Healthy People Have More …?

By David L. Katz, MD, MPH, FACPM, FACPEnjoying Good Health

I am privileged to be very healthy. There is, admittedly, an element of good fortune in that, and so I am tempted to append, “knock on wood!” But I won’t because I’m not superstitious, and I know that in this, as in all things, fortune favors the prepared.

Learning the Skills That
Let You Achieve Good Health

Good health is more about good preparation, than good luck – and we are all capable of it. Factors we control can even change the way our genes express themselves. Medical destiny is much less about DNA, and much more about the choices in our hands than most people think.

We all know that being “healthy” is a good thing. But have you ever paused to consider exactly what’s different about it? Given the prevailing conditions in our culture, what distinguishes truly healthy people from everyone else?

To narrow down the topic a bit, we might frame it as a multiple-choice question: Which of the following do “healthy” people have more of than everybody else?

(1) Years of Life
(2) Life in Years
(3) Willpower
(4) Skillpower
(5) Fun

The correct answer is all of the above. Let’s go through them one by one.

Years of Life
Life expectancy has continuously been rising in the United States, getting nearer to 80 today. Women still have a slight edge over men, and health disparities mean less years of life for the so-called “minority” groups. But we have known for years that poor health is associated with a much-heightened risk for premature death. Maybe it’s true that the good die young, but certainly the unhealthy tend to do so. Healthy people on average live longer.

Life in Years
More important, I think, than the length of life is the quality of it. Increasingly, premature deaths in the U.S. and around the world are the result of chronic diseases. These are the usual suspects: Heart disease, cancer, stroke, diabetes, and dementia. What this means is that unhealthy people lose quality of life long before they finally succumb. Living with a serious chronic disease, as so many do, steals joy, and pleasure and opportunity. Healthy people get to keep these.

We all know the expression, “If you don’t have your health, you don’t have anything” – and that is certainly true. I have had many patients over the years who made it to retirement age with their nest egg in excellent shape, but their health, not so much. The results were often tragic. There was money available to do the things they always wanted to do, like travel the world, start their own business, etc., but they were too sick to do any of it. Without health, their life was over, and no amount of money could compensate them for their loss.

We know the expression, but our culture does not act accordingly. We all try to invest in wealth, but many of us neglect health. Healthy people don’t – they take care of themselves. And they aren’t healthy by accident – they do better because being in good health has priority for them. Being healthy, in other words, begins with a will to be healthy.

And there is more to will than just wanting. The method of “motivational interviewing” was developed for health care professionals, but it can also be turned around so that you apply it to yourself, doing everything possible to maximize your will. Willful efforts can become habits, so that your priorities take on a self-perpetuating life of their own and depend ever less on will as time progresses. Achieving health begins with the will to be healthy, but it only begins this way.

I am blessed to be healthy, but it’s really not just good luck. I have the will to be healthy, and this is what I start out with. And I also have the required skill. The problem is that we talk way too much about willpower in our culture and not nearly enough about skillpower.

Imagine, for example, that you wanted to drive a car or ride a bike but didn’t know how and nobody taught you. You might try bike riding anyway, out of sheer will, but there’s only so many times you can fall down and get hurt before you say enough is enough.

In the absence of the requisite skill, bad experiences erode will. Eventually, will runs out. Skillpower fixes this. If you know how to ride a bike, it may still be a challenge at first, but gradually you gain expertise and mastery long before your will runs out. Once you have enough expertise, the demands on willpower diminish precipitously, and the task just keeps getting easier.

Learning to be healthy can be just like learning to ride a bike. What are some food-related examples? How about knowing how to take gram after gram of sugar out of your daily diet without ever focusing on foods you thought of as sweet in the first place? I refer to this as “stealth sugar,” hidden in many foods you’d never suspect; by cutting sugar here, you make no sacrifice but start to prefer food less sweet in general. Rather than relying on your will to give up your favorite dessert, you can call upon your skill – and simply learn to prefer dessert less sweet.

Similarly, skill can enable you to rehabilitate your taste buds, learning to choose and prefer foods that love you back. Knowing how to trade up food choices in every aisle of your grocery store can empower you to improve your diet and health, one well-informed choice at a time.

So, while a willpower-based approach to weight control might mean being hungry and trying to tough it out, a skillpower-based approach means controlling the quantity of calories you consume by improving the quality of the foods you choose and getting to lose weight without being hungry.

And skillpower means knowing ways to fit fitness into your daily routine in whatever way works best for you. There are many ways to fit motion into a day, and the more options you have, the more empowered you are to find the right approach. It may take a lot of willpower to get to the gym at 5 am. But with the right skillpower, tools and resources, there are ways to fit in an effective regimen, even without leaving the office if need be.

And then there’s the real prize. It’s not because the doctor wags his or her finger and says what you should do. Health isn’t about “should,” and health isn’t even really the prize. Living the way you want to live, seeing those you love live the way they want to live – that’s the prize. A better life is the real, the ultimate prize!

Good health helps you get there. A healthy life is a better life. All other things being equal, healthy people have more fun.

And there are, of course, things healthy people have less of than the rest. They take less medication. They have fewer trips to doctors and hospitals. Because skillpower can be shared, they tend to have less anguish, sorrow and loss.

We have known for decades how to eliminate fully 80 percent of all chronic disease – heart disease, cancer, stroke, diabetes, dementia, etc. – and so, to reduce our lifetime personal risk to the same degree. Think about your loved ones who have had any of these conditions, and imagine those bad things simply not happening 8 times out of 10. We have the knowledge and have long had it. I want everyone to use the knowledge we have. I want everyone to have the skillpower I have and rely on it every day.

David L. Katz, MD, MPH, FACPM, FACP is the founding director of Yale University’s Prevention Research Center. He is a board certified specialist in both Internal Medicine and Preventive Medicine/Public Health. He is the director and founder of the Integrative Medicine Center at Griffin Hospital in Derby, Connecticut. For more information visit

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

Connect with us on FacebookTwitterGoogle+PinterestLinked InYouTubeRSS

Print this page

One thought on “Healthy People Have More …?

Leave a Comment