12.2 Health Habits and Age

Each person’s routines of daily life powerfully affect their susceptibility to diseases and chronic conditions; this applies both to current routines and to those that have been in place since childhood. It is particularly true for problems associated with aging—from arthritis to varicose veins.

Consider cancer, the leading cause of death for adults aged 25 to 65. The risk of cancer increases with every year of life, but lifestyle, not age, is usually the underlying cause. According to one estimate, 30 percent of cancer cases are caused by smoking, 30 percent by diet, and 5 percent by inactivity (Willett & Trichopoulos, 1996).

Of course, the specific lifestyle effects on susceptibility vary with each disease, even each type of cancer, and uncontrollable factors, primarily genetic, play a major role in some diseases and a minor role in others. However, people can cut in half their overall morbidity and mortality during adulthood (ages 25 to 65) if they have healthy habits.

To clarify this, it is important to know the various ways in which health is measured:

• Mortality means death.
• Morbidity means disease, the rates of which depend partly on diagnosis.
• Disability, the usual result of morbidity, is the inability to do something that people usually can do. For example, one form of morbidity is glaucoma; this could mean serious disability if a person can see only shapes, but less serious disability if the person cannot read without glasses.
• Vitality—also known as life force, or joie de vivre—may be the most important, but it is the most difficult to measure. Some people with morbid conditions that increase disability and the risk of mortality are nonetheless happy and active.

The goal of good health habits is not only to reduce illness, but also to increase wellness so that adults can live for decades at full vitality.

Tobacco and Alcohol

Many teenagers believe that smoking and drinking make them cool and signify maturity. Nicotine also provides an energy boost, which seems to be an indicator of health. Accordingly, many young people pick up those habits as soon as they can, legally or not.

Even though many people eventually quit smoking, they are still at greater risk for developing cancer. We now know that cancer deaths reflect smoking patterns of years earlier. Canadian men have been quitting smoking for decades. As a result, the incidence of lung cancer among men levelled off in the 1980s and then began declining (see Figure 12.2). Conversely, smoking among women has increased over time. As a result, lung cancer rates for women started increasing in 1982 and then went up significantly, by a rate of 1.1 percent a year between 1998 and 2007, before levelling off. Even so, the incidence of lung cancer is still higher among Canadian men (60 per 100 000) than women (47 per 100 000) (Canadian Cancer Society’s Advisory Committee on Cancer Statistics, 2013).

FIGURE 12.2 Gender Differences As this graph shows, the death rate due to lung cancer has been decreasing steadily for males since the 1980s. In contrast, the death rate increased for females over the same time frame, and has now levelled off.

Source: Canadian Cancer Society’s Advisory Committee on Cancer Statistics, 2013.

Guess His Age A man puffs on a bidi, a flavoured cigarette, in Bangalore, India. He looks elderly but is actually middle-aged (about age 40). He is at risk of being among the 1 million Indians who die each year of smoking-related causes.

AP PHOTO/AIJAZ RAHI

While rates of smoking and lung cancer deaths are decreasing in countries such as Canada and the United States, they are rising in other countries, such as China, India, and Indonesia, especially among women. For instance, in these countries, more than half of the men are smokers as are just less than 10 percent of the women. The World Health Organization calls tobacco the single largest preventable cause of death and chronic disease (Blas & Kurup, 2010).

The harm from cigarettes is dose-related: Each puff, each day of smoking, each breath of secondhand smoke makes cancer, heart disease, stroke, and emphysema more likely. No such linear harm results from drinking alcohol. In fact, alcohol can be beneficial: People who drink wine, beer, or spirits in moderation—no more than two drinks a day—live longer than abstainers. The primary reason is that alcohol reduces coronary heart disease and strokes. It increases HDL (high-density lipoprotein), the “good” form of cholesterol, and reduces LDL (low-density lipoprotein), the “bad” cholesterol that causes clogged arteries and blood clots. It also lowers blood pressure and glucose (Klatsky, 2009).

However, moderation is impossible for some. Alcoholics may find it easier to abstain than to have one, and only one, drink a day. Higher amounts of drinking destroys brain cells; contributes to osteoporosis; decreases fertility; accompanies many suicides, homicides, and accidents; destroys families; and increases the risk of 60 diseases, not only of the liver but also of the breasts, stomach, and throat (Hampton, 2005).

Alcoholism increases with poverty and causes disproportionate harm in poorer countries (Grimm, 2008) because prevention, treatment, and enforcement strategies have not caught up with abuse. In general, low-income nations have more abstainers as well as more abusers, while more affluent nations have more moderate drinkers (Blas & Kurup, 2010).

