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People love giving advice about how to get healthy. There is, especially this time of year, no shortage of attractive people with six-pack abs who will happily tell you the best way to improve your well-being. The problem, of course, is that they all contradict one another. You have to do keto but also be vegan. Cardio is important—but resistance training is where it’s at. Get enough sleep, but also drink more coffee, wake up early to take an ice bath, and remember to never use your phone past 8 p.m.—except you should also make sure to keep in touch with your friends and family, as well as stay up on the latest antianxiety breathing techniques.
The thing about all of this health advice is that it’s fundamentally flawed. Although there are certainly things we can all do to improve our well-being, a surprising amount is out of our direct control. In most cases, the extent to which you can easily improve your health is dwarfed by factors that you have little to no ability to change, from genetics to where you live (“Blue Zones” may be fake, but your immediate environment still matters) to where you lived as a child (there is, for example, a long-proven association between childhood asthma and proximity to motorways) to other choices your parents made and limitations they had (for example, the children of incarcerated parents are susceptible to a range of negative health outcomes).
Beyond factors that you truly cannot change, the single biggest thing that we know can affect your health is really, really simple: money. There are literally thousands of ways in which income influences your health and well-being—from the minor, such as whether you live in a suburb with sidewalks where it’s safe to go running, to the more significant, like whether there are enough doctors in your area to treat all the people who need help. Money gives you the ability to travel if you do need to see a specific specialist, as well as the ability to take time off work for lengthy appointments in the middle of the day. Studies bear out the various health benefits of money. To cite just a couple: Rich people are less likely to get diabetes, and when they do get it, the outcomes tend to be less severe. Having an occupation that doesn’t pay well is strongly linked to developing lung disease later in life, in part because sitting at a desk exposes a person to fewer things that cause lung issues.
How much money do you need to make to enjoy some of its health benefits? It might be less than you think. One study found that an 18-year-old in the U.S. with a family income below the poverty line was expected to live to 67, while a teenager of the same age whose family income was three times the poverty threshold would probably live past 77. With a 2023 poverty threshold of $20,440 as per the Department of Health and Human Services, that’s a difference of $40,000 a year for an extra decade of life. We don’t know exactly how wealth protects from some harms, but we do know that being well-off is in general a very good blanket way to improve your health and extend your life. And sure, having lots of money can allow you to buy supplements that may not do anything, but it mostly allows you to live well in tons of tiny commonsense ways.
All this makes it hard to take a lot of the health advice that’s lobbed at people seriously. Getting eight hours of sleep a night is far better than five, but it’s also much easier to do if you work a well-paid desk job rather than if you do shift work for minimum wage. It’s easy to tell people they should improve their diet, but it’s useless advice for the single mother of two who lacks the time to even think about meal planning. Also, everyone is aware that it’s beneficial to get sleep and eat well. It’s not that it’s difficult to realize which behaviors are healthy—it’s that it’s much easier to execute them if you have money to spare. Losing weight can be great for your health, but it’s pretty challenging if you live in a food desert or can’t afford medications like Ozempic and Mounjaro. Having time to exercise and meditate is a luxury, as is being able to switch off at night. All of the little changes that could possibly improve your life are that much harder when you have to work with a tight budget and scant free time.
I’m not saying that you can’t do anything low-cost to improve your health. The most basic recommendations—don’t smoke, drink less alcohol, eat a bit less caloric food, and move as much as you can—can be executed in some way by everyone. But the idea that you can completely turn around your own health is something that is realistic for only a small minority of the population. When it comes to being healthy, it truly helps to have won the genetic lottery—and the real lottery too.
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