Wellness and Awareness: A Look at the State of Health in 2021

By Matt Phillion

The last 15 months have been a transformative time in healthcare, and as the world faced down a culture-changing health crisis, how we take care of ourselves and how healthcare organizations take care of patients have been front and center. Dr. Sanjay Gupta, chief medical correspondent with CNN and a practicing neurosurgeon, spoke with attendees at the recent Health Experience Design Conference 2021 to talk about his observations as a correspondent, his takeaways from the COVID-19 pandemic, and his views on where we go from here.

“It’s been quite a year. That goes without saying,” Gupta said. “Anyone watching this knows this has been a year that’s been transformative in many ways. I’m optimistic about where we’re going over the next several weeks and months. The fact that we have three authorized vaccines—that’s an incredible thing. It can take years, if not decades, to create a vaccine.”

He expressed hope that the U.S. is in a better position heading into the warmer months, despite seeing virus numbers rise in different parts of the country.

“We’re not done yet,” said Gupta. “It’s one of those things where science is amazing and can help rescue us, but our own personal behavior and how much we lean into those behaviors are ultimately what wins the day. … I think we’ll have cause for some sense of relief and normalcy, but it still requires some work.”

News of the vaccine expanding to individuals 16 and older had just broken at the time of the event, and Gupta chatted briefly about the impact of ramping up vaccination efforts and the risks of vaccine hesitancy.

“Now there’s a concern about vaccine fade,” said Gupta. “ ‘Do I still need it? If I’m not at risk, if I’m relatively healthy?’ Part of the reason they’re advancing overall eligibility is to say, ‘Hey, look, get vaccinated. Do it in the spring.’ ” Not only does this lean into the potential for herd immunity, but as we head into the fall, a vaccinated population will be less likely to have a resurgence, which will help keep infections manageable and contained.

Speaker Amy Heymans, founder and CXO for Mad*Pow, asked Gupta what he believed the reasons for the U.S. being so adversely affected by the virus were. “It’s an important question,” said Gupta in response. “It has to do with overall health.”

A nation’s health

Before this pandemic, the U.S. had the highest pandemic response scoring based on resources, overall wealth, and more. Yet the reality was harsher than those scores might have predicted. There are a lot of reasons the U.S. was hit so hard by COVID-19, Gupta noted, and exercises have looked at the country’s response when it came to the pandemic to shed light on why we didn’t do better.

“We should have been a leader of the response, but we were tremendously adversely affected,” said Gupta. “We’re not even 5% of the world’s population, but at times we had 20% to 25% of new coronavirus cases.”

This is due to a couple of factors, Gupta said. “One, philosophically speaking, we’ve become a society in the U.S. and other wealthy countries where we wait for the science to rescue us,” he said. “We focus more on a pill, an operation, some sort of therapeutic instead of good, healthy behaviors because we’ve had the convenience option. It’s hardly any work: Just pop a pill. We want the home run, the knockout, the touchdown—we don’t want the single base hits.”

That hubris can get in the way of success, he noted, pointing to the dire effects of the 1918/1919 pandemic in the U.S. based on attitudes similar to those espoused during COVID-19. “We believed, we’re the U.S., we can weather this, and that adversely affected us,” said Gupta.

The other factor: The U.S. is, on the whole, an unhealthy country to begin with. “The overall substrate of the U.S. is not a very healthy country compared to the rest of the world,” he said. For example, 30% of Americans are considered severely overweight or obese, which was considered a known risk factor.

“When you start looking at the overall health of the country, and [the fact that] we didn’t lean into basic public health practices, it was a prescription for being truly adversely affected,” said Gupta. “The lessons are clear, but I don’t know how well we’ve learned from them and if we will be able to lean into the basics next time.”

Gupta said he is optimistic, though, because of what we’ve witnessed with other countries where previous pandemics hit hard. Places like Hong Kong, which grappled with SARS not long ago, immediately went into aggressive containment mode in response to COVID-19, Gupta said. “Hopefully, we will learn these lessons. Epidemiologists say there will be another pandemic in our lifetimes. It doesn’t have to be a black swan event as this pandemic was,” he said. “We can make it more of a blip on the radar instead of a changing event.”