Homeostasis and allostasis may be factors: Poverty reduces the sources of pleasure and increases stress, so temporary joy comes from smoking and drinking. But then more nicotine and alcohol become needed because of homeostasis, and, over the long term, addiction begins, joy declines, and life ends (Sterling, 2012). Momentary vitality becomes morbidity and then mortality.

Overeating

Metabolism decreases by one-third between ages 20 and 60, which means that adults need to eat less and move more each year. Few adults do so; instead, obesity increases with each decade of adulthood until old age.

A Worldwide ProblemObesity is now recognized as a major health problem in many nations. Cultural solutions—a national diet that emphasizes less meat and more vegetables as in China, or fewer fast-food restaurants and more leisurely dining as in France, or more olive oil and less corn oil as in Greece—are beyond the scope of this book. Although one might hope that globalization would lead to these or other improvements in eating habits in Canada and the United States, the opposite seems true: Fast-food restaurants are proliferating in these and most other nations.

Statistics Canada reports that in 2012, 60 percent of males 18 years and older were either overweight or obese, as were 45 percent of women. Overall, slightly more than 18 percent of adult Canadians qualified as obese. The authors of this report caution that these are self-reported figures, and that the actual rates of obesity and overweight are probably higher (Statistics Canada, 2013f).

In the United States, the rates are even more alarming. There, 65 percent of adults are overweight, with a body mass index (BMI) above 25. More than half of those overweight people are obese (with a BMI of 30 or more), and 6 percent overall are morbidly obese (with a BMI of 40 or more) (Flegal et al., 2012). Rates in the other North American nation, Mexico, are also high.

Bad Habits This office worker is eating cake made with white flour, butter, and sugar. More adult deaths occur as a consequence of chronic unhealthy snacking than of drug addiction. However, it is far easier to recognize others’ destructive habits than to change one’s own bad behaviours.

OCEAN/CORBIS

Excess weight increases the risk of every chronic disease, but the most glaring example is diabetes, which affects twice as many North Americans currently as it did 40 years ago (Taubes, 2009). The direct cause is insulin resistance (where the body fails to respond to its own insulin), which, left untreated, can lead to death. Diabetes also causes eye, heart, and foot problems.

Sadly, partly because of how they are treated, obese adults avoid socializing, exercising, and going for medical checkups. As a result, their morbidity increases far more than their weight alone would predict (Puhl & Heuer, 2010).

Solutions to the Obesity EpidemicStopping any addiction is difficult because long-standing habits are embedded in each adult’s daily life. Diets—there are hundreds of them—work if they reduce calories and involve exercise, but they need to be maintained for decades, a daunting task. Sustained counselling and encouragement from health practitioners is time-consuming but effective in the long run. However, many people seek a quick, effective weight-loss method instead.

Diet drugs are one traditional option; however, many have been found to cause cardiovascular and digestive problems, or to lead to addiction. Gastric bypass surgery causes dramatic weight loss in many patients, but as with all surgical procedures, there are risks. The risks may be worth it though, since morbidly obese people have higher death rates without surgery than with it (Schauer et al., 2010).

Drugs and surgery are not enough: Patients must change their lifestyle to accommodate new eating habits and exercise. People who are highly motivated and long past adolescence and emerging adulthood are much more likely to follow through with those required lifestyle changes. For those morbidly obese teenagers who undergo surgery, the adjustments may be particularly difficult (Widhalm et al., 2011).

Developmentalists emphasize that early prevention is more effective than medical remedies. You have already read that babies born underweight often become fat children, who may become overweight adults. At that point, the stigma and discrimination experienced by obese people can have an adverse effect on their health, both psychological as well as physical (Puhl & Heuer, 2010).

Inactivity

Regular exercise protects against illness even if a person is overweight or a smoker. When any habit changes for the better, a daily hour of exercise is the best predictor of maintaining the change (Shai & Stampfer, 2008). Specific benefits of exercise include lower blood pressure, stronger hearts and lungs, and reduced risk of almost every disease, including depression, diabetes, osteoporosis, heart disease, arthritis, and even cancer. By contrast, sitting for long hours correlates with almost every unhealthy condition, especially heart disease and diabetes, both of which carry additional health hazards beyond the disease itself. Even a little movement—gardening, light housework, walking up the stairs or to the bus—helps.

Just Give Me the Usual Even bad habits can feel comfortable—that’s what makes them habits.

BRUCE ERIC KAPLAN/THE NEW YORKER COLLECTION/CARTOONBANK.COM

Walking briskly for 30 minutes a day, five days a week, is a reasonable goal. More intense exercise (e.g., swimming, jogging, bicycling) is ideal. It is possible to exercise too much, but almost no adult aged 25 to 65 does. In fact, one study that used objective assessment of adult movement (electronic monitors) found that less than 5 percent of adults in the United States and England exercise even 30 minutes per day (Weiler et al., 2010). Self-reports put the number at about 30 percent.

