Public health is about more than eating right and exercising. We must fix Southern Nevada’s social infrastructure for a healthier community
A couple years ago, two forces were whipping me around as if in a storm of anxiety. First, I was preoccupied with illness and death. And, second, I was unhealthy. Naturally, the two fed off each other like evil conjoined twins. Anxiety contributed to unhealthy habits, which led to still more anxiety, and so on. I was by no means unique, and I don’t mean for this to be some self-indulgent memoir, so I’ll keep it short. I was getting no exercise. Sure, I only smoked when I drank, but that was a few nights a week, as a crew of newsroom pals and I would submerge ourselves in a boozy ongoing conversation about the shabby state of the world, the fecklessness of the bosses, the incompetence of the other team, the grandness of the craft. (Luckily, there are no tapes, at least that I’m aware of, anyway.) By the time the conversation ended — remember, there’s no last call in Las Vegas — it was sometimes just a few hours before we were due back in the newsroom. The next day was invariably a dreadful attempt to meet deadlines, combined with the sickening feeling that there was something terribly wrong with my health. Now, two years later, I’m in the best physical shape of my life. How did I manage this? In some ways, it was dumb luck, a veritable friendly rim that induced every ball to fall in the basket. But I’ve also come to learn that health is more than diet and exercise — it’s your social network and dealing with stress and even figuring out where to live. I only share my story because I hope it will illuminate public health challenges here in Las Vegas — and show how small tweaks upstream can mean big changes downstream. Countless Las Vegans face these challenges, challenges they can’t control, challenges that make good health difficult and progressively so with time. Moreover, the stakes are high: These public health challenges — which reveal themselves in Southern Nevada’s dreadful health statistics — will create obstacles to Las Vegas becoming something more than a party town in the desert. I suspect public health is viewed in our community as someone else’s problem. I’m healthy, so leave me alone. In fact, however, public health should be viewed as an important ingredient of economic development. Our failure to confront public health problems could be another obstacle to a diversified economy that will finally deliver us out of this economic morass. In short, it’s all connected. And with that guiding principle in mind, here’s the story of my own health — and the health of Las Vegas.
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Friend me
My first step to good health? My drinking buddies left town. This may sound ridiculous, but health researchers now believe that good and bad health habits are contagious.
As reported in The New York Times Magazine in 2009, social scientists Nicholas Christakis and James Fowler used a massive set of data from Framingham, Mass., to hypothesize that our health habits can be viral, that our social networks influence our behavior in ways we don’t even realize. Think of the easy one I just shared. It was much easier to cut down on my drinking and smoking when my pals weren’t around. But it can operate more subtly, as well. For instance, if everyone around you is obese, you won’t sense unspoken cues to stop eating.
Researchers have found the contagion doesn’t just float to the people you know; it’s the people who know the people you know, and so on, for three degrees of separation. If I’m obese, my friends are 57 percent more likely to be obese — that’s what the study found about the residents it tracked. The hypothesis is still controversial, and no one has been able to explain exactly why our health habits are so contagious, but it’s surely worth considering the implications.
Malcolm Ahlo, a health educator who specializes in smoking cessation for the
Southern Nevada Health District, told me that in 2005, the smoking rate among gays and lesbians was 67 percent in Las Vegas. In that number, you can see the contagion of health habits: Bars and nightclubs were among the few places where gays and lesbians could find other gays and lesbians, and people at bars smoke. Ahlo has helped bring down the gay and lesbian rate to a still high 42 percent.
Despite the best efforts of the health district, which is trying to employ a sophisticated “social-ecological model of behavioral change,” let’s face it: We’re an unhealthy city. More than one in five of us smoke, which is well above the national average, and a bunch more of us are exposed to secondhand smoke at work. More than one-third of our incoming kindergartners are either overweight or in danger of being so, according to a UNLV survey. We gobble painkillers like candy, according to data from the Drug Enforcement Administration.
Deborah Williams, manager of the health district’s office of chronic disease prevention and health promotion, gave me the age-old cliché, that we’re at the top of the bad lists and the bottom of the good lists. If health habits are contagious, however, we need to consider that these health statistics can’t be viewed in isolation. They affect all of us in a web of expensive illness.
The power of accountability
Okay, back to my story. Not only did my drinking buddies leave, but my best friend happens to be my girlfriend, and she suggested we run a half-marathon together. I won’t say I didn’t have a choice in the matter, but it seemed like a good idea to say yes, so we started training together.
Here you see how good health can also be contagious. I had what amounted to a willpower partner because most nights, we had an appointment to run, and we ran. Willpower may be the most important muscle for people living in Las Vegas. Our whole city is based on the idea of giving in to temptation, of surrendering to desire.
John Tierney’s recent book, “Willpower: Rediscovering the Greatest Human Strength,” explains this complex human ability that seems to fail us so often. Tierney calls willpower “a form of mental energy that (can) be exhausted.” The most discouraging finding: Our willpower weakens when we’re low on glucose. In other words, sugar. You can see how that’s awful for someone dieting — one of the very things you’re trying to resist helps you resist it. But willpower can also be exhausted by attrition, via the sheer number of decisions you have to make in a day, leading to what’s called “ego depletion.” With my running partner, however, I didn’t have to exert much willpower. The sense of expectation — in short, not wanting to disappoint her — saved me from having to rely solely on my (admittedly weak) willpower.
I was also fortunate to end up with a lucky situation in which I was a glorified house sitter, and so living almost rent-free. I decided I would use some of the savings on my health, so I bought sessions with a personal trainer. Here I was again following Tierney’s dictate, because with appointed and paid-for training sessions, I didn’t have to expend much willpower getting to the gym — I’d invested in it and felt it only made sense to get my money’s worth. Moreover, once there, my trainer served as a fitness and nutrition dictator to whom I had to report twice a week, wanting to know if I’d eaten breakfast — accountability.
