Prevention is not working. Despite a flood of health information, U.S. surgeons generals' reports, and the Healthy People 2010 health promotion and disease prevention agenda laid out by the federal government, we are still falling short. It's not that most people don't know their diet is awful or their waistline is bulging or they're having risky sex. It's that they don't take it to heart.
As dedicated as public-health efforts have been in making prevention a national goal, it's fair to say that making it happen needs a major boost. What's missing, I think, is an all-out effort to mobilize moms. Mothers—not doctors or public-health experts—are the nexus of prevention. However weighty a burden this may seem, Mom is the figure everywhere in the world best positioned to influence the behavior of those she loves, and that's the influence we need to reverse the dismal trend in America's health status.
This is not to diminish the importance of fathers, of course, or the mom who lurks in many dads. But it is Mom who has the babies and who usually spends the most time with them as they grow up. Mothers largely set the nutritional tone of the household; mothers oversee the healthcare of the family, young and old, husbands and children; and mothers are the biggest consumers of health information in print and on the Web. And with a special status that enables them to relentlessly nag based on their undying maternal love, mothers are positioned to be the lever that pushes detached public-health preaching into personal action.
Wasn't this always her role? We have all internalized Mom's wisdom, and except for "Clean your plate," how lasting and wise it has been: "Wash your hands," "Stop rubbing your eyes," "Don't run with a sharp object," "Eat your broccoli," "You need your sleep," "Get some fresh air and sunshine," "Stay away from bad friends." Really, Mom's directives were all about preventive medicine. But with mounting research uncovering more about what causes disease and ways disease can be prevented, her old advice takes on new meaning—and urgency.
Look at eight of the top 10 leading health indicators laid out in Healthy People 2010: physical activity, body weight, tobacco and substance abuse, sexual behavior, immunization, mental health, and accidents. If we did better in these areas, warding off many of the medical scourges of our time would be guaranteed. But doing better mostly reflects personal health habits, which are not formed in doctors' offices or found in medicine cabinets. Personal behavior is most apt to be shaped by the forces of the home environment, and lessons drummed in early have a good chance of lasting.
Model behavior. Whether it's the environment of the womb or of the home, Mom's own behavior has a mighty impact. We've learned of the damage wrought by prenatal exposure to tobacco, alcohol, and cocaine. Poor nutrition and excessive weight gain during pregnancy increase the chance of lifelong obesity in offspring. And low birth weight is associated with high blood pressure and diabetes later in life. A home in which one or both parents smoke is more apt, and a smoke-free home less apt, to produce smokers. And children's mental development correlates with maternal education and vocabulary.
Even in the poorest of poor countries, education of women can be counted on to improve national well-being. With the benefit of only a few years of school, women create healthier homes, improve nutrition and hygiene, and bear fewer and more robust children. Infant mortality improves, but so does the life expectancy of everyone.
"Good health to you," as the old Irish greeting goes, is not a wish or an accident, nor is it just about decent jobs or good genes. At its core, it is about lifelong personal behavior. Like mom herself, the body is resilient and forgiving; health habits ideally are learned young but benefit anyone at any age. And that goes for Mom, too—she must be a mother to herself. Even if she thinks she has no time to do so, evidence that those around her are molded by her behavior should be compelling enough.
I learned an enduring lesson during my pediatrics rotation in med school: When a child is in for a well-baby visit, never forget to recognize Mom. Praise her for the good job she is doing, for she is at the center of her little one's health. As preventive medicine has emerged as well-care for grown-ups and is now viewed as critical to our nation's health, Mom, indomitable, can still be a force at the center.
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