The USA faces numerous challenges, two of the very biggest being problems with our educational system and with healthcare. The Organization for Economic Cooperation and Development (OECD) reports that the USA spends more than any other country on primary and secondary education (K-12) per student; and various studies show we spend far more than any other country on healthcare per person. We somehow aren't spending our money very wisely, as our students perform comparatively poorly on standardized tests that are administered around the world; and despite widely available, fantastic healthcare technology – partly the result of spending more than twice as much per capita as any other country on health care - we rank 43rd in the world in life expectancy, even behind countries such as Cuba.
Unfortunately, the stock answers for these problems are more spending and more programs: additional requirements for students in K-12, and more spending on healthcare, especially to pick up people who are somehow being left behind. Given that the standard strategies only seem to be making things worse, not better, is it time to try something really different? A book I recently read may help point us to a common solution for both of these problems – and so far as I know, very few people have considered its adoption as the key solution. It proposes a better way for each of us to care for the health of our minds, and all of the attendant benefits of doing that. It's not a panacea, but it could have a marked impact on both. I'll explain that further below.
The solution is aerobic exercise, coupled with other types of exercise. The evidence underlying this idea is set forth in a new book called Spark: The Revolutionary New Science of Exercise and the Brain, written by Dr. John Ratey, a professor of psychiatry at Harvard Medical School. Ratey is well known for his research in attention deficit disorder. One of his previous books is Driven to Distraction, which addresses the problem of attention deficit disorder, including in adults. Ratey's goal in Spark is to demonstrate the important link between exercise and the brain. While anecdotal evidence has suggested a link between the two, up to now there hasn't been a great deal of scientific evidence. Ratey reviews a great of scientific evidence produced in the past few years to build his case. As he notes early in the book, it's already well known that inactivity is killing our bodies, but he demonstrates that it's also killing our brains.
So what evidence does Ratey provide? The first has to do with the importance of aerobic exercise to help improve learning. He cites the examples of schools in Naperville, IL and Titusville, PA to demonstrate how changing a school's emphasis towards aerobic physical training can have a remarkable positive impact on the performance of children in schools. While the evidence for Naperville is certainly very positive, one might tend to dismiss it because its in a fairly privileged community. That's why the evidence from Titusville, PA is so instructive. Titusville is a depressed community, but it achieved similar outcomes to those in Naperville. The clear message is that instead of programs like "No Child Left Behind", we probably should have programs such as "No Child Left Aerobically Unfit".
Ratey also points out the benefits of aerobic exercise for adults, too. The benefits are not simply to improve health and one's waistline, as everyone already knows. Ratey cites evidence that aerobic exercise is beneficial to adult learning. One of the simple but great takeaways from the book is that one should do aerobic exercise before tackling any important mental tasks. The aerobic exercise helps prime the brain to be its best.
Aerobic exercise is certainly known to benefit cardiovascular health, but what's the role with the brain? Fundamentally, according to Ratey, it's an issue of balancing neurotransmitters in the brain. He provides fairly detailed explanations of the processes, but in layman's language so that it is approachable by readers who aren't medical doctors or neuroscientists.
Beyond education, however, Ratey demonstrates the importance of aerobic exercise to impact a range of health issues facing the country. He builds the case that aerobic exercise can play a very important role in helping mitigate and treat:
- Depression and mood disorders
- Attention deficit disorder
- Addiction to drugs, alcohol and smoking
- Hormonal changes in women
He isn't saying aerobic exercise is a panacea for dealing with each of these health issues, but that it can play a very significant role in mitigating them. As an example, he points to the evidence that a consistent program can be just as beneficial as drugs like Zoloft in fighting depression. According to Ratey, there's been a good deal of anecdotal of evidence, but now there is scientific evidence to back up what's been informally observed.
My conclusion is that the application of his ideas could help create major improvements in the twin problems of education and healthcare in the USA. Moreover, they could provide better outcomes for substantially lower cost. Consider education first. In the case of Naperville, IL and Titusville, PA, neither school district spent a lot of money to buy expense equipment or build fancy facilities. Probably the major expenditure was to purchase heart rate monitors, the devices many athletes use to measure heart rate. These typically are thin black straps that are fitted around the chest. It also didn't involve hiring a lot of additional teachers, education specialists or administrators, either.
