Thursday July 30 - Looking Deeply into our National Health

Vietnamese Buddhist teacher Thich Nhat Hanh


National health care is very much in the news right now. I hope that congress can come up with a workable system that gives all Americans access to excellent health care. Our present system is, like almost every enterprise in this country, geared more to profit than to service. It is not so much broken as it is wrong. I think most Americans agree that something must be done to provide good health care for all the people.

In looking at the health care dilemma as with so many tough situations, I find it very helpful to follow the advise of Buddhist teacher Thich Nhat Hanh and look more deeply into the problem, to really sit with it quietly and contemplate. It seems to me the first thing we must see in this deeper look is that what we really want and need is not so much national health care as national health. The health of our people is poor and I do not believe that a national health care system as proposed in any of the versions before congress even begins to address our ill-health. Prevention of illness or maintaining health needs to be a top priority in each person's life and it should be the top priority of any national health care plan.

So why aren't we healthy or more bluntly why are we so sick? Let's just take one common disease, type II diabetes which is reaching epidemic proportions in this country. The Center for Disease Control says that 20.8 million people which is 7% of the US population has been diagnosed with type II diabetes. WOW! As a nurse I would bet that nearly every one of those 20.8 million people received some education with their diagnosis even if it wasn't optimum. They did hear, "eat less and exercise more". You even hear that on TV almost daily. For many people with this disease the cure is really that simple. Yet we all continue to overeat and sit around even when we know how bad it is for us. I want to point out that I certainly include myself in this "we" who struggle with over-eating and weight problems. My weight has yo-yoed for the last 20 years as I gain weight, then diet to lose the extra pounds and then gain them back again. As most of us, I love all kinds of food and tastes and experiences of eating. Let's just say that today I am on top of my addiction but tomorrow or even this afternoon is a still up for grabs. I know first hand how hard it is to keep up a healthy lifestyle. It is work and it takes a lot of support and intention. You could say, just like it takes a community to raise a child, it takes a community to live healthily. Almost universally I would say we do not have that kind of community in this country.

Two thirds of US adults are overweight with a BMI over 25 and one-third of those is obese with a BMI over 30. That means that less than one third of Americans is in the range of healthy weight, BMI of 18.5 to 24.9. Thus we suffer the health consequences of heart and kidney disease and diabetes. These statistics come from WIN - Weight Control Information Network which is from the US Department of Health and Human Services.

Since I was a nurse for twenty-six years and just retired a few months ago, I would like to share just one of my many experiences with this problem. For the last five years I worked as a home care nurse in one of the poorest counties in one of the poorest states in the US. Still many people here have health care provided through either Medicare or Medicaid programs. I don't think that a national health care system modeled on the present system of health care would change things very much here. I saw many, many people suffering the consequences of obesity and poor nutrition. So that I do not violate any one's confidentiality I will use a compilation of situations. But this story even though it doesn't represent one individual is not an exaggeration of what kinds of things happen frequently.

This man was relatively young by my standards these days, about 50 years old. He weighed over 300 pounds. When I saw him he had already had diabetes for 10 years which caused kidney failure requiring dialysis treatments three times a week at our local hospital 25 miles from his home. The usual cost estimate for dialysis is about $150.00 per session. Home care nurses like myself came to his home daily to do dressing changes on a foot ulcer that was refusing to heal. Some of the creams that were used on his wound cost over $100.00 an ounce. We continued to see him daily for over a year. Each nursing visit cost Medicare about $150.00. Since the foot ulcer was not healing he was started on hyperbaric chamber treatments weekly at a hospital 100 miles away. These treatments cost about $1000.00 each time.

During all of this time this man continued to overeat and disregard his elevated blood sugars, often stopping to have hamburgers, french fries and shake at a fast food restaurant on his way home from treatment. Due to his poorly controlled diabetes he also had significant heart disease and was hospitalized several times for heart problems. He finally had to have a foot amputation which again did not heal, so eventually they had to amputate his leg. He spent some months in a nursing home and then again returned home. Obviously by this time he was very ill. Yet he and his family continued to believe that if he could just get the right medical treatment he could get back to being active in his community. Eventually he ended up back in the hospital with pneumonia. He was put on a ventilator when he could not breathe for himself. Even after weeks his family did not want to disconnect the ventilator because of his wishes to have everything possible done for him. It was months before he finally died. A very sad story. Sadly also a very expensive story for the "health care system". The family's finances were used up early in his disease. Essentially his entire bill was paid for publicly. If this is the kind of health care Americans are expecting, I believe any national health care program will fail.