In 2010, about 52 percent of Canadians aged 12 and older reported that they were moderately active during their leisure time, which was equivalent to walking at least 30 minutes a day or engaging in a one-hour exercise class at least three times per week. Walking was the most popular form of exercise (70 percent). Males were more likely to report being at least moderately active than women (54.9 percent versus 49.4 percent) (Statistics Canada, 2011e).

Hope It Helps Sitting on an exercise ball instead of a chair may help this woman increase her balance and strengthen the core muscles in her back and stomach. She can also lie on the ball to stretch out her back or do ab crunches to further strengthen her core.

COLORBLIND IMAGES/CORBIS

The close connection between exercise and health, both physical and mental, is well known, as is the influence of family, friends, and neighbourhoods. Exercise-friendly communities have lower rates of obesity, hypertension, and depression (Lee et al., 2009). This is not merely a correlation but a cause: People who are more fit are likely to resist disease and to feel healthier as they age (Carnethon et al., 2003; Shirom et al., 2008).

Researchers are now trying to pin down specifics. Does the type of exercise matter (walking, gardening, swimming, running)? Is half an hour each day better than four hours on the weekend? These are unanswered questions, but no one doubts that adults should be active, year in, year out. Maintaining any healthy habit is the hardest part, as the following explains.

Accumulating Stressors

Stress is part of life, from birth to death. Between ages 25 and 65, everyone experiences major stress (e.g., the death of a family member), minor stress (e.g., a snowstorm), and daily hassles (e.g., traffic jams).

From Stress to Stressor Not every stress becomes a stressor, however. A stressor is any experience, circumstance, or condition that negatively affects a person. How people cope with stresses, making some become stressors and others not, affects their health.

Particularly if organ reserves are depleted or allostatic load is high, the physiological toll of major and minor stressors lowers immunity, increases blood pressure, speeds up the heart, reduces sleep, and produces many other reactions that lead to serious illness. A comprehensive review finds that stress clearly affects the whole body and that the best coping measures vary for each illness and each person (Aldwin, 2007). For instance, some patients recover better from surgery if they know details of their vital signs and healing; others just need to know that doctors are working to make them better.

For some, reactions to stressors can cause more stressors. For example, a longitudinal study of married couples in their 30s found that, if the husband’s health deteriorated, the chance of divorce increased. This was apparent with all couples, but it was particularly evident for well-educated European-Americans (Teachman, 2010). One possible explanation is that these couples were less accustomed to stress and thus less able to cope. Those best able to deal with stress are those who have had some, but not too much, trauma in their lives (Seery, 2011).

Age and Gender Psychologists distinguish between two major ways of coping. In problem-focused coping, people attack their problems (e.g., confront a difficult boss, move out of a noisy neighbourhood). In emotion-focused coping, people change their emotions (e.g., from anger to acceptance). In general, younger adults and adults of higher SES are more likely to attack problems, whereas older adults and those of lower SES try to accept them (Aldwin, 2007). This may indicate that those who are poorer and older believe that there is not much they can do to change their circumstances. A pessimistic attitude about the future is more common the less money one has (Robb et al., 2009).

Sex hormones may also affect responses to stress. Men are inclined to be problem-focused, reacting in a “fight-or-flight” manner. Their sympathetic nervous system (faster heart rate, increased adrenaline) prepares them for attack or escape. Their testosterone rises when they attack and decreases if they fail. On the other hand, women are more emotion-focused. They “tend and befriend”—that is, seek the reassurance of other people when they are under pressure. In reaction to stress, their bodies produce oxytocin, a hormone that leads them to seek confidential and caring interactions (S. E. Taylor, 2006; S. E. Taylor et al., 2000). This gender difference explains why a woman might get upset if a man doesn’t want to talk about his problems. By contrast, a man might be annoyed if a woman just talks, not appreciating his advice about how to confront and solve the problem.

Adults of both sexes and of every age and income level use both strategies, depending on the situation. The worst situation is to have no strategy at all—denying a problem until it escalates and takes a physical toll. One study found that when both spouses in a marriage avoid either strategy and instead suppress justifiable anger, their death rate is twice as high as when at least one partner expresses anger (Harburg, 2008). With age and experience, adults may learn to respond wisely, as age brings a more positive attitude toward life. Then stresses do not become stressors (Charles & Carstensen, 2010).

