Seat Belts and Smoking Charges Present Folks Finally Undertake Wholesome Behaviors – however It Can Take Time We Don’t Have Throughout a Pandemic
By Randy P. Juhl, University of Pittsburgh
Why do we do things that are bad for us – or not things that are good for us – even in the face of overwhelming evidence?
As someone with a long career in pharmacy, I’ve seen some pretty dramatic changes in public health behavior. But I’m not going to gloss it over. It generally takes years or even decades to drag, kick, and yell people to finally achieve new and improved societal norms.
This passage of time seems to be an innate human defect that existed long before today’s pandemic mask and social distancing issues. Historically, people don’t like being told what to do.
Attitudes towards smoking have changed dramatically over the past 50 years. Although smoking has gradually declined, from 42% of the American population in 1965 to the lowly teenage population today, the United States still has many smokers – and premature deaths from smoking. Even healthcare workers fall victim to this unhealthy and addicting habit.
It was firmly believed that smoking was a personal choice that benefactors and the government should keep their noses out of – until studies showing harm from secondhand smoke changed the context of the subject. Feel free to do what you want, but it will be a horse of a different color if it concerns others.
Public smoking bans are the order of the day these days. However, this change in social behavior did not take place overnight or without painful discourse. The journey from the first report by the general surgeon in 1964 on smoking and health to the report by the general surgeon in 2006 on passive smoking has been a restless one to this day.
Another U-turn was the introduction of seat belts. Seat belts save lives. And most of the people are now using them because of the nagging warning alert, vehicle safety marketing, law and data.
However, this change in behavior followed a rocky road for many years. In my earlier days, I can remember more than one occasion when I jumped into a friend’s car, fastened my seat belt, and then was punished for having so little faith in my friend’s driving ability.
Seat belts were required to be installed in new cars from 1964, and New York passed the first seat belt use law in 1984. In the US, seat belt use increased from 14% in 1983 to 90% in 2016.
In the medical field, great efforts have been made to promote healthy behavior – diet, exercise, sleep hygiene, compliance with prescribed medications and vaccinations. To be honest, the success was mixed.
Studies have suggested many possible variables associated with failure to follow accepted medical advice: age, gender, race, education, literacy, income, insurance costs, nursing needs from doctors and pharmacists – and just old stubbornness. However, there is no single, easy-to-fix cause of non-adherence to healthy behaviors.
For example, properly prescribed cholesterol-lowering drugs called statins add years to patients’ lives by reducing heart attacks and strokes. Even with those with insurance and minimal side effects, 50% of patients stop statin therapy within one year of receiving their first prescription.
Vaccines and vaccinations offer another window into the puzzle of human behavior. Life expectancy in the United States increased from 40 years in 1860 to 70 years in 1960. These increases resulted in large part from decreased infant and child mortality from infectious diseases. A better understanding of infectious diseases, as well as advances in science, vaccines and antibacterial drugs were the main drivers of this profound increase in life expectancy.
Common sense alone shows the value of vaccines; How many people do you know who have polio or smallpox? However, some smart, thoughtful friends, family members, and neighbors believe that vaccines are not helpful and even harmful. Some believe that wearing a mask is nothing more than a placebo to feel good. I believe these contrary beliefs get better press and therefore more coverage than the mainstream beliefs, but there is clearly cause for concern.
The current crisis
Historically, changes in societal behavior that benefit public health come in seizures and beginnings – and never fast enough for the people who become victims before society emerges.
The urgency of the coronavirus has actually led to relatively rapid changes in behavior (masks, hand washing, distancing) in the USA – when scientists learned how the coronavirus spreads, how dangerous it can be and which groups are more susceptible. However, these behavioral changes were not as complete or as rapid as they should have been – or could have been – had they been judged on far better results in other countries.
The battle between scientific method and political ideology regarding public health discourages me. Ideology never seems to change, so it’s more reassuring to some – as science evolves as new insights expose old ideas or confirm new ones. One thing is clear to anyone who wants to listen: controlling the virus and keeping the economy going are not an either / or choice – they are interdependent.
At the same time, I am pleased that the tide seems to be turning. With a better understanding of how to treat COVID-19, and with more than one highly effective vaccine on the horizon, the “idiot scientists” are gaining ground in both the lab and bedside. Even the most famous ideologues run to the hospital for the best treatments science can offer when the effects of their maskless behavior increase to bite them.
But as history shows, science, no matter how big it is, is just the beginning of implementation in a divided population. Ultimately, both citizens and business will benefit from being shot in the arm.
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Randy P. Juhl, Dean Emeritus and Professor Emeritus of Pharmacy at the University of Pittsburgh
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