Author: mmurakam

Jogging to the Carrot and from the Stick: The Dual Motives that Fueled the Paradigm Shift of the Exercise Industry

Michael Murakami

One fall in middle school I played for a Japanese baseball team. Although I speak little Japanese, a friend of mine recruited me when a teammate moved back to Tokyo. Practices and games mostly mirrored my other teams, except for conditioning. We worked the same routine at every practice which far exceeded a warm-up jog and stretching. I struggle to recall many of the exercises (granted, most names were in Japanese) except for two. The first began when our head coach yelled “Spi-der-man” in three, slow, drawn-out syllables. We repeatedly propped ourselves up with arms and legs extended outward and bodies held inches above the ground until we collapsed. The other consisted of shutter runs in the gym under time pressure until you either collapsed or quit. As the least fit member of the team, I felt embarrassed during conditioning since I always quit first. Even more confusing, at the end of each practice, we lined up and bowed, yelling “Arigato gozaimashita!” (thank you very much) to our coaches for leading the workout. Although perhaps atypical for youth sports, this experience illustrates a modern characteristic of exercise: we physically punish ourselves in the name of fitness out of a desire to avoid negative outcomes alongside pursuing positive outcomes…and then give thanks for the suffering. The old carrot that motivated exercise, the desire for health and wellness, recently became accompanied by a larger fear of the stick: stigmas and public shame.

The Carrot and the Stick1

Posited Virtues of Exercise

Exercise as an intentional activity (rather than indirectly resulting from manual labor) initially gained popularity for its positive physical and mental outcomes. Before analyzing the recent shift in mindset surrounding exercise, it is essential to acknowledge the benefits of and reinforce the need for a moderately strenuous exercise routine. First, exercise yields numerous positive physical outcomes. In his paper, Health Benefits of Exercise, Greg Ruegsegger explains how exercise is strongly correlated to an extended lifespan and the delayed onset of dozens of conditions and diseases, which improves peoples’ quality of life.2 Further, exercise benefits mental health. Kathleen Mikkelsen explains in Exercise and Mental Health how activity alters peoples’ moods positively and improves symptoms of anxiety, stress, and depression.3 Moreover, in the long term, exercise, especially endurance training, improves the overall mental health of those who partake.

On the one hand, this makes sense since better physical shape can make parts of life easier. Moving and performing enjoyable activities may reasonably increase one’s happiness. On the other hand, rather than being hedonically motivated, exercise may improve one’s quality of life and mental health by escaping from the negative societal implications of being viewed as “unhealthy.”

Modern culture rewards good health and, to people who fall into the “healthy” category, the positive attributes of exercise appear to be an achievable outcome. While this belief may seem reasonable and even beneficial in an isolated state (one may believe that these positive affirmations of exercise would encourage the healthy behavior of exercise), the implicit negative sentiments created about those determined to be in “poor” health are undeniably damaging. The following three sections will illustrate different sides of the same coin: negative stigmas surrounding poor health and positive reinforcement of dangerous “healthy” mindsets and activities.

Stigmas of a Lack of Exercise and Poor Health

In chapter 10 of Illness Narratives, Arthur Kleinman describes how we derive the term “stigma” from Greek, referring to “marks that publicly disgraced the person.”4 Especially in ancient societies, many stigmas plagued societies’ social structure. Societies commonly developed stigmas about race, gender, wealth/social class, and a plethora of other visible characteristics. In modern society, as we attempt to reconcile historical inequalities equitably, new stigmas have arisen in the name of a seemingly “beneficial” characteristic: health. The primary issue is that stigmas surrounding health create a false sense of causation between the size/shape of the body (a physical attribute) and the overall health of a person (a generally non-physical characteristic). The result is that stigmas against those viewed as “unhealthy” only target people who appear to be overweight, which dangerously fails to capture reality.

To disprove that physical appearance and health are necessarily causally related, I will provide two examples. First, some people eat diets that are objectively unhealthy (per standard medical dietary standards) and/or perform health-damaging activities like smoking or vaping and appear healthy since their bodies have quicker metabolisms or the effects of their actions are long-term, not yet harming the individual. Since stigmas attack physical characteristics, they would not be stigmatized as “unhealthy” since (often) the consequences of their actions are not realized in the short-term. 

