I am privileged to be very healthy. There is, admittedly, an element of good fortune in that, and so I am tempted to append, "knock on wood!" But I won't, because I'm not superstitious, and I know that in this, as in all things, fortune favors the prepared. Good health is more about good preparation, than good luck – and we are all capable of it. Factors we control can even change the way our genes express themselves. Medical destiny is much less about DNA, and much more about the choices in our hands than most people think!
[Read: Recipe for Health.]
To narrow down the topic a bit, we might frame it as a multiple-choice question: Which of the following do "healthy" people have more of than everybody else?
1. Years of Life
2. Life in Years
4) Skill Power
The answer is…all of the above, with the last two – skill-power and fun – highlighted for good reason. Let's go through them one by one.
1. Years of Life
Life expectancy has been rising in the United States, getting nearer to 80. Women still have a slight edge over men, and health disparities mean less years of life for the usual so-called "minority" groups. But we have known for years that poor health is associated with a much-heightened risk for premature death. Maybe it's true that the good die young, but certainly the unhealthy tend to do so. Healthy people live longer.
2. Life in Years
More important, I think, than the length of life is the quality of it. Increasingly, premature deaths in the United States, and around the world, are the result of chronic diseases. These are the usual suspects: heart disease, cancer, stroke, diabetes, dementia and so on. What this means is that unhealthy people are losing life from years long before they surrender years of life. Living with a serious chronic disease, as so many do, steals joy, and pleasure and opportunity. Healthy people get to keep these.
We all know the expression, "If you don't have your health, you don't have anything," and it is certainly true. I have had many patients over the years who made it to retirement age with their nest egg in excellent shape, but their health – not so much. The result was tragic. There was money available to do the things they wanted to do, like travel the world, but they were too sick and spent to do any of it. Without health, their lives were over, and no amount of money could compensate.
We know the expression, but our culture does not act accordingly. We invest in wealth, but many of us neglect health. But healthy people don't; they care. They aren't healthy by accident – they are healthy because health is a priority. Being healthy, in other words, begins with a will to be healthy.
[Read: 6 Ways to Make Time for Your Health.]
And there is more to will than just wanting. The method of "motivational interviewing" was developed for health care professionals, but it can be turned around so that you apply it to yourself, doing everything possible to maximize your will. Ambivalence can be overcome. And then, willpower can be adapted into habits, so that your priorities take on a self-perpetuating life of their own and depend ever less on will as time goes by.
Achieving health begins with a will to be healthy; but it only begins with will. Without will, it doesn't matter whether or not there's a way. But with will, there may or may not be a way.
4) Skill Power
Skill paves the way. I am blessed to be healthy, but it's really not just good luck. I have the will to be healthy, and it starts there. But I also have the skill! We talk way too much about willpower in our culture and not nearly enough about skill power.
Imagine, for example, that you wanted to drive a car or ride a bike but didn't know how, and nobody taught you. You might try bike riding anyway, out of sheer will, but there's only so many times you can fall down and get hurt before you say: Enough is enough! In the absence of the requisite skill, bad experiences erode will. Eventually, will runs out.
Skill power fixes this. If you know how to ride a bike, it may be still be challenging at first – which is where will comes in – but you gain expertise and mastery long before will runs out. Once you have expertise, the demands on willpower drop precipitously, because the task just keeps getting easier. Learning to be healthy can be just like learning to ride a bike.
What are some examples? How about knowing how to take gram after gram of sugar out of your daily diet without ever focusing on foods you thought of as sweet in the first place? I refer to this as "stealth sugar," hidden in many foods you'd never suspect; by cutting sugar here, you make no sacrifice but start to prefer food less sweet in general. Rather than relying on will to give up your favorite dessert, you can call upon skill – and simply learn to prefer dessert less sweet.
Similarly, skill can enable you to rehabilitate your taste buds, learning to prefer, and love, foods that love you back. Knowing how to trade up food choices in every aisle of the grocery store can empower you to improve your diet, and health, one well-informed choice at a time. One of the many virtues of more nutritious foods is that they fill you up on fewer calories.
So while a willpower based approach to weight control might mean being hungry and trying to tough it out, a skill power-based approach means controlling the quantity of calories you consume by improving the quality of foods you choose– and getting to thin without going hungry.
And, skill power means knowing ways to fit fitness into your daily routine in whatever way works best. There are many ways to fit motion into a day, and the more options you have, the more empowered you are to find one that works for you. It takes a lot of willpower to get to the gym at 5 a.m. But with the right skill power, tools and resources, there are even ways to fit in activity without leaving the office. More skill power means less need to lean so heavily on will.
And then there's the real prize – why health matters. It's not because a doctor like me wags a finger and says what you "should" do. As I've written before, health isn't about should, and health isn't even really the prize. Living the way you want to live – seeing those you love live the way they want to live – that's the prize! A better life is the prize. The simple reality is that health helps you get there. A healthy life is a better life, other things being equal. Healthy people have more fun.
And there are, of course, things healthy people have less of than the rest of us. They take less medication. They have fewer trips to doctors and hospitals. Because skill power can be shared and paid forward, they tend to have less anguish, sorrow and loss.
We have known for literal decades how to eliminate fully 80 percent of all chronic disease – heart disease, cancer, stroke, diabetes, dementia, etc. – and so, to reduce our lifetime personal risk to the same degree. Think about your loved ones who have had any of these conditions, and imagine those bad things simply not happening 8 times in 10! We have the knowledge, and have long had it, but if you believe knowledge is power, here's your reality check! Knowledge isn't power if you don't know how to use it. That's where skill power comes in.
I want everyone to use the knowledge we have. I want everyone to have the skill power that I have and rely on every day and have shared with my wife, and our five children, and my parents, my patients and, to the extent possible, everyone I care about and have been able to reach.
And to that end, I am pleased and proud to bring to your attention my new book, "Disease Proof," available online and coming Sept. 26 to bookstores nationwide. The culmination of years of work, "Disease Proof" is my attempt to pay forward my skill set for healthy living. The book is all about the factors that matter most to health – in particular how we use our feet (physical activity) and our forks (dietary pattern). It's about how to maximize will and, mostly, it's about the relevant skills. I have the skills it takes to be healthy in a modern world that conspires mightily against it – and I want everyone to have them. That's why "Disease Proof" was written.
Most of my work is about making the world a place where health resides on a path of lesser resistance rather than the road less traveled. But you and those you love can't afford to just keep waitin' on the world to change; that tends to be a slow process.
Fortunately, you don't have to wait. With the right skill power, you can disease-proof yourself and those you love today.
Hungry for more? Write to email@example.com with your questions, concerns, and feedback.
David L. Katz, MD, MPH, FACPM, FACP, is a specialist in internal medicine and preventive medicine, with particular expertise in nutrition, weight management, and chronic-disease prevention. He is the founding director of Yale University's Prevention Research Center, and principal inventor of the NuVal nutrition guidance system. Katz was named editor-in-chief of Childhood Obesity in 2011 and is president-elect of the American College of Lifestyle Medicine. His latest book, "Disease Proof: The Remarkable Truth About What Makes Us Well," is being released this month.