The stress connection
I’m not rich, but I’m also not poor, and this offers huge advantages for my health — especially by cutting down on stress. Let’s contrast my good fortune with our community’s impoverished, whose ranks have skyrocketed since the recession. The portion of children in the Clark County School District eligible for free or reduced-price lunch, for instance, has risen from 37 percent to more than 50 percent since the recession.
Tierney posits that maintaining willpower is especially challenging for poor people, because they constantly have to make difficult decisions that lead to depleted willpower. Do I pay the doctor or the electric company? What groceries can I buy with $30? This ceaseless, stressful decision-making leads to ego depletion, which can then lead to impulsive decisions. Not surprisingly, as Tierney notes, research shows that self-control — or lack of it — is a key ingredient of poverty. Poverty, and more broadly, the economic travails experienced by so many Nevadans the past five years, are incredibly stressful.
“It’s a stressful place for people who don’t have a good income,” says Nancy Menzel of the UNLV School of Nursing and former member of the Southern Nevada District Board of Health. The website and magazine rankings are, of course, wildly subjective, but given our housing crisis and unemployment, it’s easy to see how Las Vegas has ranked as one of the most stressful cities in America the past few years. As we all know by now, stress is deeply damaging to the body. Stress releases the fight-or-flight hormone cortisol, increases heart rate and blood pressure, and activates the immune system. Too much of this is toxic, leading to sickness of the heart and other organs. Children exposed to toxic stress, such as physical abuse, substance abuse in the home, and even persistent poverty, will also suffer health effects.
“The relationship between childhood trauma and ill health is well established,” Menzel says.
Since we’re talking about kids, let’s return to my own childhood, because that’s where my health advantages started. Our family wasn’t free of misfortune, but I was raised in a loving home with intellectual stimulation, a yard with a makeshift baseball field and basketball court and a steady diet of vegetables.
Does this affect my health now? Yes, especially insofar as I was free of trauma. Dr. Jack Shonkoff, the director of Harvard University’s Center on the Developing Child, recently wrote: “For the one in seven U.S. children who experience some form of maltreatment, such as chronic neglect or physical, sexual or emotional abuse, biological adaptations can lead to increased risk of a compromised immune system, hypertension and heart disease, obesity, substance abuse, and mental illness.” How does this work? The architecture of a child’s brain and body can be influenced, which is to say damaged, by high levels of traumatic stress. We’re not talking sad memories of a bad childhood. We’re talking fundamental brain wiring.
These findings should be particularly concerning to Las Vegas. Even just five years ago, we could proudly say that although we were plagued with social problems, our laissez-faire economy and thriving construction and gaming sectors had led to widespread prosperity and relatively low rates of childhood poverty. We can no longer say this. Poverty rates now affect more than one in five children, up 32 percent since the recession.
This economic decline is stressful in itself, while leading to other problems that ramp up the stress still more. As Greg Duncan of the University of California at Irvine and Katherine Magnuson of the University of Wisconsin recently wrote, “A long line of research has found that low-income parents are more likely than others to use an authoritarian and punitive parenting style and less likely than others to provide their children with stimulating learning experiences in the home.”
The social network
Finally, even though my drinking buddies left town, I was still left with a good social network of friends and family in other cities, a supportive home life and a fun (for the most part) and stimulating job with interesting colleagues. I was never at risk of suffering from social isolation, aka, loneliness.
By contrast, this is a dangerous risk for many in Las Vegas, a city not known for its deep social networks. We’re a city of transplants and transients, a city most of us came to so we could leave something behind, a city that can be downright lonely.
As I wrote last year, neuroscientists are learning about the dangerous effects of social isolation on the body and brain. Social isolation is stressful. Think of this in evolutionary terms: The person isolated from the tribe, alone in the forest, was always scanning the horizon for threats in a lonely and dangerous world. Lonely people face the same situation now, if only assuaged slightly by the random numbers of a slot machine or a few far off “friends” on their computer. Isolation can also damage our brain, specifically the part that’s crucial for our executive function, our impulse control, as evidenced by prisoners held for long periods in solitary confinement. Again, this is not the best city to live in if you struggle with impulse control.
Catching the health virus
Notice that I’ve not even addressed access to health care services, which are infamously mediocre here in Las Vegas. That’s because I haven’t required health care, but that’s sort of the point. Menzel was being flip, but not entirely so, when she told me that a key to good health in Las Vegas is avoiding the operating room here.
Here’s an understandable response to what I’ve thrown at you, especially if, as I suspect, you’re the kind of healthy person who reads this upscale magazine: Who cares? A bunch of people in Las Vegas are unhealthy. No surprise there. I’m healthy, and my spouse and kids are healthy.
Perhaps, but I again take you back to the contagion of good and bad health. If health habits are contagious, the data is worse than a mere blow to our civic pride. It’s more like we all live in an old mining camp, a place where the food and living conditions are unsanitary, allowing disease to move from one house to the next. In our case, it’s a little more advanced, so instead of literal disease, it’s the bad health habits that spread. And those bad habits will surely lead to today’s biggest killers — cancer, heart disease, diabetes, stroke.
Given this contagion, I wonder if we can continue to isolate our public health problems from our economic problems. There are the links between health and economy in the obvious ways, in that sick people are less economically productive and sick parents less able to properly rear their children, who in turn will also be less productive.
But also, consider America’s healthiest cities, places such as Minneapolis, San
Francisco, Boston. Notice how they avoided the worst of the recession and are now again economically vibrant. Conversely, can an unhealthy city be a prosperous city? Las Vegas: Is this a question we really want to test?