Map of life expectancy at birth from Global Education Project.

Friday, July 13, 2007

The illusion of free will

I can't give you a link on account of you're not one of the elect, but Dr. Philip Mellen decided to find out whether people diagnosed with hypertension follow the standard dietary recommendations (called DASH, for Dietary Approaches to Stop Hypertension), and as he told the American Society of Hypertension, for the most part they aren't. Only 22% said they were -- and who knows, half of them might be lying.

This also happens to be the right diet for everybody. You already know the drill -- whole grains, fruits and vegetables, low fat dairy if any, lean meat and fish, nuts and legumes, no saturated or trans fats, steer clear of added sugar, low salt, around 2000 calories a day depending on your height and physical activity level . . .

The reason this diet prevents hypertension, diabetes, heart disease, and even some forms of cancer is because it's the diet our ancestors ate back on the African savannah* a million years ago. It's the right way for Homo sapiens to eat. And, everybody knows this. Our doctors tell us. It's on posters in the subway, it's on the TV, it's common knowledge. But we don't do it.

The cornerstone of clinical management of Type 2 diabetes is said to be diet and activity, but just about everybody with diabetes takes pills because they just can't do Plan A. Ditto with hypertension. Obesity is just about intractable and it's getting more and more prevalent and more and more extreme all the time. On the subway, it's now standard for two people to take up three seats. And there's the answer to all of it, two paragraphs above. Is eating that way horribly unpleasant, boring, depressing, disgusting? Of course not. You can make an endless menu of meals worthy of the very finest restaurants out of those criteria.

The problem is that we only imagine that our behavior is controlled by a "self," that our consciousness is co-extensive with an executive who is in charge, and that we decide everything we are going to do. On the contrary, there are wetware modules running inside our skulls of which we are largely or entirely unaware that generate much of our behavior. Back on the grassland, with our stone spear points and wooden digging sticks, 20,000 times Great Grandma could generally come up with the calories she needed but it took a lot of work and that put her in a bind sometimes -- the harder you work, the more calories you need. The sugar in extra sweet fruit or honey was worth grabbing. The game was very lean so a little fat was nice to have, and so was the simple starch in some tubers. Mega-Great Grandma was toiling all the time so when she got a chance to take it easy for a while and save a few of those scarce calories, it felt good. Evolution hard-wired her to like those things and to get them when she could.

Put her descendants into a world where they swim in sugar, fat and potatoes, and they can get essentially unlimited quantities while barely lifting a finger, and that's the wrong wiring. This problem is not about willpower, or individual choice, because those are largely illusory when it comes to basic drives like eating. It's an environmental problem. Those of us with more resources of time and money can modify our personal environments to some extent, and one dimension of the problem is that a better diet costs more. Also, those of us with more education, who grew up in higher income, more empowered households, develop more ability to delay gratification and make choices based on long-range criteria. (This is a sociological fact.) So obesity and it's attendant ills are more prevalent among lower income people. But it's a problem in all social classes.

It's a win that here in Massachusetts, it appears we're going to have the country's first state-wide ban on trans fats. The movement to get sugary drinks and other junk food out of schools has made some progress, but we have a lot further to go with that. Just think of everything else we could do through public policy to change our national food environment for the better, from the Department of Agriculture to the Department of Commerce to the Department of Education to the FDA.

Here's a powerful example of why the ideology of the "free market" and consumer sovereignty is so profoundly false. We can modify the food environment in such a way as to shape people's choices, and as a result, we can have a healthier population, that is more productive, suffers less, lives longer, and costs a hell of a lot less for health care. We can be happier, and healthier, and wealthier, if we make the food industry accountable to the public good.

* I'm among those who are convinced that the traces of a period of semi-marine existence are written into our bodies and psyches. At some point in human evolution, our ancestors lived by the ocean and spent a lot of time in the water.

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