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Elephant in the room

By: Anthony John Kostelnak, BSN, RN

When there is an elephant in the room, introduce it…

Those who watch the news, particularly CNN, have seen the COVID-19 ticker that often appears on the right-hand side of the television screen during programming. The death toll climbs higher and higher every day here in the United States and around the world. And, one must ask themselves… how & why? How did this ever happen to us? Why did it get so bad? I often joke with my friends, saying, ‘can you imagine if someone in 2019 sent you a picture of what life would look like in 2020 (and likely, 2021)? What would you have thought happened?’ I think it is fair to say, no one predicted this last year.

But, what we did know last year, and have known for many years, is that the U.S. is one of the unhealthiest industrialized nations in the world. What are the facts, and what do we know? The prevalence of obesity for both men and women has increased almost every year since 1999. Currently, obesity prevalence in men is 38%, whereas for women 41%. We know that obesity is correlated with excess morbidity and mortality. As obesity rates rise, so does the prevalence of hyperlipidemia, hypertension, and type 2 diabetes.1 Overall, the US has the highest chronic disease burden and the highest rate of preventable deaths than any other industrialized nation. When compared with our peer nations, the U.S. has the lowest life expectancy, and our citizens visit the doctor less frequently.2

COVID-19 was the fault line in an already medically unstable society. A recipe for disaster.

Let’s address a couple of things. First, as a frontline worker who has seen many people severely ill, and die, from COVID-19, I do not underplay its severity as a deadly disease. It will forever change the way I practice as a nurse and will forever be a part of me.

But, what I do understand is the science. That those with type 2 diabetes, hypertension, severe obesity, chronic obstructive pulmonary disorder (COPD), cardiovascular disease, and certain cancers – many of these are preventable diseases through lifestyle intervention – are in the high-risk group for severe illness and death from COVID-19. I have seen this with my own eyes in practice. I also acknowledge that many in the “high-risk group” have underlying conditions that could not have been prevented, including older adults, those who are immunocompromised, have sickle cell disease, or congenital conditions. Let it be clear, the devastating effects of COVID-19 are through no fault of any individual, but rather, exacerbated by an environment that promotes poor lifestyle choices. COVID-19 has exposed how vulnerable we are as a society, that we must start taking health promotion and our health care system seriously, for the greater good of our economy, our society, and our well-being. I suggest that nurses have an opportunity to take the lead!

Implications of a Healthier Workforce

In May 2017, The American Nurses Association (ANA) launched the Healthy Nurse, Healthy Nation campaign, affirming that wellness promotion begins with over four million registered nurses serving as role models and wellness-advocates within communities throughout the country. To best enhance health promotion efforts here in the country, nurses are expected to model positive wellness behaviors for their patients, peers, colleagues, and family. The World Health Organization states that it is concerning if nurses, the largest healthcare workforce with the most direct patient contact, are less inclined to discuss wellness-promoting behavior with patients because they have difficulty maintaining a healthy lifestyle.3 Nurses are role models, advocates, and educators and are the most trusted profession. We can lead health care change.

The health issues that many Americans face are not going anywhere. We have made little progress to significantly reduce the number of chronic diseases, leaving us, yet again, vulnerable to another COVID-19-like pandemic.

We must continue to be at the forefront of advocating for health care policy, encouraging wellness, and importantly, caring for ourselves. This pandemic has changed the way society lives, but I am unsure that we have truly addressed what I believe to be one of the most revealing problems of them all: an unhealthy nation plagued by underlying medical conditions. By acting now, we may be able to prevent another pandemic from overpowering our communities, our families, and our friends.

Anthony John Kostelnak is a staff nurse in acute geriatric medicine at NewYork-Presbyterian Weill Cornell Medical Center and assistant research scientist at New York University.


1. National Center for Health Statistics. Health, United States, 2018. Hyattsville, MD. 2019.

2. The Commonwealth Fund. The U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? Retrieved from https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019

3. World Health Organization. (2018). The 2018 update, Global Health Workforce Statistics, World Health Organization, Geneva. Retrieved from https://www.who.int/chp/chronic_disease_report/part1/en/index11.html

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