Editor's Note: Mark's column this week is his essay from Shepherd University's "This I Believe" essay readings.
Nearly 20 years ago I entered Family Medicine with a vision of shaping healthier communities. Over this time our disease based health care has devolved into a complex, disjointed, horribly expensive and by current evidence often dangerous mix of medications, tests, specialists, shifting payers and complex rules. Even the often discussed preventive "care" being discussed in think tanks is implying that the ticket to better health is dependent on the "care" (i.e. screening and exams) a health provider gives to an individual.
What is often surprising to the public is that the ritual annual "physical" has not been shown to save lives or decrease costs and that accepted screening tests (i.e. cholesterol, colonoscopy, PSA, pap smears, even mammograms) unfortunately are blunt tools at best and at worst lead to costly and painful interventions and treatments when applied broadly to well populations. Have a sincere conversation with your doctor and decide for you what prevention is and what is wise screening or early detection.
Without debate are the benefits of a comprehensive healthy lifestyle in societies throughout the world that share common practices. Massive longitudinal studies have been carried out in thousands of patients over decades such as the Okinawa Centenarian Study (www.okicent.org), the HALE Project (jama.ama-assn.org/cgi/content/abstract/292/12/1433), the EPIC/Norfolk UK Study (www.plosmedicine.org/article/info:doi/10.1371/jour nal.pmed.0050012), the MacArthur Study of Successful Aging (www.aging.ucla.edu/successfulaging.html) and revolutionary studies performed by Ralph Paffenbarger (Harvard Alumni Study - www.hmiworld.org/hmi/issues/Jan_Feb_2006/around_exercise.html) and studies of the Cooper Institute (www.hmiworld.org/hmi/issues/Jan_Feb_2006/around_exercise.html).
A recent book called the "Blue Zones" highlights several longevity pockets throughout the world. When these populations migrate to become more modern they quickly adopt the health status not of their native lands but of their new place of living. There is nothing new and innovative in these traditional lifestyles: they do moderate physical activity their entire life, eat a plant based diet, do not smoke, maintain their weight, most have a drink a day and give care forever. There is something magical about the elderly being weaved into their culture in a valuable and serving way, not left forgotten and at the mercy of a corps of medical providers. A perfect example of this is our local legend Frank Buckles who died at 110. His mantra was "you must stress the body." He respectfully dismissed the advice of his health care team when they advised him to get off the tractor at age 103 and rest.
So as the health care policy makers and interest groups debate over who will pay for the inefficient and costly "care," maybe we need to give more "thought" into how we live and promote policies that support an active and healthy lifestyle for all generations.
In our rural county of West Virginia, we are growing a project titled "Wild and Wonderful Trails for Every Child." We are reshaping the built environment and nutritional education to align with the principles of healthy living. Freedom's Run is raising funds and leading programs to teach citizens to move more and eat better. Our focus extends the medical home into the medical home's backyard - the place where real health occurs.
Perhaps the thought we put into this local initiative could be translated into a larger national forum - and maybe in the future we will be providing less care, like they do in the Blue Zone societies.
Mark Cucuzzella is a community columnist for The Shepherdstown Chronicle. His opinions are his own and not that of the paper's. He can be reached at firstname.lastname@example.org.