If the COVID-19 pandemic has taught us anything, it’s that people have the capacity to change entrenched behaviors when the stakes are high enough. Who among us declared that 2020 would be the year for us to perfect the practice of physical distancing? Although we were clueless about pandemic practices a mere three months ago, we’ve adopted this new habit to avoid getting or spreading the virus. But what about other unhealthy behaviors that have the potential to shorten life spans across the US? On January 1, 2020, some of us made New Year’s resolutions aimed at improving our health: to eat less, lose weight, exercise more, drink less alcohol, stop using tobacco, get more sleep, start meditating regularly, schedule that colonoscopy, and so on. Might there be hope for gaining traction with one or more of these healthy behaviors, too?
Moving from clueless to changing behavior
Health psychologists and addiction medicine professionals like me use a standard model of behavioral change to understand how people move from a mindset of cluelessness to one of action. Predictably, we pass through the following six stages of change:
- Precontemplation (“Life is short — there’s nothing I need to change.”)
- Contemplation (“I suppose I should consider making a change.”)
- Preparation (“The time to make this change is very close. Here’s my plan.”)
- Action (“I’ve done it. I hope I can keep it up.”)
- Maintenance (“I can make this work for as long as I need to; I’ll keep on keeping on.”)
- Moderation or Termination (“I’ll rely upon my common sense and sound medical advice to decide whether to maintain or let up when the time is right.”)
The empty streets of New York and many other major US cities bear witness to the fact that with regard to social distancing, large numbers of Americans have moved rapidly from precontemplation to maintenance. Because we have embraced this dramatic change and the mortality curve is being flattened in some parts of the US, the actual death toll from COVID-19 is likely to be a fraction of what it would have been if we had stayed put, mired in precontemplation or contemplation.
The pandemic is not the only danger to our health and lives
But wait a second. Don’t lifestyle blights like obesity, hypertension, addiction, and violence exact a far greater human toll from us than COVID-19? And aren’t these biopsychosocial maladies correlated with low socioeconomic status? And aren’t COVID-19 fatalities particularly high in disadvantaged people who suffer from one or more chronic illnesses?
A quick look at US death rates and life expectancy on a state-by-state basis suggests, sadly, that the answer to all three questions is yes. The impact of “lifestyle health” and socioeconomic status on life expectancy is very high: residents of Marin County, California can expect to live a dozen or more years longer than residents of Harlan County, Kentucky!
What enables us to change our social behaviors so rapidly to combat a viral adversary, while, relatively speaking, we are losing the war against lifestyle and socioeconomic enemies like obesity, addiction, and violence? Perhaps this has to do with the fact that when it comes to the latter, the famous words of Walt Kelly’s Pogo apply: “We have met the enemy, and he is us.”
Human nature is complex. Compared with seemingly intractable lifestyle afflictions, which may be determined or amplified by socioeconomic factors, a coronavirus represents a more tractable adversary. It’s possible that the scientific, medical, and technological expertise of our hyperconnected global brain trust might ably defeat it. But individually as well as collectively, we seem to be less proficient when it comes to taking on and defeating the lifestyle enemies that “are us.” We stay mired in precontemplation and contemplation until it is too late. Why do so many smokers opt to quit only after a diagnosis of lung cancer? Why is it that some alcoholics do not stop drinking until the onset of jaundice caused by end-stage alcoholic liver disease? How many more shrines shall we erect to the victims of senseless violence directed to the self or others, pledging now to wake up and make a difference?
Just as our society has rallied to take on a wily viral adversary like COVID-19, starting right now it is just as important for us to focus attention on addressing, curing, and — better yet — preventing lifestyle afflictions like obesity, addiction, and violence. We can start small during this time of sheltering in place, by combating couch-potato tendencies with daily exercise, avoiding the temptation to get buzzed, and keeping the Healthy Eating Plate in mind as we wrestle with the temptation to manage stress by consuming unhealthy comfort food.
Together — as individuals, families, communities, and a society — we should resolve to take action to promote health. Our successes battling this viral pandemic should inspire us to combat every serious adversary that threatens our well-being, not merely those that pose a sudden, immediate, and frightening threat.