Behavior Is a Miracle Drug for Our Health

Healthcare is broken. Chronic diseases are eating up an increasing share of healthcare resources in every healthcare system across the world in ways that are not sustainable. Yes, there is a golden age of innovation happening in the form of new technologies like gene therapy, neural technology, immunotherapy, and increasingly the impact of AI on diagnoses and drug development, but we can’t let these extraordinary technological advances blind us to the tragedy of modern healthcare and to the much neglected miracle drug right in front of us: our daily behaviors. Whether for preventing disease or optimizing the treatment of disease, behavior is indeed a miracle drug.

There are five foundational daily behaviors that, together, make up this miracle drug: sleep, food, movement, stress management, and connection. Because the science is clear that when we improve these daily aspects of our lives, dramatic improvements in our health and well-being follow. The breakthroughs this can bring in our health aren’t over the horizon—they’re here right now.

What’s clear is that what we’re doing right now isn’t working. According to the World Health Organization, chronic and noncommunicable diseases, like heart disease, diabetes, and respiratory diseases, kill 41 million people each year. At the current rate, by 2050, chronic diseases will be responsible for 86% of the 90 million deaths each year, an astounding 90% increase in raw numbers just since 2019. Worldwide, over 500 million people are living with diabetes, and that number is expected to rise to 783 million by 2045. By 2040, the International Diabetes Foundation predicts that spending on diabetes could exceed $800 billion a year. “The most heart-rending symbol of America’s failure in healthcare,” writes Nicholas Kristof in The New York Times, “is the avoidable amputations that result from poorly managed diabetes… A toe, foot or leg is cut off by a doctor about 150,000 times a year in America.”

There’s no healthcare system in the world successfully managing health outcomes against this onslaught of chronic diseases. Whether it’s single payer, nationalized healthcare or systems based on private insurance, all healthcare systems are losing the battle. In the U.S., around 90% of our $3.8 trillion in healthcare spending goes toward the treatment of chronic and mental health conditions. From 1960 to 2021, U.S. healthcare costs soared from 5% to 18% of GDP. In the UK, the list of those waiting to receive medical care has reached 7.47 million. Clearly it’s not just a failure of prevention—our healthcare systems are even failing at the narrower goal of delivering adequate sick care.

The potential to reverse these trendlines can be found in the data: Medical care accounts only for an estimated 10% to 20% of health outcomes, while our daily behaviors drive 36% of outcomes. What does that add up to in terms of our health? According to the UN, the combination of maintaining a healthy weight, regular exercise, a healthy diet and not smoking can reduce the risk of developing the most common and deadly chronic diseases by as much as 80%. The dramatic decline of smoking in America in the last two decades and the impact this has had on health is one example of what’s possible.

Both our lifespan and our healthspan—the period of time in which we’re not just alive but healthy and enjoying a good quality of life—are hugely influenced by our lifestyle. Harvard economist Raj Chetty has found that behaviors such as eating habits, exercise, and smoking affect our life expectancy even more than access to healthcare. In other words, how long we live and how well we live are in large part governed by the choices we make each day. To truly change healthcare, along with the power of life-saving drugs and technologies, we must focus on the power of life-transforming habits within each of these foundational behaviors. Because while healthcare is episodic, health itself is continuous. Health is what happens between doctor visits.

A study in the journal Circulation gives us a vivid look at how powerful behavior can be. Researchers found that people who, at age 50, were practicing five healthy habits—exercising regularly, eating healthy, not smoking, maintaining healthy weight, and not drinking excessive alcohol—added over a decade to their lives (14 years for women and 12.2 years for men). “The main take-home message is that there’s huge gains in health and longevity to be had just by simple changes in our behavior pattern,” said study co-author and Harvard Medical School professor Dr. Meir Stampfer.

So why is the power of behavior change so overlooked? Some dismiss it because they think it’s too soft—how can something like behavior change be in the same category as technological advances and new diagnostic tools? Others give up on behavior change because it’s too hard—it’s the doctor telling us to eat our broccoli and go to the gym. Eating healthier and getting some exercise are things most of us know we should do, but simply being told to do them doesn’t set us up for success.

For the first objection, it’s not either-or. Of course, behavior change isn’t a substitute for drugs and medical treatment, but there’s a ton of hard science showing that it’s an essential companion that optimizes the management of disease. For instance, a study by researchers at Fred Hutchinson Cancer Research Center found that getting good sleep can increase rates of survival for breast cancer patients. “Sleep is certainly something that is controllable,” said epidemiologist and lead author Dr. Amanda Phipps. “We have control over it more than family history of the disease. These results generally suggest that the more attention we give to sleep as an important aspect of overall health, the better we might do for breast cancer patients.” Studies have also found that chronic stress increases the growth of cancer cells. And exercise can reverse stiffness in the heart associated with a condition called left ventricular hypertrophy. All five of our foundational daily behaviors deeply impact how effective medical treatment will be.

And for the second objection—yes, behavior change is hard. But here, too, the science shows that behavior change is absolutely possible when it’s done right. Behavioral science has a long history. Our habits are not formed in a vacuum, and there are certain conditions and strategies that make behavior change much more likely to succeed.

One of those proven strategies is to start as small as possible, which is why Thrive’s behavior change platform is based on Microsteps—too-small-to-fail steps you can take to immediately begin improving your life. Not only is behavior change possible, but it’s going to get easier and more effective with the rise of AI, which Thrive is using to give people real-time nudges and personalized Microsteps in their life flow when they need them most.

Along with Microsteps, other proven strategies are storytelling, compelling content, and community that engages, inspires, motivates and supports people to take charge of their own health and move from awareness to action. This is the scientific methodology that makes behavior change not only achievable but sustainable. We’ve seen the dramatic results that starting off with small Microsteps can have in the lives of employees at the companies we work with around the world.

For instance, there’s Pele Mase, a Walmart associate who lives in Tulsa. She started with a single Microstep of drinking water instead of soda, and progressed to Microsteps around her food, movement, and stress management until she lost 100 pounds.

And there’s Jerry Ouellette, a director of network services for AT&T. After his doctor told him at his annual checkup that he was pre-diabetic, Ouellette started with the goal of walking one mile a day, and then worked his way up to five: “I’ve lost 32 pounds, my sleep apnea is gone, I feel great and I’m getting ready for my annual wellness check and I expect my doctor is going to give me a lot better news. It’s been a great journey.”

Of course, there are chronic systemic health inequities that make it much harder for people to live healthy lives—food deserts, violent neighborhoods, housing instability, lack of access to healthcare —and we should be relentlessly focused on fixing those, both at the policy and at the community levels. But again it’s not either-or. While we are working to improve the social determinants of health, people don’t have the luxury to continue to ignore the impact of behavioral determinants of health—taking small steps to reduce their suffering and improve their lives and the lives of their children. That also means taking advantage of modern digital solutions, like Instacart’s availability to 93% of people living in food deserts. These steps cannot wait until systemic problems have been solved. Too many lives are at stake.

People are hungry for help and support in managing their health. A recent survey by CharityRx found that 65% of Americans turn to Google for health advice—but only 40% find online health information reliable. What makes this moment so exciting is that this growing focus on behavior change is happening at the same time that new powerful technologies—like AI, personalized digital tools and wearables—are emerging to support real and lasting behavior change.

Yes, we can look forward to new medical breakthroughs, and we should celebrate them when they happen. But if we’re truly going to move the needle on chronic diseases, we also need the miracle drug of daily behaviors.