Was it Worth It?

M. Courtney Hughes
mchughes@approachhealth.com

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Dear Dad,

           In the thirteen years since you passed away, I’m reminded almost every day that over half of all deaths in the United States are preventable, and I have a hunch yours was one of them. Behaviors like smoking, being inactive, eating poorly, and abusing alcohol cause the majority of deadly chronic diseases like your heart disease. I think about this almost daily because after your passing I left finance and entered health research. Trading in investment models for epidemiological probability curves and SEC filings for JAMA articles, I wanted to use my quantitatively oriented brain—wired similarly to yours—to develop health promotion strategies that would improve population health and essentially help prevent your fate in the lives of others.

           For the past couple of decades the media has reported findings that key health behaviors prevent disease and premature death, eliminating ignorance as an excuse for poor health behaviors among Americans. So why do the majority of us overeat and not exercise? Why is binge drinking so prevalent in the U.S.? Why on earth do twenty percent of Americans still smoke?

           When considering difficult questions as a kid, I always asked for your help, Dad. My inner child instinct intact, I’m turning to you again, Mr. Edward “Rascal” Haskell, for insight. You always listened but didn’t always provide me with answers, teaching me that asking the question, simply formulating my thoughts sometimes reveals an answer. I hope that is the case here.

           In the back of my mind as I’ve conducted exercise and nutrition studies, analyzed national health datasets, and developed health incentive plans for employee groups, you’ve been there staring blankly at your cardiologist as he prescribes a different lifestyle to which you would never adhere. I want to ask you, “Was it worth it?” Others might look at your five grandkids you never met, missed graduations and holiday gatherings, your unstamped passport, and say “Of course not!” Not so fast everyone. Dad, if the bar and fridge were empty of beer and liquor, the menu vegetarian, and the treadmill worn out, would you have enjoyed your daily moments? What would you have looked forward to?

           My first graduate-level course, Philosophy of Science and Research, was based on the scientific method. It’s the foundation for research, and you probably remember it from high school chemistry when you used the scientific method as you determined the optimal ratio of baking soda to vinegar that would blow up the biggest balloon.

           In the laboratory of the real world, you engaged in the scientific method with your own adult life. I’d argue your subconscious hypothesis in this unwitting experiment was ‘I can live the lifestyle I want and still live to an average old age. ‘ You tested your hypothesis by not exercising, eating lots of red meat, working two stressful jobs almost every day, and drinking liberally even after you were on heart medications. You found you were still able to play catch with your kids whenever you wanted, received lots of compliments on your grilled culinary creations, and made a great living financially. The data you mentally collected said ‘this works.’ Even after you had a severe cardiac event from a clogged artery at age 40, the stent the cardiologist inserted did just the trick. Back to catching, cooking and working. With these results, no wonder you drew the conclusion that this life worked for you. You were happy.

           Never mind the fact that your life was the replica of a risk factors page of a public health pamphlet titled, How to Avoid a Heart Attack. Male, family history of heart disease, high cholesterol, high blood pressure, physical inactivity, obesity, poor diet and uncontrolled stress; the only omission to your list was smoking. You were smart, educated and way above engaging in that lower class vice. A college graduate pulling in six figures from your two jobs, your degree and bankroll gave you confidence in your choices and from a societal perspective you were sitting pretty.

           As for the uncontrolled stress, you had reasons for rising daily at 6 am after 5 hours of sleep to go to your own real estate appraising firm where you worked hard all day. I’m guessing you didn’t think twice about heading over to the local harness racing horse track around 6 pm, fulfilling your duties as presiding judge for the 10-12 races held each night. Evenings filled with debating race results, reprimanding jockeys for misconduct, and preparing the comprehensive daily report. This was a state job with health benefits and you relished the ‘tough guy’ gambling atmosphere. The Sundays off (and beers and Manhattans) were plenty of time to recharge your batteries, right? And, hey, the two jobs kept you away from the stress of four kids so what was there to complain about?

           Enter statistics, a subject you understood better than most people. You got a perfect 800 score on your math SATs in high school, won consistently in craps on your trips to Las Vegas, and loved teaching me about odds when we played Parcheesi. I have to believe deep down you knew the odds for a long, healthy life were against you. Despite your non-smoking status and drinking the cranberry juice you boasted about consuming, you knew your three uncles died before reaching age 55. You were present when the mirror reflected a 5 foot 10 inch, 245-pound frame.

           At age 45, if you were in Vegas betting on the longevity race, would you have bet on yourself? What would the odds have been that you’d win? 15:1? 50:1? Betting on the Rascal Haskell risky horse is essentially what you did. You took your chances and hoped for a huge payout that never came. You wagered your life on a steady diet of whiskey, steak and work. You probably thought the lifestyle might land you at one or two standard deviations below the average male lifespan of 74 years, but you were a gambling man and not worried about that scenario. As for multiple standard deviations, being an outlier is so unlikely…

           Let’s consider your social network. Rough and tough horse jockeys, judges and staff; older investor friends who liked their cocktails, dinners and after dinner drinks; and friends and family who always knew Rascal as that instigating, but fun-loving devil responsible for the latest practical joke—an adult Dennis the Menace.