Yet the results were pretty dramatic. In both cases, student performance on standardized tests improved fairly significantly. Not only that, but teachers also no longer had to deal with as many behavioral problems with students. It wasn't that the educational curriculum changed. It wasn't the result of a fancy new approach to teaching, new textbooks, new computers, or other new systems. It was simply getting kids to do various forms of aerobic exercise. For many, it was running around a track, but that wasn't the only choice available to students.
With respect to health care, Ratey's proposed solution also doesn't involve a lot of expenditure. If anything, it involves less expenditure. Aerobic and related exercise replaces medication, in whole or in part. For example, instead of medicating children and adults with ADHD, exercise is substituted, with exercise producing results as good as the medication, maybe even better. In other cases, the aerobic exercise regimen provides a way to avoid other costs, for example:
- The cost of treating addiction in the standard ways
- The cost of treating dementia in older adults, because exercise can help stave off the disease for a longer period of time
- The cost of treating the various diseases associated with aging, because exercise provides a way to help keep older adults healthy for a longer period of time. Ratey is saying that exercise will prevent these diseases, but it can help delay the onset of symptoms, as well as reduce severity.
What Ratey is suggesting is pretty simple, and should be pretty obvious, but unfortunately, it probably won't happen, at least not on any large scale. That's because there are lots of institutional and other forces arrayed against this outcome. No, it isn't because of some grand conspiracy, or even a series of mini-conspiracies, it's just that for Ratey's approach to be adopted, lots of institutional inertia will need to be overcome.
For example, Ratey's strategy will result in far fewer pharmaceutical products being consumed, at least when it comes to trying to solve problems with the mind. For lots of people, that would probably be a great thing, but the pharmaceutical industry certainly won't be amused by this. After all, pharmaceutical companies are in the business of selling drugs, not sneakers: Roche is not Reebok, Abbott is not Adidas, and Novartis is not Nike. Moreover, medical doctors are much more in the habit of prescribing pills, not exercise regimens; and even if they were, they still need to persuade their patients. Which may be the ultimate problem: the average American finds it easier to pop a pill than to exercise. Until that somehow changes, Ratey's strategy will stay in the realm of "that's a great idea, but not many people will do it".
It may be different, however, for the education problem. What Naperville and Titusville have done was pretty simple, and pretty inexpensive. One could make an argument that teachers and administrators might oppose it, but once they see the outcomes, they're likely to want to join the bandwagon.
Ratey would like to start a bandwagon, but one hasn't formed, at least not yet. Why? Most likely, because the Naperville and Titusville programs aren't particularly well known, at least outside a fairly small circle. I think the reason may be because what Ratey is proposing is counter-intuitive – hugely counter-intuitive. But it seems to work, not for magical reasons but for ones based upon the emerging science of exercise and the brain.
One of the surprises of Naperville and Titusville is that it wasn't that hard to get kids to participate … and that may lead to an overall strategy for both education and healthcare: get kids to lead the change. Here's how that might work:
- Kids getting into better shape, with an associated improvement in educational performance, as well as health
- Teaching kids the relationship between exercise and brain function so that they grow up understanding the relationship
- Getting kids to influence their parents.
We're accustomed to having older generations teaching the younger generation. In this case, the reverse might come into play, with the younger generation leading the way.
If that happens, then it would eventually impact overall health and healthcare spending. It would just take a generation or so. If a generation of kids grows up understanding the relationship between exercise and brain health, then eventually there may be changes in healthcare as well. No guarantee, but there's a real chance. Until that happens, though, nothing is likely to change. That's because adults already know they should exercise … and some do … but a huge percentage of the adult population doesn't. It's still easier to reach for a pill made by Roche, not a pair of sneakers made by Reebok. Not only that, but it's still easier for doctors to prescribe pills, even where the better prescription may be aerobic exercise.
On the other hand, we're talking about our brains. What Ratey is proposing is a fundamentally different way to think about how to take care of our brains, and the positive impacts that could have in so many ways. If people realize the impact of exercise on mental health, and everything connected with it, maybe they'll get more serious about exercise.
Even if Ratey's strategy isn't widely adopted, it could still provide lots of benefits to individual schools and individuals dealing with health care. It's a strategy that can benefit not only the well to do, but also poor people.
Spark is a most interesting book, and thought provoking as well. I encourage you to pick it up.