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 expe