The second example is the overuse of socially acceptable substances. The majority of US adults consume caffeine daily,5 and a large number drink or otherwise consume unhealthy amounts (greater than the recommended maximum of 400 mg per day). In fact, popular energy drinks like BANG and Reign contain nearly this much caffeine in each can. However, given that caffeine is a socially acceptable, productivity-boosting drug and it is difficult to measure another’s consumption throughout the day, certain substance abuse remains generally unstigmatized.

Since the results of these activities are not generally visible and/or are socially accepted, the seemingly only prevailing stigma attacks people labeled as “unhealthy” due to appearing overweight. Even worse, stigmas are not limited to adults. One notable campaign attacked children for their obesity in the early 2010s. Strong4Life created advertisements like the one below which demonizes fat children and asserts the need for lifestyle changes. It is truly unimaginable that any marketing department would consider this a promising advertisement, which could only happen after they approve it as acceptable. Neither feels right.

Strong4Life’s Advertisement6

Medicalization of Exercise

Once understanding this stance taken on people viewed as “unhealthy,” it is next important to understand how society changed as a result. In Medicine as an Institution of Social Control, Irving Zola describes how medicine and “health” became an institution of social control. This shift results from medicalization, or the integration of medicine and medical research into everyday activities that otherwise would be separated.7 Play for children and exercise for adults recently became medicalized, from programs like Play 608 to the daily tracking of activities towards goals like counting steps, measuring the distance walked, and tracking heart rate on devices like Apple Watches. Many industries took this a step further, with employers pressuring employees to exercise by rewarding tracked activity monetarily (my firm, PwC, utilizes a program named VirginPulse9) and insurers creating programs called “interactive life policies”10 which personalize rates and create discounts based on continually tracked health metrics.

While some people enjoy optimizing their exercise and routines, this data collection represents a dangerous external motivation that destroys the equilibrium activity level for others. External motivation can result from third parties who directly benefit from someone becoming more “healthy,” such as an employer or insurer, or more innocently from friends. Apps such as Apple Fitness+, Strava, and Garmin Connect, all three of which I personally use, motivate activity through comparisons to friends and direct competition against others for more calories burned, miles run, etc. Since the data is public, even those considered “healthy” by society face new stigmas if they fail to hit their move goals on any given day. Such layered stigma and motivation perpetuate and exponentiate the toxic nature of the fitness industry by creating a desire for perfection in action and perfection in results.

Apple Fitness Competitions11

Rotten Carrots: The Faux Acclaim of Physical Perfection

When someone pursues the health benefits of exercise to an extreme, the positive physical and mental health outcomes quickly disappear. A factor creating the culture of excess in exercise is blatant in fitness-related social media, specifically in the language influencers use. The industry is infested with lies and unreasonable extremism which pollute the mindset of a balanced person. First, social media highlights influencers who mislead audiences about their lifestyle, the use of performance-enhancing drugs (PEDs) to exponentiate their outcomes, and more. The average person is constantly exposed to unattainable physiques which may swing them in one of two directions: either their relative lack of progress compared to a PED user discourages them from continuing a fitness lifestyle or it creates a mindset to overtrain in pursuit of unrealistic outcomes.

The first outcome is damaging simply because it discourages the pursuit of a healthy and balanced lifestyle. Any of the aforementioned positive outcomes of fitness disappear and the person’s overall quality of life generally decreases. This is clearly undesirable.