           Research studies show that poor health behaviors like overeating, smoking and abusing alcohol can be contagious. People with friends and friends of friends who engage in certain behaviors are more likely to engage in those behaviors themselves. So it’s not surprising you led a lifestyle of overeating and drinking, given the individuals you chose to be around. And the community folk who didn’t fit into the gluttonous comrade category knew you as the “Rascal” who was tons of fun and earned himself the good life of fine food and plentiful drinks; you had a role to fill.

           I think of behavior change theories and models I learned in my graduate courses. There is the Transtheoretical Model, a five-step series of states a person goes through to achieve complete behavior change. Precontemplation is the first stage, during which someone is not even thinking yet about changing the behavior. Arguably you never left the precontemplation stage. From what I saw, you spent no time feeling guilty for your pleasures or developing an action plan for health.

           Another popular model, the Health Belief Model, states that people will take action to improve their health if they believe 1) they are susceptible to a serious health condition, 2) they could decrease their own risk for the condition, and 3) the benefits of doing so are worth the effort. I’m confident you knew you were susceptible to a serious heart attack and you could decrease your risk by engaging in certain healthy behaviors. The problem was the final piece—the benefits of eating and drinking less, exercising and relaxing were not worth living a boring, considerably less enjoyable life.  

            Looking at your 47-year-old self, you were happy—comfortable financially due to your own hard work and investment acumen; emotionally fulfilled hanging out with your kids on Sunday afternoons; and proud of your plentiful group of admiring friends. Annual trips to Notre Dame football games and thoroughbred racetracks provided respite to your demanding routine of appraisals by day and judging horse races by night.

           For most individuals, a major cardiac event at age 40 would negatively impact one’s quality of life. For a drinker, the doctor warning, “You should not drink alcohol with these medications” would put a damper on things. Urging from a man’s mother, wife and kids to exercise might seem annoying. But not you dad, you just ignored us all, escaping to the bar in the basement or your office in town.

           The University of Toronto’s Quality of Life Research Unit uses the categories “being”, “belonging”, and “becoming” in defining quality of life. Your quality of life was arguably quite high. You liked being Rascal Haskell, belonging to your small hometown and becoming a financially successful family man. For you, mission accomplished.

           The more I ask the question, ‘Was it worth it?’ the more I’m reminded of how smart you were and not at all delusional. I’m convinced you knew what you were doing. No, you didn’t know you were going to die when your youngest son was seven and you were preparing to walk me down the aisle at my upcoming wedding. But you knew you were taking a big risk.

           Sure, you were optimistic, hoping you’d turn out to be like the sleeper horses who unexpectedly win races every so often at your track. You may have shown poor health form in your forties but once you really hit it big with some investments, you would live the best life—a fit, tennis racket carrying AARP member in the enviable position to play all day and rehydrate in the evening with guilt free liquor.

           Deep down, though, you were a realist. You exhibited the persona of a guy who’s got things under control like your television namesake, Eddie Haskell; your anima revealed by the Cadillac life insurance plan you purchased.

           The United States Department of Health and Human Services provides health objectives each decade with a vision of “a society in which all people live long, healthy lives.” Dad, I’m asking if you would even have aspired to a personal version of this vision. If living a longer, healthier life meant changing your lifestyle, there is a chance you would have rejected this goal. Arguably, you did just that.

           Unlike you, others walking about—or rather sitting, eating, drinking, and smoking—are here living on earth and can answer this question. Given this fact, I guess it’s time I change my tense and audience. So I will ask the employee wellness groups I work with, “Is it worth it?” For those who the answer is ‘no’, I will leave them alone and let them enjoy the time they do have living.

           In the meantime, Dad, I’ll personally continue to race triathlons, eat more produce than meat, and practice meditation. When I’ve left this world, perhaps my descendants will pose the rhetorical question to me “Was it worth it? If the cupboards were empty of green tea and ground flax, the menu not vegetarian, and the treadmill still like new, would you have enjoyed your daily moments?”

           Dad, thanks for listening. I love you no matter what your answer to my burning health question.


Your daughter,
Courtney

 

About the Author

    • M. Courtney Hughes, Ph.D., M.S., is a health promotion researcher and consultant living in the Chicago area. In addition to academic writing, she enjoys creative writing with articles in Stymie, SportingKid Magazine, and an upcoming issue of The Prompt. For more information, visit www.approachhealth.com.

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  • Published: June 27, 2013