Looking past the pandemic: Could building on our willingness to change translate to healthier lives?

If the COVID-19 pandemic has taught us anything, it’s that people have the capacity to change entrenched behaviors when the stakes are high enough. Who among us declared that 2020 would be the year for us to perfect the practice of physical distancing? Although we were clueless about pandemic practices a mere three months ago, we’ve adopted this new habit to avoid getting or spreading the virus. But what about other unhealthy behaviors that have the potential to shorten life spans across the US? On January 1, 2020, some of us made New Year’s resolutions aimed at improving our health: to eat less, lose weight, exercise more, drink less alcohol, stop using tobacco, get more sleep, start meditating regularly, schedule that colonoscopy, and so on. Might there be hope for gaining traction with one or more of these healthy behaviors, too?

Moving from clueless to changing behavior

Health psychologists and addiction medicine professionals like me use a standard model of behavioral change to understand how people move from a mindset of cluelessness to one of action. Predictably, we pass through the following six stages of change:

  • Precontemplation (“Life is short — there’s nothing I need to change.”)
  • Contemplation (“I suppose I should consider making a change.”)
  • Preparation (“The time to make this change is very close. Here’s my plan.”)
  • Action (“I’ve done it. I hope I can keep it up.”)
  • Maintenance (“I can make this work for as long as I need to; I’ll keep on keeping on.”)
  • Moderation or Termination (“I’ll rely upon my common sense and sound medical advice to decide whether to maintain or let up when the time is right.”)

The empty streets of New York and many other major US cities bear witness to the fact that with regard to social distancing, large numbers of Americans have moved rapidly from precontemplation to maintenance. Because we have embraced this dramatic change and the mortality curve is being flattened in some parts of the US, the actual death toll from COVID-19 is likely to be a fraction of what it would have been if we had stayed put, mired in precontemplation or contemplation.

The pandemic is not the only danger to our health and lives

But wait a second. Don’t lifestyle blights like obesity, hypertension, addiction, and violence exact a far greater human toll from us than COVID-19? And aren’t these biopsychosocial maladies correlated with low socioeconomic status? And aren’t COVID-19 fatalities particularly high in disadvantaged people who suffer from one or more chronic illnesses?

A quick look at US death rates and life expectancy on a state-by-state basis suggests, sadly, that the answer to all three questions is yes. The impact of “lifestyle health” and socioeconomic status on life expectancy is very high: residents of Marin County, California can expect to live a dozen or more years longer than residents of Harlan County, Kentucky!

What enables us to change our social behaviors so rapidly to combat a viral adversary, while, relatively speaking, we are losing the war against lifestyle and socioeconomic enemies like obesity, addiction, and violence? Perhaps this has to do with the fact that when it comes to the latter, the famous words of Walt Kelly’s Pogo apply: “We have met the enemy, and he is us.”

Human nature is complex. Compared with seemingly intractable lifestyle afflictions, which may be determined or amplified by socioeconomic factors, a coronavirus represents a more tractable adversary. It’s possible that the scientific, medical, and technological expertise of our hyperconnected global brain trust might ably defeat it. But individually as well as collectively, we seem to be less proficient when it comes to taking on and defeating the lifestyle enemies that “are us.” We stay mired in precontemplation and contemplation until it is too late. Why do so many smokers opt to quit only after a diagnosis of lung cancer? Why is it that some alcoholics do not stop drinking until the onset of jaundice caused by end-stage alcoholic liver disease? How many more shrines shall we erect to the victims of senseless violence directed to the self or others, pledging now to wake up and make a difference?

Just as our society has rallied to take on a wily viral adversary like COVID-19, starting right now it is just as important for us to focus attention on addressing, curing, and — better yet — preventing lifestyle afflictions like obesity, addiction, and violence. We can start small during this time of sheltering in place, by combating couch-potato tendencies with daily exercise, avoiding the temptation to get buzzed, and keeping the Healthy Eating Plate in mind as we wrestle with the temptation to manage stress by consuming unhealthy comfort food.

Together — as individuals, families, communities, and a society — we should resolve to take action to promote health. Our successes battling this viral pandemic should inspire us to combat every serious adversary that threatens our well-being, not merely those that pose a sudden, immediate, and frightening threat.


  1. azure

    I was in NY, on Long Island for 11 days in mid March. I always walk a mile to two in the neighborhood I stay in–I see maybe 3 or 4 other people walking usually. By now, I know where the less heavily trafficked streets are & always include them in a walk. This past March, there was less vehicular traffic then there’d been in the past 15-120 years and far more people walking and cycling.

    As soon as people have places to drive to–restaurants, workplaces, etc. they’ll be driving. And it’ll be just as unpleasant (polluted, risky as most of that neighborhood has no sidewalks) to walk. Oh, and usually alot of commercial jets are periodically routed over that part of the Island although it’s 15 miles from the nearest airport. The air was far less polluted–by noise, jet fuel exhaust, and motor vehicle exhaust. There weren’t even many landscapers at work, so less leafblower, huge lawnmower exhaust noise.

    As soon as traffic, landscaping and jet noise resume, the number of walker & cyclists will shrink. Except in places like Manhattan, (and even there, motor vehicles are allowed to dominate -take up the most space, ditto aircraft like helicopters), where walking is the best way to get around at times/for many–at least before you get on a bus or the subway.

    In the US, people don’t walk or cycle because it’s often unpleasant and risky to do so. Pedestrians deaths have increased in the US, and particularly in supposedly “green” cities like Portland, OR. They drive to exercise–how many people work out in gyms when they could walk or run outside for at least 5 months out of the year?
    That’s how the US is. As someone who’s tried to change that where she now lives, I can say that it’s very difficult. Public officials, elected and hired, pay lip service to creating a more “walkable” town (and a small one at that), but the money’s spent elsewhere. There’s always a ‘reason’. There’s alot more federal funding for highways, etc., then there is for sidewalks, bike lanes, bike paths, or best of all separated (by space/preferably green, from vehiclular traffic) multiuse paths with enforcement of cycling rules, i.e, you don’t run over/crowd pedestrians off of a shared path.

    As little as people in the US, and apparently MDs, are willing to admit it, you can’t just change it on your own unless you’ve got alot of money or are close to obsessed. You need community support, you need elected and appointed/hired public officials who are at least willing to listen and to experiment–to build on the work of others in the US who have taken concrete & successful steps towards building places where people can safely walk and enjoy walking and cycling AND use those means of transport as a way to get where they want and need to go.

  2. Al Lewis

    Thanks for posting, Steve. Imagine how vigilant we would be if we were all twins and our twin just had a heart attack. That’s how we’ve reacted to COVID, or as you say, you quit smoking after you get lung cancer.

    Or if you lose at Boggle to someone you always beat, you go home and practice.

    The other thing is, we know how to avoid COVID. We don’t know how to lose weight and keep it off. So that’s another part of the equation.

    Nonetheless, here’s hoping you’re right!

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