The second outcome is potentially more dangerous. Although some of the physical benefits of exercise relative to a sedimentary life may still be realized at the highest level, many mental health benefits are quickly wiped away. This unfortunate outcome happens for a few reasons. First, as training becomes a larger part of someone’s day, other aspects of life must be minimized. The marginal benefit of additional exercise is mitigated by losing time for sleep, relationships, and other activities, all of which damage a person’s mental health. Further, the language found in the extremes of the fitness industry creates punishing mentalities that take mental and physical tolls on people. A clear example comes from David Goggins, former Navy SEAL turned fitness influencer who in his social media clips and books routinely encourages this mentality of excess and extremism with quotes like:

“We’re either getting better or we’re getting worse,”
“Don’t stop when you’re tired. Stop when you’re done.”12

David Goggins, Can’t Hurt Me

The Exercise Paradigm Shift: From Play to Work

Goggins and similar fitness influencers exemplify the overall paradigm shift found in exercise that Gabriel Winant describes succinctly; “Once associated with play, exercise is now closer to a form of labor: measured, timed, and financially incentivized by employers and insurers.”13 Here we find a dramatic shift. In our society fueled by a desire for progress and productivity, a growing proportion of our lives transform into new forms of labor. And much like other so-called jobs, forms of workaholism and gross excess appear. This flawed view of exercise that resulted from this shift quickly damaged society. 

In the end, balance is important. There is no question that there are various benefits to physical activity that ought to be neither overlooked nor ignored, but taken to an extreme, the fruits of our labor quickly become rotten carrots that we endlessly continue to pursue. Although difficult in a productivity-focused world, it is imperative that our culture accept and normalize a moderate, healthy amount of exercise without slipping into unnecessary extremes or abandoning fitness altogether. In my opinion, this is most important for children. Rather than the rigid minds of adults who may already habitually follow an extreme, children should be shielded from exposure to an unhealthy form of labor. Such a shift would allow future children to not fear Sunday morning baseball practice as I did, but to look forward to time with friends playing a game they love. At a minimum, society ought to let kids be kids again by encouraging them to play in any condition, rain or shine, rather than mandate exercise and conditioning.

My teammate, Ray, and I after a game.

Works Cited

  1. Taylor, Justin, “Donkeys, Carrots, Sticks—and the Gospel.” The Gospel Coalition, 5 Dec. 2011, www.thegospelcoalition.org/blogs/justin-taylor/donkeys-carrots-sticks-and-the-gospel/. 
  2.  Ruegsegger, Gregory N., and Frank W. Booth. “Health benefits of exercise.” Cold Spring Harbor perspectives in medicine 8.7 (2018): a029694.
  3.  Mikkelsen, Kathleen, et al. “Exercise and mental health.” Maturitas 106 (2017): 48-56.
  4.  Kleinman, Arthur. Illness Narratives: Suffering, Healing, and the Human Condition. BASIC Books, 2020. 
  5. “National Coffee Association.” NCA, www.ncausa.org/Newsroom/NCA-releases-Atlas-of-American-Coffee. 
  6. Lohr, Kathy. “Controversy Swirls around Harsh Anti-Obesity Ads.” KERA News, 24 Aug. 2020, www.keranews.org/2012-01-09/controversy-swirls-around-harsh-anti-obesity-ads. 
  7. Zola, Irving Kenneth. “Medicine as an Institution of Social Control.” Ekistics, vol. 41, no. 245, 1976, pp. 210–14. JSTOR, http://www.jstor.org/stable/43618673. Accessed 20 Mar. 2023.
  8. “Official Site of the National Football League.” NFL.com, www.nfl.com/causes/play60/. 
  9. “Changing Lives for Good.” Virgin Pulse, 2 Dec. 2022, www.virginpulse.com/. 
  10. Barlyn, Suzanne. “Strap on the Fitbit: John Hancock to Sell Only Interactive Life Insurance.” Reuters, Thomson Reuters, 19 Sept. 2018, www.reuters.com/article/us-manulife-financi-john-hancock-lifeins-idUSKCN1LZ1WL. 
  11. “How to Start an Activity Competition with a Friend in Watchos 5.” MacRumors, www.macrumors.com/how-to/start-an-activity-competition-in-watches-5//. 
  12. Goggins, David. Can’t Hurt Me: Master Your Mind and Defy the Odds. Lioncrest Publishing, 2020. 
  13. Winant, Gabriel. “A Radical Critique of Wellness Culture.” The New Republic, 23 Mar. 2023, newrepublic.com/article/148296/barbara-Ehrenreich-radical-critique-wellness-culture.

