Crimes of the Heart

Article excerpt

It's time society stopped reinforcing the bad behavior that leads to heart disease--and pursued policies to prevent it.

Until last year, the residents of Albert Lea, Minn., were no healthier than any other Americans. Then the city became the first American town to sign on to the AARP/Blue Zones Vitality Project--the brainchild of writer Dan Buettner, whose 2008 book, The Blue Zones, detailed the health habits of the world's longest-lived people. His goal was to bring the same benefits to middle America--not by forcing people to diet and exercise, but by changing their everyday environments in ways that encourage a healthier lifestyle.

What followed was a sort of townwide makeover. The city laid new sidewalks linking residential areas with schools and shopping centers. It built a recreational path around a lake and dug new plots for community gardens. Restaurants made healthy changes to their menus. Schools banned eating in hallways (reducing the opportunities for kids to munch on snack food) and stopped selling candy for fundraisers. (They sold wreaths instead.) More than 2,600 of the city's 18,000 residents volunteered, too, selecting from more than a dozen heart-healthy measures--for example, ridding their kitchens of supersize dinner plates (which encourage larger portions) and forming "walking schoolbuses" to escort kids to school on foot.

The results were stunning. In six months, participants lost an average of 2.6 pounds and boosted their estimated life expectancy by 3.1 years. Even more impressive, health-care claims for city and school employees fell for the first time in a decade--by 32 percent over 10 months. And benefits didn't accrue solely to volunteers. Thanks to the influence of social networks, says Buettner, "even the curmudgeons who didn't want to be involved ended up modifying their behaviors."

Isn't it time we all followed Albert Lea's example? Diet and exercise programs routinely fail not for lack of willpower, but because the society in which we live favors unhealthy behaviors. In 2006, cardiovascular disease cost $403abillion in medical bills and lost productivity. By 2025 an aging population is expected to drive up the total by as much as 54apercent. But creative government programs could help forestall the increases--and help our hearts, too. A few suggestions:

Require graphic warnings on cigarette packages. It's easy to disregard a black-box warning that smoking is "hazardous to your health." It's not so easy to dismiss a picture of gangrenous limbs, diseased hearts, or chests sawed open for autopsy. These are exactly the types of images that the law now requires on cigarette packages in Brazil. In Canada, such warning images must cover at least half the wrapping. In 2001, the year after the Canadian law took effect, 38 percent of smokers who tried to quit cited the images. Think of it as truth in advertising.

Sponsor "commitment contracts" to quit smoking. Yale economist Dean Karlan spearheaded a test program in the Philippines in which smokers who wanted to quit deposited the money they would have spent on cigarettes into a special bank account. After six months those who had succeeded got their money back, while those who had failed lost it. Such a program could be run here by public-health clinics and offer greater incentives, such as letting winners divvy up the money forfeited by losers. …