Heymans circled back to the overall health of the U.S. and its impact on the pandemic—and what we can do to improve those stats. “You’re trying to provide people with good health knowledge, accessible knowledge that makes a difference in their lives,” answered Gupta. “As a position reporter, you’re spending at least half of your time clearing out bad information first. It’s important to do because 90% of the journey toward good health is getting rid of bad info at the start.”

Gupta said getting rid of those bad assumptions, removing the things incorrect information is predicated on, is a matter of explaining things well. “I’ll say something generally which has really informed me in terms of how I look at this: There’s all sorts of [specifics] about how you tell people to nourish their body, move their body, rest their body,” he said. “There’s a reason I say nourish versus eat, move versus exercise.”

It’s about how the person or patient lives, Gupta said—finding the right nourishment for the individual.

“One of the great fallacies, and it took me a long time to arrive at this and how I educate my own patients or talk to people on TV, is the belief that we have to engage in these healthy behaviors and I’m not going to enjoy it,” said Gupta. “First of all, it’s not hard. It’s probably easier than what you’re currently doing in the pursuit of good health. The human body is remarkably good at staying healthy if we get out of the way.”

We often think of adopting healthy practices for the long term, for the future, Gupta said—to live longer, to be more functional at the end of our life. But we can focus instead on how to feel better right now. “Abiding by healthy practices isn’t about the future. Those things feel good now. It’s closing the loop,” he said. “Don’t just tell patients what to do. ‘So, Doc, you’re asking me to eat right and exercise, and nothing happens to me?’ So I’ll tell them, ‘If you do these things, you’ll feel better.’ ”

This includes rest, Gupta noted. “Remind people that that’s a time when your brain can be metabolically active,” he said. “It clears out the waste from your brain. Waste is always being cleared out, but during rest is when it’s most efficient. I’m not just spouting anecdotes—there’s real research behind what I’m saying.”

The impact of stress on healthcare

Heymans brings up Gupta’s recent documentary, One Nation Under Stress, and the concept of deaths of despair. “Right now we’re dealing with a lot of stress, and stress is a big deal during a pandemic,” she said.

Gupta said the documentary was a labor of love, because of all developed nations, only the U.S. is seeing a decrease in the life expectancy of its citizens. The top three causes the documentary focuses on are suicide, accidental drug overdoses, and cirrhosis of the liver due to alcoholism, which Gupta identifies as the deaths of despair.

“There’s a very long discussion to try to figure out why the U.S. in particular is affected by this,” Gupta said. “And when it all came down to stress, I talked to researchers, isolation researchers, loneliness researchers, and all of these things emerged. We always say stress is bad, we want to obviate stress from our lives, but we now know that’s not the answer. We need stress. Stress gets us out of bed.”

Stress in animals, for example, can save lives, Gupta said, such as by helping them outrun predators. Humans also need stress as a survival mechanism, but the difference is “when [the danger is] over for the animal, the stress is gone. For humans, we have a hard time turning it off. We’re constantly bombarded,” said Gupta.

Rather than remove all stress, Gupta pointed to a reasonable goal of letting the stress come down so we’re not constantly hit with stress hormones. “I will say this: Don’t stress about stress,” he said. “It just compounds the problem.”

Reciprocal altruism

“You have this quote: ‘In order to best care for ourselves, we have to also care for each other,’ ” Heymans said. “In the past year—where stress has been an issue, there’s more isolation than usual—that quote reminds me of the things you say about joy and gratitude and relationships and social connections, and how all these things connect to our health.”

Gupta said that when he wrote the quote, he knew it might be interpreted as a euphemistic thing to say. But it has to do with something researchers term reciprocal altruism.

“It means exactly what it sounds like—reciprocating altruistic behaviors,” Gupta said. “Why would we give away some of our resources to someone else? How did that get encoded in our DNA? I think the reason it happened is it’s how we survive as a species. It’s helped us as a species. And it feels good: how can you ask for more than that? It’s a guiding light for me. You want twofers in life? Where it feels good to do good? You’ve got it right there.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.