St. Matthew, Adam Smith, and Immanuel Kant: an Unempathetic and an Empathetic Justification for Expanding Rural Healthcare Access

Michael Murakami

As an accountant and economist by trade, the theological story I am most naturally drawn to is when Jesus calls upon Matthew the tax collector (soon to be St. Matthew, Patron Saint of Accountants) to join him in ministry. Jesus’ quote in Matthew 9:12, “It is not the healthy who need a doctor, but the sick”1 was always memorable; knowing that sinners (the sick) could be drawn into and saved in the church by Jesus (the doctor) comforted me. Yet in modern society, this initially metaphorical line now applies in a very literal sense: many regions of the United States, like rural communities, are populated with “sick” people who are unable to receive treatment for a variety of reasons, such as time, cost, and access.

The Calling of St. Matthew, Caravaggio2

Background on Rural Communities

Social determinants of health (SDoH) impact rural communities by decreasing the healthcare access and utilization of residents. Some of the most common SDoH in rural areas relate to lower levels of income, education, health-related infrastructure, and health literacy as well as other determinants such as race, ethnicity, sexual orientation, and environmental impacts.3 

To exemplify the impact of a SDoH, Elisabeth Rosenthal describes in her piece, Paying till It Hurts: The $2.7 Trillion Medical Bill,4 how patients with lower incomes suffer because of rising costs and doctor-patient information asymmetry. The example she uses is colonoscopies, where it is shown that pricing is not equal nor well understood, even by doctors. However, even worse, because of the specialized knowledge of the medical field, patients typically do not understand what procedures or checkups most efficiently diagnose or aid their issues and are cornered into what doctors prescribe. The fundamental problem that results is that the motivations of doctors can be fueled by popular, but misguided medical beliefs (in this case, that colonoscopies are the best method for the early detection of GI issues) or lobbying of medical firms (more often seen in pharmaceuticals). In either case, low-income and low-access patients are most impacted by ineffective and unnecessary testing because they are least able to afford or access further care. 

Beyond lower financial access and utilization of medical care, geography plays a critical role in physically limiting the access of rural patients from doctors. According to a study comparing rural and urban specialty healthcare access by Melissa Cyr et. al., both urban and rural areas struggle with the availability and accommodation of healthcare, although rural areas are considerably worse off (a problem compounded by additional limiting factors) as seen in the infographic below.5 Here, Cyr et. al. shows the existence of a variety of significant barriers to healthcare access in rural areas.

A frequency chart of mentions of the hindrances of healthcare access from Access to specialty healthcare in urban versus rural US populations: a systematic literature review, Melissa Cyr et. al.5

This dramatic difference in access and utilization tangibly impacts the quality of life and longevity for rural and poorer communities. In his piece, Inequality and the Health-Care System in the USA, Samuel Dickman explores the lower quality of life and shorter life expectancies for low-income patients. He explains that chronic and acute conditions alike have higher prevalence with declining income (which is correlatable strongly to rural communities) as well as considerably lower life expectancy.6 These results exemplify how the negative outcomes associated with SDoH decrease the quality of an already shortened life.

The Role of Rural Communities in the United States

With an understanding of the existence of disparities and deficiencies in healthcare from the above pieces, one may ask why only a small segment of society pushes for changes to the status quo. A common response draws upon economics in a resource-constrained game; proponents believe that the tradeoff of additional healthcare being invested in densely populated areas will help more people than in rural areas. This utilitarian stance, although logical on the surface, lacks consideration for the whole picture when further analyzed. To understand an unempathetic, economic argument in support of expanding rural healthcare, one must understand the role of rural, especially farming, communities in the United States. In rural America, approximately one out of ten workers are in industries such as agriculture, fishing, and hunting which, although decreasing over time, comprises a large portion of the community and nationwide production.7 

Open market and even Keynesian economists may argue that we should help rural communities in order to directly strengthen our food source, therefore bettering society. This stance stems from a belief that farming communities (and other rural industries, however, farming is a clear example) will become more productive with increased average levels of health and health outcomes. Adam Smith points to this idea in The Wealth of Nations, the foundational text in support of capitalism and market economies. He describes how “no society can surely be flourishing and happy, of which the far greater part of the members are poor and miserable.”8 Even in a true capitalist market economy (which the United States is not), Smith argues that those rich in money and/or other goods will only live in a flourishing society by ensuring a respectable minimum living threshold for its members. In this case, the reward of a “flourishing” society results from the positive externalities associated with more efficient, healthier farmers who create more food for everyone. Uplifting rural farming communities’ healthcare resources and overcoming existing SDoH from this economic perspective is not an emotion-based decision but rather a net-positive sum game and an economically sensible choice. 

