In 1979 and 1980, I practically lived with Dr. Lewis C. Robbins (deceased) and his wonderful wife, Margaret, in Indianapolis (he was about 70 years old then and I was 24). He was my mentor and friend. At the time, he was in semi-retirement producing the first Health Risk Appraisal (HRA), then called a Health Hazard Appraisal (HHA).
He was also the former Chief of Cancer Control for the U.S. Public Health Service, and one of the key people responsible for getting warning labels placed on cigarette packages, which occurred in the 1960s.
What I remember most about this very special man was his passion for preventing disease, and seeing people live a life of full potential. His vision was positive, can do, and competitive!
What Americans Did Not Want to Hear About Cigarettes
I often think about him in the prime of his career when he was trying to convince doctors not to be in advertisements for cigarette companies. And then telling the public what they didn’t want to hear – smoking can kill you, and most assuredly will, if you continue to smoke.
You can’t be a wall flower and take on that agenda.
Dr. Robbins wanted to keep people from making lifestyle choices that robbed them of energy, money, passion, and love of life. He was soft spoken, odd in a charming way, a small man physically − but a giant of inspiration.
Here are the top 5 lessons I took from my relationship with Dr. Robbins. All are as relevant now as they were in 1980.
1. Being healthy is normal: Most people are born with good health. They have the potential to use that health to live a productive, exciting, and rewarding life. And with some common sense maintenance, they can keep a high level of health right up until near the end of their days. Health is a gift, a privilege that we should all nurture and cherish. Often good health is not fully appreciated until it’s lost.
2. Disease uses poor lifestyles as an invasion route: We open a door to disease and the loss of our health, energy, vitality, and productivity when we make poor lifestyle choices. People must be made to be aware that a poor lifestyle choice is like crossing an invisible line that alters the natural course of a healthful life. It is an invitation for an enemy to invade our lives.
3. Primary prevention is what we need to emphasize: He drilled me on the differences between primary prevention (lifestyle choices), secondary prevention (screenings, immunizations, check-ups), and the treatment of illness (disease management). He said, “as educators we should always know where we’re at on that continuum.” And he wanted to see the practice of medicine take deliberate steps into making primary prevention education the highest priority.
4. Use the shop talk of the people: Today we would refer to this as “plain language.” Dr. Robbins would explain how every type of job has its own terms and phrases. He called it “shop talk.”
The doctor expects to be understood by the auto mechanic, but we all know the doctor wouldn’t understand much of what was going on if he had to work with the auto mechanic all day. So we need to think about our messages. And make sure we use shop talk that is familiar to people “to wake up an idea in them.” He said what we have to say should hit them like a “clap of thunder.” And he would clap his hands together as he said it.
5. People do not understand risk: Dr. Robbins spoke often of the difference between real risk (1 out of 1,000) vs. relative risk (30% less). We talked a lot about “out of 100 people how many will… ?” He said the problem with using relative risk in health education is that we don’t know what it is relative to. Years later, in 2006, a wonderful book on this issue was published called, Helping Patients Understand Risks: 7 Simple Strategies for Successful Communication, by John Paling, Ph.D. You’ll never think about the topic of health risk the same way again after you read this masterpiece.
Dr. Robbins was easily 15 years ahead of his time with his progressive thinking, his HRA (which we all take for granted now), and with his vision of public health. I often wonder what he would think of today’s wellness movement? But I know what he would say: “We can do better than this, let’s get right at it.”