published Thursday, August 23rd, 2012

Cleaveland: Changing behavior should start early

Clif Cleaveland

Consider four scenarios:

• A middle-age woman is repeatedly brought by ambulance to her community emergency room because of alcoholic intoxication. Eventually, she develops liver failure due to cirrhosis and needs a liver transplant if she is to survive.

• A man weighs in excess of 450 pounds. As a consequence of his weight, he experiences diabetes, sleep apnea, disabling arthritis of his hips and knees and chronic heart failure. He is wheelchair-bound, oxygen-dependent and requires multiple in-patient admissions yearly.

• A young man, addicted to prescription narcotics, is transported to an emergency room because of overdosage. Later,he fails to keep outpatient appointments at a mental health clinic.

• A woman who smokes two packs of cigarettes a day requires repeated hospitalization to treat problems related to emphysema and chronic bronchitis. She must use oxygen continuously at home.

Each illness represents a consequence of addiction. Each, it could be argued, represents self-inflicted injury. These are common scenarios, the treatment of which is costly in terms of health care, lost employment and added responsibility for family care-givers and community-service organizations.

Disability qualifies some in this group for Medicare. Many will qualify for Medicaid, depending upon the eligibility criteria of their home states. Others who lack health insurance will turn to public hospitals, community agencies and emergency rooms for care.

Emergency health care cannot be denied either legally or ethically. Still, acute care of addicted persons is often limited to patching them up and referring them for follow-up care in an outpatient setting. In many communities, follow-up care simply does not exist because of slashed budgets for public-health services. Addicted persons sometimes lack motivation to pursue sustained care.

Solutions depend upon preventive strategies, especially public education. Wise behavioral choices cannot be made without information.

Some states, including Tennessee, have mandated inclusion of material aimed at healthy diets in all grades of public schools. Why not expand the curriculum to cover nutrition, exercise, sex education and legal and illegal drug use (including tobacco and alcohol)?

The long-range prospects for success in any post-school career will depend upon a foundation of good health. A coordinated health curriculum extending from kindergarten through high school would serve as a valuable complement to other academic material. Imaginative presentation with accompanying texts could capture the attention of students at each grade level.

A health curriculum should include physical education at each level. This is a logical place to include training in first aid, cardiopulmonary resuscitation and prevention of sports-related injury.

Advertising powerfully shapes our perceptions and our behavior. Could we match every televised commercial for a fast-food chain or a carbonated beverage with information on healthful eating patterns? What would result if advertisements for beer and wine were coordinated with information on safe use of these products? Imagine logos related to disease prevention vying with commercial logos at sporting venues.

Controls of offending substances pose political challenges. Tobacco and alcohol taxes have been imposed for years to raise revenues and to deter usage of these products. We have imposed age limits as well.

Proposals to tax sugary drinks and snacks with no nutritional benefit, by contrast, bring charges of government interference with personal dietary choices. The counter argument contends that higher taxes would reduce consumption of products linked to obesity and generate funds to care for persons with weight-related illness. Efforts to enact such taxes have generally failed.

Public pressure on fast-food restaurants and producers of sugary drinks and treats could lead to alternative, healthier products, to prominent posting of nutritional content and to funding of public information on safer dietary practices.

Left unchecked, addictive behaviors will place unsustainable strains on health-care resources. Preventive strategies centered on education can save countless lives and health care dollars.

Email Clif Cleaveland at cleaveland1000@comcast.net.

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