Yet, this economic argument does not feel satisfying, even to an economist like myself. Instead of uplifting communities for their intrinsic value, this action derives its motivation from how it benefits me and my community. Rather, it may be beneficial to consider shifting the argument away from the expected net societal value of healthcare expansion and towards viewing farmers as intrinsically valuable and deserving of better health outcomes. For this view, we turn to Immanuel Kant, who describes how we must:

“Act in such a way that you treat humanity, whether in your own person or in the person of any other, never merely as a means to an end, but always at the same time as an end.”

Immanuel Kant, The Metaphysics of Morals9

Rethinking Rural Healthcare

Therefore, more than a means to efficient food production, one ought to look at the problem of rural healthcare from the lens of helping the communities in and of themselves. This empathetic call for improved rural medical access stems from the societal obligation to help create access to foundational resources to highlight the inherent and divine dignity of every person. The conversation thus returns to the ministry that Jesus called Matthew the tax collector to join. 

Theologically, the societal obligation to assist others for their intrinsic value appears prior to the Gospel of Matthew in the Old Testament, for Proverbs 31: 8-9 declares that we must “Speak up for those who cannot speak for themselves, for the rights of all who are destitute. Speak up and judge fairly; defend the rights of the poor and needy.”10 It is not just for privileged communities to look down upon lower average health outcomes in rural communities. Much the opposite. We as members of a privileged section of society are each called upon in the fight to assist rural areas by creating new opportunities for financially and geographically feasible healthcare access. 

From all of these ideas, we find the final conclusion. It does not matter whether rural communities are viewed as a means to resources for the rest of society or end in themselves, for healthcare is not and has never been a net-zero sum game. Rather, all perspectives understand the positive-sum nature of increased healthcare and better medical outcomes for rural communities. What implementing this solution looks like in real life is not in my wheelhouse, I am just an economist after all. But in this fight, all members of society should and ought to support actions that help rural communities overcome the SDoH that plague the status quo. 

Works Cited

1)  “Bible Gateway Passage: Matthew 9 – New International Version.” Bible Gateway, www.biblegateway.com/passage/?search=Matthew+9&version=NIV. 

2)  “The Calling of Saint Matthew.” Artble, Artble, 19 July 2017, www.artble.com/artists/caravaggio/paintings/the_calling_of_saint_matthew. 

3)  “Rural Health Information Hub.” Social Determinants of Health for Rural People Overview, www.ruralhealthinfo.org/topics/social-determinants-of-health. 

4)  Rosenthal, Elisabeth. “The $2.7 Trillion Medical Bill.” The New York Times, The New York Times, 1 June 2013, www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html. 

5) Cyr, Melissa E., et al. “Access to Specialty Healthcare in Urban versus Rural US Populations: A Systematic Literature Review.” BMC Health Services Research, vol. 19, no. 1, 2019, doi:10.1186/s12913-019-4815-5. 

6)  Dickman, Samuel L, et al. “Inequality and the Health-Care System in the USA.” The Lancet, vol. 389, no. 10077, 2017, pp. 1431–1441., doi:10.1016/s0140-6736(17)30398-7. 

7)  Staff, America Counts. “More Work in Education and Health Care.” Census.gov, 15 Sept. 2022, www.census.gov/library/stories/2017/08/rural-economy-not-completely-dependent-on-farming.html. 

8)  Smith, Adam. The Wealth of Nations. Seven Treasures Publications, 2009. 

9)  Kant, Immanuel. The Metaphysics of Morals. Bobbs-Merrill Education, 1965. 

10) “Bible Gateway Passage: Proverbs 31:8-9 – New International Version.” Bible Gateway, www.biblegateway.com/passage/?search=Proverbs+31%3A8-9&version=NIV.