The power of engagement?
Is there truly a piece of mind over matter in creating healthy people?
The NYtimes has an an interesting piece where a couple of Harvard psychologists turned awareness of healthy behavior into meaningful improvement in health metrics.
At the start of the study, Langer and Crum quizzed 84 maids at seven carefully matched hotels about how much exercise they got. Fully a third of the women said they got no exercise at all, while two-thirds said they did not work out regularly. Langer and Crum took several measures of the women’s basic fitness levels, which indicated that they, indeed, had the poor health of basically sedentary people. Then just over half the women were told an unfamiliar truth: cleaning 15 rooms daily — pushing recalcitrant vacuum cleaners, scrubbing tubs, pulling sheets — constitutes more than enough activity to meet the surgeon general’s recommendation of a half-hour of physical activity daily. The researchers even provided specifics: 15 minutes of scrubbing burns 60 calories, 15 minutes of vacuuming burns 50. The basic message and the details were then posted in the maids’ lounges in the hotels where the 44 women worked, to serve as reminders, while a control group was left in the dark.
A month later, Langer and Crum checked back with the women to find, as they reported in the February issue of Psychological Science, remarkable results. The average study-group maid had lost 2 pounds, while her systolic blood pressure had dropped by 10 points; by all measures the 44 women “were significantly healthier.” Yet there were no reported changes in behavior, only in mind-set, with the vast majority of the women now considering themselves regular exercisers.
This has some interesting correlations to other stories of expectation, notably the Pygmalion in the Classroom example of a teacher with high expectations for a “gifted” class of randomly selected students ended up with a group of high achievers at the end of the year.
Simply put, when teachers expect students to do well and show intellectual growth, they do; when teachers do not have such expectations, performance and growth are not so encouraged and may in fact be discouraged in a variety of ways.
In our current environment of 6 minute doctor visits focusing on metrics treated as “bad” with very little adult conversation about how to correctly address healthy lifestyles, may we be condemning our current healthcare users to a poor fate? If so, it may not be surprising that people feeling increasingly helpless over their own health act in ways that are increasingly disengaged, creating a self-fulfilling prophecy driven by scientific reductionism.
Consumerism (not CDHP, but consumerism) may then be our way out– simply engaging the population and empowering each individual to feel responsible and in control of their own health may in turn benefit it in by driving differentiation through the summation of a series of insignificant and unremarkable choices over time.
This would be a remarkably different approach to thinking about care than we’ve seen in the past week, with government agencies deciding consumers need professionals in the loop, even if they don’t want to engage them, in order to pick a statin (Mevacor OTC application denied), address minor medical needs (MA puts off the opening of MinuteClinics due to need to write more regulation), or decide what they want to pay their doctor for services (MA decides to cut payments to docs and hospitals under subsidized mandatory plans).
Indeed it seems that Big Brother likes doing whats best for all of us, rather than letting us engage in the way we best see fit. Given that enlightened self-interest has generally driven progress in human society, when will we start to see the backlash against inefficient planned systems?