Since 1990 there has been a 76% increase in type II diabetes in the age group of 30 to 40 year olds. So how many more people are there each day who live out a variation of the above story? And why? The most obvious answer to me is that we have become a nation of addicts. We are addicted to over-eating and unhealthy food. This is one of the big problems that I believe a true national health care program would address. How can we get back to health? In the quote below from his book Living Buddha, Living Christ Thich Nhat Hanh is speaking about drug addiction but I think his words apply to the problem of any addiction that is causing us harm.

"Drug users know how destructive their habit is, but they cannot stop. There is so much pain and loneliness inside them, and the use of alcohol and drugs helps them to forget for a while... trying to stop the drug traffic is not the best use of our resources. Offering education, wholesome alternatives, and hope, and encouraging people to practice the Fifth Precept ( this is a precept on mindful consumption) are much better solutions. To restore our balance and transform the pain and loneliness that are already in us, we have to study and practice the art of touching and ingesting the refreshing, nourishing, and healing elements that are already available. We have to practice together as a family, a community, and a nation. The practice of mindful consuming should become part of our national health policy. Making it so should be a top priority..."

At first glance like most of this gentle teachers words, they seem too simple, almost child-like. But on deeper consideration, I believe there is much here for us to consider. What would it mean to have a health care system that offered "education, wholesome alternatives, hope and encouragement" to practice a precept of mindful consumption? What would it mean to make mindful consuming a "top nation health priority"? How can we learn to practice "the art of touching and ingesting the refreshing, nourishing and healing elements that are already available."? These are discussions that our communities need to have. We can not just leave it to our congress people. It is clear that they are influenced by corporations with their zeal for greater profits. This is another case where that old bumper sticker hits the mark, "If the people lead the leaders will follow." We each need to take responsibility for our health and make a contribution to the health of our community. Maybe the politicians will see the light some day but we can't count on it. We have to start creating the health we want for yourselves and our communities.

Of course I clearly understand that we cannot prevent all illness and we are not guilty for getting sick. Poverty and violence in one's life take a tremendous toll on a person's health. We don't have complete control over the quality of our air, water or our food or the predispositions of our genetics. But we do need to take some personal responsibility for those many aspects of our health and our nations health over which we have some control. In our society it seems like blasphemy to suggest that our body is not our own. Individualism is one of our gods. But just listen to a little bit different view again from Thich Nhat Hanh in his book The World We Have.

In modern life people think that their bodies belong to them, and they can do anything they want to themselves. "We have the right to live our own lives", they say. The law supports such a declaration; that is one of the manifestations of individualism. But according to the teachings of the Buddha, your body is not yours. Your body belongs to your ancestors, your parents and future generations. It also belongs to society and to the other living beings. All of them have come together - the trees, the clouds, the soil, everything to bring about the presence of this body....Keeping your body healthy is a way of expressing gratitude and loyalty to the whole cosmos, to all ancestors and to future generations. If we are healthy everyone can benefit from it...

You may not agree that your body is not our own. But I think everyone can agree that if we are healthy everyone can benefit from it. As I think about this new way of approaching health, I realize how many of the essential questions and issues are not individual but are questions for the whole community. Should we let corporations profit from selling soda and candy in our schools or serving our children milk laden with growth hormones and antibiotics? How can we support our local growers and farmer's markets which provide us with healthy food? What should we serve at our community gatherings? How can we support people who need to make changes in their lives to get more healthy? I would like to see real health taught in our schools, in our hospitals and clinics, our churches and community centers. Obviously the questions and issues are far-reaching and many, but we need to start talking and making some changes. Since our president is pushing for national health care reform maybe we can also talk about real lasting reform and the deep questions we need to address in order to achieve an acceptable level of national health.