Personal vs. Structural Strategies for Increasing Longevity

Personal vs. Structural Strategies for Increasin" rel="nofollow">ing Longevity Your textbook describes how daily choices, such as smokin" rel="nofollow">ing, nutrition, physical activity, and so on, affect not only our current health, but how long we will live. The National Academy of Sciences’ Institute of Medicin" rel="nofollow">ine has claimed that more than half of mortality from the 10 leadin" rel="nofollow">ing causes of death in" rel="nofollow">in the US can be traced to personal behavior. Of course, remember that this type of data must always be correlational. That means you can’t tell whether personal behavior causes differences in" rel="nofollow">in mortality or whether they are related through a third factor, and separatin" rel="nofollow">ing what is genetic and what is environmental is difficult to do. As an example of the importance of the concept of correlation does not equal causation, recall that the origin" rel="nofollow">inal research on hormone replacement therapy (HRT) in" rel="nofollow">in women showed a protective effect for heart disease (HRT usage was correlated with lower heart disease). Later longitudin" rel="nofollow">inal studies found that long-term use of HRT was actually associated with in" rel="nofollow">increased in" rel="nofollow">incidence of heart disease. Some believe that the origin" rel="nofollow">inal studies found HRT to be related to lower heart disease because both heart disease and HRT usage are related to socioeconomic status (SES). Women who have higher SES used more HRT and also had less heart disease (probably for a variety of reasons, such as access to education, healthcare, and so on). If half of the mortality from the leadin" rel="nofollow">ing causes of death is personal behavior (or at least correlated to personal behavior), the other half must be caused by other factors, in" rel="nofollow">includin" rel="nofollow">ing genetics, but also to changeable factors such as access to health care, access to healthy work environments, exposure to discrimin" rel="nofollow">ination, and so on. Did you know that countries that have a larger in" rel="nofollow">income gap between the rich and the poor have poorer mortality rates (even for wealthy people) than those with a smaller gap? (For data within" rel="nofollow">in the US, see this website: http://www.ncbi.nlm.nih.gov/pubmed/8616393. Right click on this lin" rel="nofollow">ink to open it in" rel="nofollow">in a new win" rel="nofollow">indow.) We rarely hear people exhorted to go out and change health care, improve work environments, close the wealth gap, or change discrimin" rel="nofollow">inatory practices to in" rel="nofollow">increase longevity. But we hear regularly that we should exercise more, eat better, and quit smokin" rel="nofollow">ing. Should public health measures to in" rel="nofollow">increase longevity focus on gettin" rel="nofollow">ing people to change personal behaviors (diet, exercise, and so on) OR on workin" rel="nofollow">ing to change other structural factors (access to to health care, discrimin" rel="nofollow">ination, and so on)? Obviously both of these are important, but your paper must argue for workin" rel="nofollow">ing to change either personal behaviors or structural factors. Which do you thin" rel="nofollow">ink would be most beneficial and why? If you wish, you can imagin" rel="nofollow">ine you are a foundation dedicated to in" rel="nofollow">increasin" rel="nofollow">ing longevity. Will you spend your money on tryin" rel="nofollow">ing to get people to change their personal behaviors, or will you spend it makin" rel="nofollow">ing structural changes? Be sure you thin" rel="nofollow">ink about what strategies will most benefit diverse people. People in" rel="nofollow">in the US have different access to resources for improvin" rel="nofollow">ing health. For example, encouragin" rel="nofollow">ing people to exercise more may improve the health of those with time to exercise, but tellin" rel="nofollow">ing a sin" rel="nofollow">ingle mom workin" rel="nofollow">ing two jobs to support her family that she should exercise more frequently may not do much to improve her health. If you are in" rel="nofollow">interestin" rel="nofollow">ing in" rel="nofollow">in calculatin" rel="nofollow">ing “how long you will live,” you can click on the lin" rel="nofollow">ink below and use either the short calculator or longer one. (Remember no one can say how long an in" rel="nofollow">individual will live. These are just estimates based on the factors in" rel="nofollow">in their equation, but leavin" rel="nofollow">ing out other factors and chance factors, such as an accident.) While these calculators in" rel="nofollow">include family history (which should have a genetic component, but also is related to SES and other environmental factors), they mostly focus on personal behavior. The one exception is the in" rel="nofollow">inclusion of exposure to radon. The longer version does in" rel="nofollow">include occupational questions. http://gosset.wharton.upenn.edu/mortality/ (Right click on the lin" rel="nofollow">ink to open it in" rel="nofollow">in a new win" rel="nofollow">indow.) Be sure you read all the in" rel="nofollow">instructions, in" rel="nofollow">includin" rel="nofollow">ing the timetable, for this assignment.