With the presidential debates gearing up again we are sure to hear more about health care. But we propose a slightly different question. In addition to asking how we can get more people healthcare coverage, we should also ask why so many people are sick in the first place.

The words of John Kennedy might today be, "Ask not what the health care system can do for you. Ask what you can do to reduce the health care burden". But before delving into what we can do, let's take a look at some realities that our next president could face in their first 'State of the Union' address.

On the downside -

* We are not healthy: 60% of adults and 20% of kids are overweight; 30% of today's kids are anticipated to become diabetic; 20% of high school kids have early stages of heart disease. The estimated economic burden of depression for the year 2000 (most recent estimate) was $83.1 billion, and this is just one of many brain-related diseases

* We are aging: within the next couple of decades, about 20% of the population will be of retirement age; 4.5 million people already have Alzheimer's disease and by 2050 there will be 16 million cases.

* We are heavily medicated: anti-depressants are the leading selling drugs in the United States; record numbers of children are on these and anti-psychotics; for adults, cholesterol and blood pressure medicines are becoming as common as breakfast cereal.

On the upside -

* The US government estimates that healthier lifestyles could save $71 billion per year in health care costs and another $14 billion in lost productivity.

* 1 out of 7 deaths are premature and could be avoided with better diets and active lifestyles.

Perhaps the next president should spend a little effort promoting methods to improve these statistics. But how?

We typically think of heart disease, diabetes, depression, and Alzheimer's dementia as very different problems. But the more we learn about disease, the more we realize that these seemingly different diseases often have a lot in common at the cellular and molecular level. They also have a lot in common when it comes to how they gained a foothold in your brain and body to get started in the first place.

However, we have an arsenal of tools proven to help reduce common cellular damage to maintain fit brains and bodies. What are those tools? Some high tech drugs and medical equipment that is out of reach for much of the population lacking health care insurance? Actually, no. These tools are very low tech and available to everyone. They are:

1. Eating a quality diet

2. Getting regular physical activity

3. Keeping your mind active and engaged

4. Getting enough sleep and rest

Sounds easy, right? So why don't we all do it, and why didn't we have all of these problems 50 and 100 years ago?

First of all, in yesteryear a breakfast muffin contained about 150 calories. Today that muffin is 400 calories. A large drink at the soda fountain totaled 12 ounces. Today, that drink is the smallest size on most menus. Yes, we are suffering from proportion distortion. We love to eat, and it ain't peas and carrots we are a cravin'.

Second, for many people going to work actually meant going to work, physically. Today, the extent of our office exercise is finger aerobics on our QWERTY keyboards. Physical activity used to be a regular part of everyday life, not a chore that you have to schedule into your day.

Third, as Alvaro pointed out on a recent Sharp Brains blog, many of us 'outsource our brains' and no longer think for ourselves. With mass media messages, GPS systems, calculators, spell checkers and electronic organizers, we must ask the question how well we could function without them. I know I am guilty of this one, myself.

Finally, we are staying up later and getting up earlier to meet those deadlines. On average, we get 1.5 hours less zzzzzs than we did about 100 years ago. Not only that but we spend far more time busy, busy, busy when we are awake than we ever used to.

Now, change happens. We shouldn't expect to always do things the way we used to, and we're not suggesting that. Food, in all its irresistible varieties, is much more available. Are we supposed to just not eat it. Well, uh, it wouldn't hurt to pass on the second helping of triple chocolate cheesecake now and then.

And no, we can't jog around our office but we can do simple things to introduce more activity into our day. Walk instead of drive those 1-mile errands. Park further from the door, take the stairs . . . you've heard all this before. So why don't we do it?

One reason is that no one likes to be told what to do and subjected to some guilt trip, most people just don't respond to that. Also, most people haven't really thought about what they really want their health to look like or developed a reasonable plan to reach their health-goals. As the old adage says, "If you don't know where you are going, you are sure to get there", plus it helps to have a map. Finally, even with a plan many folks will give up after the first sign of failure or fatigue. These changes don't become easy until we make them an integral part of our lives.

So how do you motivate people to take action to maintain their health? Since everyone is different, many options exist. The obvious answer, that will motivate the most people, is money, money, money . . . money (did you hear 'The Apprentice' theme song).

At a policy level, it would be exceptionally helpful if the next president worked to create incentives for healthy lifestyles and behaviors. Now, I know this is easy to say, probably not as easy to do (and keep everyone happy), but you have to walk before you run.

What if the next presidential administration actually incentivized (is that a word yet?) us to take better care of ourselves? What if health insurance companies gave discounts to people that tried to live a healthy lifestyle? What if the government gave us tax breaks to eat healthier food and exercise? What if each individual had one government subsidized continuing education, or self-enrichment class each year? Would this reduce the overall health care burden for employers and make it more affordable to cover more people? Help reduce sick days and increase productivity and creativity? Hmmm....

We realize there are many caveats to implementing such a plan but something has to be done and maybe some bright politician can figure out how to do it. Who would lose if the country were to improve their health?

Insurance companies wouldn't have to fork out as much. Medical providers would be able to divert more of their attention to preventing disease, instead of managing chronic illness. The government wouldn't be in such a hot seat for the health care crisis. Big Pharma might sell fewer drugs, but there are several new health-related industries that they have the expertise to tap into. Basically, we would all win.

So back to our initial question: "Why are we so sick in the first place?" If you step back and see the forest for the trees, our world has changed drastically in the last 50 to 100 years. With technology, and the availability it brings, we may have become a little complacent, a little too trusting that the magic cure-all pill is there for us.

It is true that we are living longer. But I'm sure with increased longevity, everyone would want at least a reasonable quality of life and currently that isn't the status quo. So the answer to our question seems to be....lifestyle choices. Making the best lifestyle choices, and maintaining them, isn't always easy but the best things in life rarely are.

So Madam or Mister President, will you help us help ourselves?