Preventive Medicine Column

Dr. David L. Katz

We, the people of the United States, are not socialists.  But we, like all people, are social- and it’s not even a choice.  We are innately, biologically social creatures.  Not all animals are.  Adult male polar bears are loners.  So are tigers.  But we, like creatures as diverse as dolphins and ants, wolves and chimpanzees, bees and lions- are, and have always been, social animals.

Why do I care?  Because our attitudes about all things social impact my day job directly.

Culture is social; culture shapes behavior; and behavior shapes health.  In fact, our behaviors and the social institutions that influence them have a greater impact on health than anything else.

A steady stream of research publications dating back to 1993 have reaffirmed consistently that fully 80% of the chronic disease burden in modern society- heart disease, cancer, stroke, diabetes, etc.- could be eliminated with better use of fingers (not smoking), forks (better dietary patterns), and feet (more routine physical activity).  Feet, forks, and fingers are the master levers of medical destiny- exerting a vastly more potent influence on years in life and life in years than everything else under the rubric of so-called ‘health care’ combined.

And yet, this knowledge has not proven to be power.  We have known for 20 years that we could make heart attacks, strokes, diabetes, and cancer disappear 8 times in 10, but have not done so.  What stands in the way?

For one thing, the companies profiting from the status quo.  The very opposite of socialism; pure, unfettered capitalism.

But for another, it’s our lack of collective action.  It’s our resistance to policies and programs that could help make eating well and being active every day the norm in our society.

Often, that resistance takes the form of calls for personal responsibility- an every man, woman, and child for him/herself mentality.

But while it’s true that how I use my feet and fork is up to me- is anyone truly naïve enough to think that environmental and social factors are irrelevant?  Since we now have widespread obesity and type 2 diabetes among 7- and 8-year-olds, and never did before- are we to infer that today’s 7-year-olds have less personal responsibility than every prior cohort?

As a specialist in health promotion and disease prevention for more than two decades, I am entirely convinced that many of the best defenses of the human body reside ineluctably with the body politic.  Many of the actions most certain to increase years in life and enhance life in years are collective actions. Ill-informed castigations that call into question our Americanism itself every time such actions are contemplated forestall vital progress.  Progress that would redound to the benefit of my patients- and my family- and yours.

I am an American- privileged and proud to be so.  I do not feel I am suffering the brutal oppressions of socialism when our government takes my tax money to support the social enterprise of our military, which defends the American freedoms I enjoy.  I do not feel my children’s recourse to public education makes me a socialist.  Nor do I feel so burdened when an ambulance rushes to the aid of a crash victim without first verifying their capacity to pay the bill when it comes due.

Those several of our institutions that represent the closest approximations of socialism- organized religion, our military, Medicare- are among our most widely revered, and universally supported.  The denigration of all collective action for the common good as ‘socialism’ is inaccurate nonsense.

There are inalienably social aspects of our society.  There are inalienably social aspects of every human society.  We are, since long before there were political institutions of any kind- social animals.  To renounce that as vehemently as some now seem inclined to do stands between us and health advances that could improve our lives, and the lives of those we love.  Health lies along the road less traveled.  Only collectively can we put it on a path of lesser resistance.

To renounce the value of collective action for common good, and argue for an all-for-none and none-for-all society ignores aspects of time-honored human reality as fundamental as the hive to the bees, the pride to the lions.




Dr. David L. Katz;