Inconvenient Truths in U.S. Public Health

Preface: Versions of this article have been submitted to more than 20 publications… only one of them was willing to publish it. Thanks to The Sentinel for have the courage to share these important ideas. The stats and figures below were all collected from the CDC and the National Institute of Mental Health. The states profiled were selected with a final publication location in mind, since our organization has friends who therein reside.

Does your behavior match your goal? It’s a legitimate question. In order to answer it, you first have to identify what your goal is. We have to look closely at what we actually want, and design a path to accomplish it.

If the primary goal is to keep people alive and well (an obvious overarching purpose of Public Health) then the COVID-19 pandemic should be taken seriously. As of 12/20/20, more than 317,000 Americans have lost their lives to the symptoms and complications of COVID-19. Those numbers will undoubtedly increase over the winter months, as people increasingly congregate indoors.

We profiled five U.S. states to better understand the risks of the disease, as well as some of the additional complicating factors of the pandemic (other forms of physical and mental health). Those states were Illinois, Oklahoma, Mississippi, Texas, and Ohio. What we found, obviously enough, was that this is a serious issue.

For those who might compare COVID to the flu, consider that flu/pneumonia accounts for approximately 9,568 annual deaths across those five states (exact figures in Table One). Mortality rates from COVID-19 (currently at 56,796 deaths) are already 4.6 times higher than the flu in those states. That mortality rate, nearly five times higher than the flu, is stacking up in the presence of increased guidelines and restrictions. Without those increased guidelines, surely more lives would have been lost.

StateFlu/ Pneumonia deathsCOVID deathsCOVID deaths / Flu deaths
Table One.

So if the goal is to keep people alive and well, we should we shut down these states, right? Not so fast.

Remember that the primary goal of Public Health is to keep people alive.

The number one killer across the five states profiled was heart disease. Nearly 117,464 of their residents die each year from heart disease (exact figures in Table Two). We lose approximately 15,061 more to diabetes. Heart disease and diabetes are associated with obesity – in each of those states, approximately 65% are overweight and nearly 30% of their residents are classified as obese. Obesity is associated with more than 13 types of cancer; cancer was the second leading cause of death in each of the profiled states.

To keep those numbers down, the CDC recommends exercise. Knowing this, how can we willingly shut down gyms? How can we tell people they cannot play sports with precaution? And how could we possibly tell people not to exercise, when it is an essential component to saving lives?

StateHeart Disease deathsDiabetes deathsPercent Overweight (Obese)
Illinois25,3942,92762.2 (28.2)
Oklahoma10,7721,39866.3 (30.4)
Mississippi7,9441,16467.9 (34.0)
Texas45,3465,83265.9 (27.7)
Ohio28,0083,74065.0 (29.2)
Table Two.

The link between exercise and physical health is obvious. There is also a direct correlation between physical activity and mental health. Exercise helps battle anxiety and depression through a variety of methods, including a significant modulation of the neurochemical serotonin, which has a stabilizing effect on mood and well-being. Perhaps most notably, a number of studies have demonstrated the connection between routine exercise and decreased risk of suicide.

Suicide claims the lives of more than 48,000 Americans every year at the rate continues to increase. Those numbers were released before the isolation, fear, and financial despair felt by many during the pandemic.

Gyms offer not only the mood-boosting benefits of exercise, but the opportunity for people to improve and become empowered. Perhaps most importantly, especially in the conversation of mental health, is that gyms offer a sense of community. In this moment of global isolation, that seems more important than ever.

So we should not shut down opportunities for people to exercise and enhance their health. But we should be careful.

A shut-down is one thing; a set of regulations is another. When those regulations are implemented, they should be followed. 460 Fitness, a popular gym in Virginia, recently had a coach test positive for the virus. That coach had exposed at least 50 gym members… but none of them have since tested positive. Why? Because they were creative and thorough in their prevention protocol.

On the other hand, there are gyms charging forward with unsafe conditions and a high level of perceived arrogance (like Atilis Gym in New Jersey) which are complicating the discussion.

We have to work together on this. Gyms like 460 Fitness are leading the way.

We should prioritize our health and wellness, which will give us the best shot at fending off the virus, and we should do our best to adhere to public health recommendations, which will give us the best shot at limiting the spread of the virus.

We have to frame COVID as an essential public health concern, but not the only public health concern. This is a moment to maintain thoughtful perspective, not entrench ourselves in one side of the discussion or other.

Instead of running against the grain, we should run with it. If we run this race together, we will get to our destination faster, healthier, and there will be more of us at the finish line.

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