Why is this so hard?


This winter the Legislature will be considering how to regulate and finance health care. Many of the factors that determine whether or not we are healthy are related to our own behavior: what we choose to eat or drink or smoke or otherwise consume. How to regulate legal and illegal drugs is also under consideration, and how to best provide and pay for the treatment that those struggling with addiction need. And addiction is driven by our choices.

There are many contributing factors to why we behave in unhealthy ways, but it can seem so contradictory. How is it that a person with diabetes can get up in the morning planning to eat healthy and end up eating three pieces of cake at a party? How is it that a person can get up in the morning with good intentions and end up getting high and forgetting to feed their kids? No one gets up in the morning with the plan to get drunk, drive drunk, and cause a deadly car crash. Why is it so hard for us to match our moment to moment daily decisions to our long term plans? I wonder if we may overestimate our capacities to make good decisions in some cases.

The dominant model of individual consumer decisions is that we choose what will be best for ourselves, and that each of us is the best judge of that. There is considerable truth to this in many circumstances, but I think that when we are confronted with whether to choose certain items our capacity to make decisions in our own best interests is compromised. We lose the ability to keep our immediate choices in line with our long term plans because the intense sensations generated by certain consumables can overwhelm our ability to be rational. Sometimes the need to get immediate relief from the stress and pain with which we struggle enters into the choice. We can become unable to choose what is actually best for ourselves.

People crave sugar, salt, and fat because we evolved under conditions in which such essential nutrients were scarce. We are therefore hardwired to work hard to get them. But now we have such productive technology that we can easily obtain large quantities in concentrated forms, and we consume so much of them over periods of time that we can literally make ourselves sick. But the gratification of the intense short run desire overwhelms the known long run negative effects over and over for many of us.

An even more destructive way in which the power of our technology allows our desires to lead us astray has to do with the mind altering substances that we can now create. Chemical substances that may have been used for thousands of years in unrefined states and small amounts can now be produced in quantities and intensities that are historically unprecedented. People may have chewed coca leaves for stimulation in the past. But now we can concentrate the chemical components to create crack cocaine, which apparently fires all the pleasure systems at once. Nicotine, alcohol, opiates, and other substances also function to essentially hijack our neurophysiology – their intensity in current forms just overwhelms our nervous systems. Many of them have legitimate medical uses for pain management and others can in moderation be part of the pleasures of life. But they can also damage our pleasure systems so that with repeated use we no long have any pleasures, and are seeking merely the absence of pain.

Many cases of drug addiction begin with medication under a doctor's supervision. But how is it that for so many this escalates into illegal use of opiates – how is it that law abiding people begin to break the law? I think that these substances have physiological effects that compromise our ability to make choices in our own interests even when we are not actually under their influence.

The state may need to regulate or tax certain substances differently, but we definitely need to focus on making our daily consumption decisions as part of a long term plan for investing in our health. Decisions of what to eat, drink, or otherwise consume should be framed as either investments in mental and physical health or choices that damage them. This investment frame goes against the dominant theme of commercial consumer capitalism, which urges us to satisfy all desires immediately. This message is delivered by companies pushing legal foods and substances and also by drug pushers offering illegal drugs, and it must be counteracted.

By looking at these problems in terms of individual choices I do not mean to put all the responsibility on individuals alone. I am trying to consider how the way that we make decisions in combination with how society operates can generate such destructive results, and how we can prevent and treat illness and addiction with better regulations and more effective programs. Individuals are responsible for their behavior, but our society is responsible for facilitating healthy decisions. Both state policies and individual decisions must be based on a clear understanding of why these problems are so difficult for us to solve.

I welcome your comments and criticisms concerning my discussion of these difficult issues. I can be reached at cbrowning@leg.state.vt.us or leave a message at the state house at 802-828-2228. I continue to hold legislative office hours over breakfast every Saturday from 8 to 9:30 am at Chauncey's on Route 7A in Arlington.

Cynthia Browning is a state representative to the Legislature, representing the towns of Manchester, Arlington, Sunderland and Sandgate.


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