity and attendant chronic disease.  Those who can least afford to succumb to the obesigenic, morbidigenic elements of modern society – are most vulnerable to them.

Don’t get me wrong.  I believe in personal responsibility, with regard to eating, exercise, and employment alike.  I expect my daughters to work hard to find work- and eventually succeed.  At the end of the day, each of us must accept responsibility for how we choose to use our feet, and our forks.

But the choices available to us are not necessarily under our control.  We can share in responsibility for the solution without being to blame for the problem.  We can take responsibility only when we are empowered.

So if you look out at rampant unemployment and epidemic obesity and see some inexplicable contagion of irresponsible, stupid, lazy gluttony for which there is no scientific evidence, I encourage you to wipe your lens.  You are missing the forest for the trees.  There are bigger forces in play.




Dr. David L. Katz;