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Seven 'health sins' can lead to early demise California doctor creates 'don't' list


LOS ANGELES -- As if he were a medieval artist depicting the depravity of the seven deadly sins, Dr. Lester Breslow, a California public health specialist, has created a solemn portrait of self-destruction. The weapons are seven unwholesome habits he first identified more than a quarter-century ago.

By following the fates of nearly 7,000 adults living in California's Alameda County over three decades, he proved that the more of these poor health habits people practiced in 1965, the greater their chances were of dying within 10 years.

And now his latest study shows that even fewer people than thought escape the ravages of their health "sins." In a study conducted with his son, Norman, a statistician at the University of Washington in Seattle, Dr. Breslow has shown that the unhealthy habits portend not only early death for many but chronic and costly disabilities for those who survive.

Two of the poor health practices, as Dr. Breslow calls them, obesity and physical inactivity, are reminiscent of the ancient sins of gluttony and sloth.

The others include both the predictable -- smoking and drinking too much alcohol -- and the surprising -- sleeping too much or too little, eating between meals and skipping breakfast.

Based on studies he and others did in the 1960s, Dr. Breslow singled out these seven factors as likely to predict an early death.

His first Alameda County report revealed in 1972 that in combination these poor health practices could double a person's chance of dying prematurely.

Now, in his latest paper, published in a recent issue of the journal Preventive Medicine, Dr. Breslow, himself a hearty 78, reports that even when the practices do not lead to an early death, they increase the risk that a person will suffer one or more physical or medical limitations that can degrade the later years of life.

Their study found that those Californians whose lives in 1965 were characterized by six or seven of the poor health practices were twice as likely to be disabled 10 or more years later as were their neighbors with no more than two of these habits.

Even without taking age or initial health status into account, among those with no poor health habits or just one, 12.2 percent were disabled, and for those with two or three poor health habits, 14.1 percent were disabled. In contrast, 18.7 percent of those with four or more poor health habits were disabled.

Dr. Jonathan Fielding, chairman of the board of the non-profit California Wellness Foundation and chief health-policy planner for Johnson & Johnson, said Dr. Breslow's newest study was "critically important" at a time when the nation is trying to revamp its approach to health care.

"The results really say that how you live determines how long you will live without your state of health interfering with the things you want to do or forcing you to make changes in your life to accommodate your health problems," Dr. Fielding said in a telephone interview.

The Breslows' findings underscore a theme that public health specialists have been promoting for decades to a nation that has listened with less than half an ear: Preventive health practices are important not only in decreasing premature deaths but also in reducing costly debilitating illnesses.

Dr. Breslow fears that current efforts to overhaul the health-care system put the cart before the horse by focusing on crisis medicine.

"It's a gross mistake to call what is being attempted now by the Clinton administration health-care reform," Dr. Breslow said in a recent interview.

"It is medical-care reform. To reform health care, we have to address how health can be maintained apart from medical services.

"There are indications that the Clinton administration is aware of this, but the issue is not yet being tackled as an integral part of the reform effort."

Dr. Fielding said economic incentives for companies, health maintenance organizations and individuals would be needed to goad them into fostering and practicing preventive medicine.

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