Age brings another advantage. Emerging adulthood is a time of heightened aggravations (Aldwin, 2007). Once life settles down, some stresses (dating, job hunting, moving) are less frequent. Adults are more capable of arranging their lives to minimize the occurrence of stressors (Aldwin, 2007).

SES and Health Habits

Money and education protect health in every nation. According to Statistics Canada, less-educated people live two to three years fewer than their well-educated peers (Greenberg & Normandin, 2011). Similarly, an economist who analyzed historical U.S. data determined that after age 35, the average life span increases by 1.7 years for each year of education (Lleras-Muney, 2005).

It is not obvious why this connection is so strong. Does education teach better health habits? Does income result in better medical care? Does high IQ added to high family SES in childhood allow more education, followed by living in better neighbourhoods, with less pollution and more opportunities to walk, bike, and play outside? Are wealthy people better able to insulate themselves from stressors because they can hire people to help them?

For whatever reason, the differences are dramatic. The 10 million U.S. residents with the highest SES outlive—by an average of about 30 years—the 10 million with the lowest SES (C.J. L. Murray et al., 2006). Recent data find the SES gap widening in the United States (Olshansky et al., 2012).

Although not as glaring as in the U.S., Canada’s income disparity is also at a record high. A recent report from the Conference Board of Canada (2013b) noted that not only did income inequality increase between 1990 and 2010, but since 1990, the richest group of Canadians has increased its total share of national income, while the poorest and middle-income groups have lost share (see Figure 12.3). A Montreal study that examined the social inequalities in health found an 11-year difference in life expectancy between those who lived in the poorest neighbourhoods and those in the richest neighbourhoods (Agence de la santé et des services sociaux de Montréal, 2011).

FIGURE 12.3 Richer/Poorer One way to track income inequality is by dividing the population into five groups (quintiles), and then calculating each group’s share of income. If each group has the same share of the nation’s total income—i.e., 20 percent—then the distribution is equal. As this graph shows, the richest income group in Canada has by far the largest share of the total national income. This group was also the only group to increase its share of the national income over the last 20 years; every other group has lost share (Conference Board of Canada, 2013b).

Source: Conference Board of Canada, 2013b.

SES is protective between nations as well as within them: Rich nations have less disease, injury, and death. For example, a baby born in 2010 in northern Europe can expect to live to age 79; in sub-Saharan Africa, to 55 (United Nations, 2012).

Diseases of affluenceCertain diseases, including diabetes, lung cancer, and breast cancer, were once called diseases of affluence because they were more common among the rich than the poor (Hu, 2011; Krieger, 2002, 2003) and in wealthier groups within each nation—Japanese-Canadians more than Filipino-Canadians, for instance. However, when smoking became less expensive (between 1920 and 1950), fast food more available, and illness better diagnosed, the diseases of affluence did not correlate with wealth at all; they were more common among the poor.

Distinguishing the effects of income, education, cohort, and culture is difficult because, as you remember from Chapter 1, all these factors overlap. For example, currently, African-American women are more likely to die of breast cancer than are women of other U.S. ethnic groups, but medical researchers are not sure why (DeSantis et al., 2011). The reason could be genetic, but it could also be a lower quality of health care, poorer eating habits, more stress, or an avoidance of doctors.

A recently proposed hypothesis is that low SES in the United States (and possibly in other parts of North America) leads to poor health habits—overeating, smoking, drinking—as ways of coping with stress; such practices impair physical health while reducing depression and anxiety. This may begin prenatally: A poor pregnant woman, worried about how she will provide for her baby, is less likely to follow good nutritional and sleep routines. Wealthier adults, on the other hand, tend to avoid poor lifestyle habits and are generally in better physical health, but, ironically, accumulation of stress may lead to higher rates of mental disorders among them (Jackson, 2012). Whether it is the case that the wealthy actually have higher rates of depression and anxiety, or rather that the data merely reflect a higher rate of diagnosis and therapy seeking, is not known.

Health of ImmigrantsData on immigrants complicate the connection between SES and health. Recent immigrants to both Canada and the United States tend to be healthier yet poorer than the native born: They have less heart disease, drug abuse, obesity, and so on than do their wealthier co-ethnics (Garcia Coll & Marks, 2011).

One suggested explanation is that healthy people are more likely to emigrate; then their good health protects them even though they may be poor. Or, as Morton Beiser at the University of Toronto has noted, immigrants are healthier primarily because Canada has selection criteria that emphasize good health, and all potential immigrants must undergo a comprehensive medical screening (Beiser, 2005). All this may be true; however, the data find that the “healthy migrant” theory is not sufficient to explain immigrant health (Bates et al., 2008; Garcia Coll & Marks, 2011). Perhaps psychological or ethnic influences in low-SES cultures foster good health habits that continue after emigration.