Ano is a Justmeans staff writer for health, and an instructional designer for the newly created Master of Health Care Delivery program (mhcds.dartmouth.edu) at Dartmouth College. Ano brings over a decade of evidenced-based health research and writing, and a Masters of Public Health from Dartmouth Medical School to the Justmeans Editorial section. Special interests include health policy, conflict ...
Health Lessons from Somali Pirates?
Online opinions have been flowing freely about the recent murder of four American sailors aboard the private yacht Quest off the coast of Yemen this past Tuesday. The comments section of the New York Times story, for example, racked up around 500 reader comments in about a day. Many folks expressed militaristic fantasies about what should be done to pirates in general, and many more questioned he rationality of the yachties who sailed into waters clearly known to be dangerous.
The story struck a personal chord with this writer. Bear with me as I reminisce, since it actually does relate to something larger than myself or this singular tragedy: As a youngster I sailed on a yacht through the exact same waters where this tragedy unfolded (Coastal Oman, Yemen, the Gulf of Aden). It was a different time, and piracy was not as rampant in that area, though instability was the norm: Engine troubles forced a stop in Port Aden where sunken yachts and artillery damage remained from a just-ended civil war. At that time the South China Sea was the pirate "hot spot," and much like the Quest, we took no precautions when sailing through the South China Sea. The conventional wisdom at the time was that pirates were thieves bent of cash and electronics. Give up your goods and they wouldn't harm you was the hope. (An ocean going tug that passed us at the time even warned that they had received an SOS call from a yacht being boarded by pirates). Today's Somali pirates are, of course after people to hold hostage, so the stakes have changed dramatically.
So why would my parents risk everything to sail blissfully through the South China Sea, just as the owner and crew of the Quest decided to venture into the known perils of the Gulf of Aden?
Stick with me, this will get back to health in a few sentences.
The Yachting life is fantastic, but its also about fantasy. You sail to amazing places, see amazing sights. Its real, but it also alters your sense of reality. It becomes very difficult to put real dangers into perspective. Plus, oceans are vast and powerful beyond imagination. Once you've crossed an ocean or two and survived, you begin to realize a couple of things: I'm really lucky, disaster is rare and happens to other people; and the ocean is so vast that the odds of a pirate locating me are infinitesimally small. In short: Fantasies that you are immune to the unthinkable, and trust that the odds are in your favor.
By what the media has reported, the owner and crew of the Quest were not thrill seekers, nor were they newbie's. They had, after all, made it at least partially across the Pacific and entirely across the Indian Ocean. Adventurous and idealistic, yes, but not irrational risk takers.
So what does this tragic incident teach us about health?
It correlates well with health decision-making, and the difficulties of both health communication and behavior change. Here's how it works: There are many health risks that we know are dangerous, such as smoking, eating too much fat and not getting enough exercise. How many of us have gotten behind the wheel of a car after perhaps a drink too many? Many of us have intimate knowledge of the consequences: We all have close friends or loved ones who have either suffered from cancer, stroke or heart disease (all leading killers largely associated with modifiable behaviors). We've all been told by our doctors, have read articles and watched TV programs admonishing us to eat better, stop smoking, and get some exercise.
And yet we still persist with many dangerous behaviors. Why? There are many reasons, but some of them are exactly the same as what caused the Quest tragedy:
Despite knowing the risks, we believe that bad outcomes are what happen to other people. If we know there's a 20% chance of contracting a disease linked to a certain favored behavior, we believe we are in the 80% that will remain disease free. In short: Fantasies that you are immune to the unthinkable, and trust that the odds are in your favor.
As far as those who admonish Phyllis Macay, Robert Riggle, Jean Adam and Scott Adam for their decision to sail into the waters that ultimately lead to their death its worth considering the following: Death at the hands of pirates is an exceedingly rare way to die. The odds that they faced were much more in their favor than the odds that many of us take routinely with the poor behavior choices we make.
This also relates to our perception of health: Despite the frequent unwillingness to take meaningful steps to improve our own health, we often blame others for the burdens that their disease place on us: "All those fat people are so lazy they end up with diabetes."
Finally, the macho fascination of the "lets exterminate the pirate" crowd also closely mirrors a tendency to want to wage war on disease: The war on cancer, the war on obesity. This fixation on the pirate (or the cancer) may ultimately miss the point that there are underlying contributing causes designed (intentionally or otherwise) to produce murdering Somali pirates, or carcinomas in various human tissues. Perhaps a focus on those upstream causes is in order?
Compassion may also be on order: Phyllis, Robert, Jean and Scott personally paid the ultimate price for their decision. There's no second-hand smoke in this story, no innocent bystander struck down by a drunk driver.