Health and the Pareto Principle

Get the Big Things Right

Many people are familiar with the Pareto principle, also called the 80/20 rule. It is the idea that the majority of an outcome is driven by a minority of causes. In business, for example, 80% of revenue might come from 20% of the customer base. Or conversely, 80% of problems arise from 20% of customers. In healthcare policy, the vast majority of healthcare expenses (about 80%) at any one time are incurred by a minority of patients (about 20% of the population). Or in another example, roughly 80% of the wealth in a country is controlled by about 20% of the population.

This is not meant to be an absolute— it might actually be that 77% of the outcome is accounted for by 18% of the causes. Its not true in all situations, and for every time it is true, there are exceptions. The Pareto Principle is an observation, not a law of nature. However, as a lens through which to view problems, it is useful. It can reveal new insights.

The Pareto Principle applies in two ways when it comes to our health: which behaviors we engage in, and how we engage in those behaviors. In both cases, 20% of what we do probably accounts for about 80% of the outcome. If we can figure out that highly important 20%, we can put our focus and attention there and so really move the outcome. After all, we cannot prioritize everything, we have to choose what is most important.

Regular exercise has been shown, over and over, to be beneficial across an enormous range of health outcomes. Whether it’s dementia, cardiovascular disease, mobility, diabetes, anxiety, or anything in between, exercise makes it better. You can find studies on the benefits of walking, running, weight lifting, exercising in nature, rock climbing, mountain biking, group sports… the list goes on. While there is plenty to debate about what is optimal (intensity, duration, type, etc), the vast majority of the benefit comes from moving your body and using your muscles. Focus on keeping active.

Social connections keep us healthy, prevent disease, improve disease outcomes, and make us happy. We are a social species, and loneliness is not good for our health. Exactly what this looks like is different for different people (friends vs. family, more people with looser connections vs. fewer people with closer connections), but having friends and being embedded in a community is key. Interestingly, there is research saying that being a part of a faith community in particular is good for your health, though specifically what that faith is matters less. Related to this, having purpose, meaning, or a reason to keep living is associated with longer lifespans and happier days.

Diet unsurprisingly impacts our health— both what you eat, and how much. Whether you follow the DASH diet, the Mediterranean Diet, or something else, healthy diets consist most of plants, are low on highly processed ingredients, include fish, and are generally low on meat. An unprocessed, plant based diet again is not absolute— there is no prohibition against steak— instead its another illustration of the 80/20 rule. There is probably not one “right“ diet, but all healthy eats habits can be summarized as: mostly plant based, generally unprocessed, and in moderation.

Sleep and stress management help us feel better and live longer. The exact amount of sleep we need varies from person to person. Its broadly true that you should sleep at night, wake up in the morning, and get enough time in bed to wake up feeling rested. We all experience stress, and one person‘s intolerably difficult is another person’s completely manageable. The point is not what the stressor actually is, and more how its perceived. Finding ways of letting stress go is important— we need rituals or routines that help our stress fall away from us.

Lastly, minimize toxic exposures. I use this as a little bit of a grab bag, and put in this category both personal habits (like smoking and excessive alcohol intake), and certain environmental factors (like living next to a coal plant).

These things are not new. And yet, despite the fact that we value our health and happiness, we often do not do the important things. I’d like to close by reflecting on three reasons that we end up ignoring the big things.

First, understanding this is simple. Doing it is hard. If we reflect again on the Pareto principle, the goal is not to be perfect with any of these, but instead to get the overall idea right. If we can let go of the idea that we have to be perfect and go to the gym everyday, and instead focus on being active most days, we will get most of the benefit. If we recognize that stress is going to be a part of life, and instead of beating ourselves up for it, focus on letting go of that stress, we’ll do better.

Second, a lot of this is only partly under our control. Acknowledging that reality helps us be realistic about what we can do. If we eat with people (encouraging social connection), we sometimes have to compromise on what we eat. That’s ok. If we want go for a walk with our friends (a great idea), we might walk a little slower, or for a little less time. That’s ok too— its the 80/20 principle in action. Our environment is not built for health. It is car centric, makes healthy food hard and lousy food easy, breeds isolation and let’s stress fester. As an individual, we can only do so much. Let’s focus on what we can do, and let go of the 20% we can’t control.

Third, we seek novelty. Because of this, we are constantly drawn to the new shiny thing with big promises, pulling our attention away from the daily basics that really make us healthier and happier. Our time and attention are finite, and if we are attracted to the latest and the greatest, by definition, our focus on the things that move outcomes declines. By recognizing this part of our human nature, we can find habits, routines, and reminders to keep our focus on the 20% of factors that drive 80% of the outcome.

So, put your focus on the big things. Work to get those right. It might not be everything you can do, but it might just be good enough.

-Doc