Social Challenge or Individual Problem: How We Talk About Chronic Disease Matters

Last month, the American Medical Association officially labeled obesity a disease. The AMA’s decision has unleashed a flood of news reports and Op-eds, and the coverage largely emphasizes solutions focused on the individual, without discussing the critical need for a population approach. In “The Changing Battlefield Against Fat,” a Washington Post blogger zeroed in on how the AMA’s decision could pave the way for individualized medical interventions that take “advantage of rapid advances in biotechnology and genetic research.” An Op-Ed in the Tennessean embraces the personal responsibility frame, proclaiming, “if obesity is, indeed, a disease, as the American Medical Association argues it is, then you get to be the doctor and treat yourself!” 

We can’t let this conversation get away from us—it’s too important. We don’t yet know what effects the AMA’s decision will have, but it’s clear we’ve reached a crucial juncture in our national conversation about health. And among the challenges we face in moving forward with a public health agenda are the very words we use when we talk about chronic disease. The O-word keeps the focus on individuals, not on policies that could help curb harmful industry practices and create healthier environments. Ultimately, what policymakers and the public understand as the root causes of chronic disease will determine the course of our nation’s health over the coming years. Will we adopt an individual approach, focusing treatment on one person at a time? Or will we take this opportunity to change policies and improve the places where people live, learn, work and play to promote health, not disease? 

Berkeley Media Studies Group’s Heather Gehlert explains that use of the O-word is problematic “because once the conversation is framed in ways that highlight individuals, public health advocates must jump over even higher hurdles to show that we have a need for solutions beyond changes in individual behavior... obesity is a bodily condition, not a social condition—people are obese, communities or neighborhoods aren't obese. Using the term makes it harder to illustrate the conditions that inhibit healthy eating and activity.” 

Don’t let the “O-word” stall out the conversation. We’re at a critical moment and the language and frames we use to describe the causes and solutions to the health problems we face will shape the next steps we take as a country.

Here are some examples of coverage that shifts the frame from the individual to the environment:

• KQED Radio’s Forum, June 25: “Is obesity a disease?” 
  During KQED’s Forum program, Elissa Epel--professor at UCSF Department of Psychiatry and director of the UCSF Center for Obesity Assessment, Study and Treatment said: “The best possible outcome of labeling obesity as a disease is that people who are now paying for obesity—the health insurance and health care industry—will make the food industry accountable. The root cause of the obesity is that we have a toxic food environment.” 
• Los Angeles Times, June 18: “AMA declares obesity a disease”
  The LA Times explored the potential for the AMA’s decision to support or undermine investments in public health and prevention. One the one hand, the paper noted, categorizing the condition as a disease “might boost support for obesity-prevention programs such as physical education initiatives and reforms to school lunch.” On the other hand, declaring obesity a disease “might also shift the nation's focus too much toward expensive drug and surgical treatments and away from measures to encourage healthy diets and regular exercise.”
• Huffington Post Blog, July 19: “The AMA says obesity is a disease. Now can we talk about prevention?” 
  Prevention Institute’s Larry Cohen states, “The AMA’s action highlights the different directions we can take in trying to improve health and prevent chronic illness. We can approach the health problems that stem from unhealthy eating and physical activity simply as individual concerns requiring individual treatment. Or we also can recognize that there are social influences that affect what we eat, how we live and how healthy we end up—long before we enter the doctor’s office.”

Here are some ways you can take action:

• Post a comment online in response to related coverage you’ve seen, or write a letter to the editor in support of policies that put firm limits on junk food marketing, increase access to healthy food, and foster safe places to play and be active. 
• Write an Op-Ed or pitch a story to a local reporter highlighting your community’s efforts to improve health. 
• Get inspired! Read our latest blog post about our 2013 Award for Excellence in Media Advocacy winners and nominees. 

Here are some angles to cover in your letters to the editor, Op-Eds and online comments:

• We need policies that protect children and families. And that means stronger government oversight of food marketing. The current system puts the onus on parents to shield their kids. But when food marketers have access to children in schools, in stores, on television, and increasingly on the internet, parents have the odds stacked against them. Policies that limit the reach of junk food marketing shift the balance in the right direction. After all, parents can't do it all alone.
• Healthy people live in healthy, safe and equitable communities. Almost nothing affects our health as profoundly as the places we live. People thrive when they have jobs and live in communities with safe affordable housing. They thrive when they have easy access to parks, playgrounds, and grocery stores selling nutritious food. Healthy communities provide the foundation and context for healthy behaviors and outcomes. Community prevention makes that possible.
• Public health has a long, proud history of using policy to protect health and individuals. Seat belt laws and policies regulating lead in paint are built on the same principle of protection. Such laws are a given today, but they were controversial when first introduced, too. Kids didn’t used to be automatically put in car seats—parents couldn’t buy them or afford them, cars didn’t accommodate them, and our culture didn’t support them. Our country worked together along with businesses, local government and families, using policy to encourage car seat use. That’s the same kind of shift we’re working toward today. We want children and parents to take for granted that the places they live, work, play, and learn are going to support them in healthy eating and physical activity—not make it harder.

Get something in the news? Send us a quick note so we can make sure your efforts are recognized.