My annual social media timeline has seasons. Winter is the season of passings and sad farewells. Spring brings new life and bundles of joy to love. And summer is the season of newly minted nuptial unions. Each June and July my timeline is filled with images of happy young beautiful newlyweds starting the journey of a lifetime. Images of hope and optimism, youthful radiance and health, the strength of the young.
Perhaps I have lived too long in a nation facing epidemic levels of non-communicable diseases often linked to obesity that results from dietary and physical fitness choices or non-choices made during a lifetime. In my age group too many couples are saying their last goodbyes to each other.
In what seems like a short time ago when viewed from where I am at 57 years old, she looked at her future husband and said I do to a youthfully healthy if not outright muscular young man. When she looked at you and said I do, there was an implicit obligation to her to maintain, to the extent the exigencies of time and aging permit, that physique she saw when she said I do.
Perhaps some men have an expectation that their wife should look good for them. I hold rather the expectation that I should do what I can to look good for her. Perhaps I have less hair on my head than when my wife agreed to journey with me, and perhaps I never really had boyish good looks to lose, but I need not arrive in my fifties looking like I might be pregnant with twins.
When you pledge I do to her, pledge also to yourself to work to retain, for her, the physically fit and healthy physique you have on that special day that she said I do to you.
Exercise and physical fitness are not things to put off until some doctor recommends them to you in your forties. Exercise and an active lifestyle should begin from your youth. I began running in 1978. I do not run far nor everyday. As I head into my own fall season of life, my running has helped me arrive at 57 without a veranda over the tool shed, healthy blood pressure and blood sugar levels, and legs with a couple muscles in them.
Every year I dread the arrival of late May and early June. I have perhaps lived here a decade or two too long. May and June are the months when the island tragically loses some of the best and brightest of the youth of the nation. Although I attempt to engender learning in my statistics course, I do not pretend to know either the statistics nor the cause of the tragedies. I only know that hearts will be ripped out of the chests of parents who have lost a child. I know that survivors will live with guilt and “what ifs” for the rest of their lives. For all, there is a loss that can never be returned. A pain that time cannot and will not heal. And no words that anyone can say that comfort those who have been left behind. There may be solace for a brief moment, but then you turn around for some reason expecting him or her to be there, and suddenly you realize they are not and will never again be. There. And the gaping hole reopens. Ten years after. Twenty. Forevermore.
No, I do not know the causes. No, I do not know the solutions. In the absence of causes and solutions, doing nothing is tantamount to accepting the annual injuries and occasional losses. Might I suggest a change in habits. Give flowers. Not money. Give mwarmwars, leis, garlands, blossoms, and balloons. Giving money may lead to bringing flowers to the family later. Better to give flowers now rather than money now and flowers later. End the gifting of money to the graduates. Do not tuck that money into their hands at graduation. Hug them, flower them, balloon them, have a family get together at home. And remind them that they are not done, they have only just begun.
She turns slightly as she faces the mirror, flexing her shoulder muscles, their underlying contours sharply defined on her now lean, lithe, muscular body. A hint of a smile crosses her face, she is pleased with what she sees. The work outs have been hard, but she can see the progress.
I look at her and see an athlete. The mirrors in the fitness center might have been placed there to ensure one is executing a lift with proper form, but the athletes therein know that the mirrors are there for posing. An athlete is concerned about their body, their appearance. They come to view their body as something that has to be cared for physically. The athlete learns from their performance, their sense of energy, that the type of fuel which goes into the machine matters. The athlete comes to care about nutrition. Their joy in their body form leads from working out to eating right which leads to improved health outcomes.
Micronesia is wracked by non-communicable diseases. Here in the FSM the 30% rate of diabetes in the adult population, the 80% to 90% of the population with body mass index over 25, is particularly devastating. Lives cut short, lives lived with horribly reduced quality of life. Kidney failure, dialysis, amputations, and death. As the Pacific Island Health Officers Association declared, this is the equivalent a natural disaster, a very real health emergency.
Yet the approach to solutions is typically health, nutrition, and maybe then fitness in that order. The largest health insurer in the nation pours money into health – treating the disease. As an insurance entity the insurer seems unable to grapple with the inevitability of the future collapse of a health insurance model that focuses on treating disease instead of preventing disease. There are too many with disease to be supported by the few who are healthy.
The insurer currently is responding to the crisis by raising rates, but eventually the rates rise to levels that the healthy are no longer will to pay. At some point the healthy members opt out, take the risk of being uninsured and paying their own way medically, and the company becomes fiscally insolvent. The health insurer disappears in sea of red ink.
Other organizations focus on nutrition and eating right. Some entities have been engaged in nutrition education for decades out here. Decades during which the national diabetes health profile has gotten worse, not better. These programs sound good, look good on paper, might even feel good, and ultimately have no substantive impact. Behaviors are not changed.
Only the athlete makes long term behavioral changes in their diet and moves on to positive health outcomes. First comes fitness, then comes dietary choice changes, and the result is health. The current approach focuses money on health, then diet, and a few crumbs are tossed to fitness and sport. Even the Compact funding is primarily in education (K-12) and health – with health being primary, secondary, and tertiary treatment-of-disease health care. Compact health sector funding might fund a hospital but never a fitness center nor a gym nor a track.
Yet only only money poured into fitness, exercise, and sport will make any long term lasting difference. Only fitness can save lives and improve the quality of life in the long haul.
What would a national plan look like that put fitness and physical exercise first? Significant, if not massive, increases in funding sport-supporting facilities, sports councils, active support for entities such as SHIP-HOOPS sports programs, and the FSM NOC. Funding at the state and national level for indoor fitness centers in each state, maintenance of existing facilities such as tracks, tennis courts, gymnasiums, and pools. An insurance program that incorporates incentives for a physically active life style. Partnerships between insurers such as MiCare, fitness centers, and facilities owners/operators. For example, the existence and continued operation of a swimming pool or publicly accessible track should be viewed as a benefit to an insurer such as MiCare; lack of maintenance of that facility should be seen as a loss.
Improved health care and health care facilities that focus on treatment will not reduce the disease burden. Increased nutrition education will not lead to changes in dietary choices that are contributing to the disease burden. Increased athleticism will lead to individuals making healthier dietary choices as they choose to value their physique. The result will be improved future health profiles.