How Our Mental Models Shape Our Health Outcomes

Imagine an isolated tropical village in which being Caucasian is some weird anomaly. The locals have decided it is a genetic disorder and they call it Pale Skin Disorder.

Thanks to the tropical location, the people there wear little to no clothing. Only a weirdo would do something like cover up.

Thanks to the strong sun and lack of clothing to protect from it, people with Pale Skin Disorder are chronically sunburned. In fact, they are very often sunburned to the point of peeling.

It's a very, very serious and quite miserable health issue. It's crippling and horrible and these people cannot live normal lives.

Because of the chronic, severe sunburns, people with Pale Skin Disorder are very prone to developing skin cancer. They tend to die at very young ages, often of either skin cancer or complications from being chronically sunburned.

Now imagine that a Caucasian foreigner shows up who knows that, yes, being pale skinned puts you at greater risk of sunburn and skin cancer, but, no, your life doesn't have to be utterly ruined by a relative lack of melanin. This person is simply aghast at what is happening to the Caucasians in this village.

This white foreigner tries to tell people that folks with Pale Skin Disorder are simply different, not defective, and they can have more or less normal, healthy lives if they will just make a few simple lifestyle changes, such as covering up in appropriate clothing when outside, staying out of the sun (especially during the hottest part of the day) and using sun screen.

Even if a few desperate people with Pale Skin Disorder try some of these suggestions, it doesn't constitute an immediate miracle cure. There will be a lot of other things that need to happen to actually heal the existing damage.

But if the kids with Pale Skin Disorder got appropriate accommodation, they wouldn't have to ever get so terribly damaged to begin with.

The most likely reaction to this white foreigner would be to snicker and point: "You can't cure cancer by putting on a long-sleeved shirt!! Whatchu been smoking?? Har Har."

The foreigner gets treated like a kook. The local Caucasians continue to go out into the sun, continue to be terribly sun burned and continue to die at very young ages, often from skin cancer.


Hi there! I'm that so-called kook saying that "I can't change my genes, but I can change my health outcome -- and quite substantially -- by simply changing my diet and lifestyle." and getting treated derisively by most of the world

Many years ago, I dreamed that I was chained down and that I couldn't break the chain at my end where it was on my body, but I could break it at the other end where it was connected to a wall. In the dream, I was able to break free.

The chains represent both my DNA and social or cultural stuff. I can't change my genes, but I can break loose from social expectations and change my outcomes. That's what I've been doing for more than eighteen years at this point.

Your genes do not dictate your health outcomes. They are only one factor.

This is not an original thought that I personally made up. This is well-established, scientific fact.

The only thing I've done is I took that idea and ran with it.


Of course, the metaphor about Pale Skin Disorder works for me because it's only a slight exaggeration of what actually goes on in the world. According to Skin cancer in Sunny Queensland:
The incidence of skin cancer in Queensland, Australia, is the highest in the world...The cause is almost certainly exposure to subtropical and tropical sunlight for which their fair skins were never intended.
Hopefully, everyone knows that pale-skinned Caucasians burn more readily than people with other skin tones and hopefully people know that being badly sunburned increases the risk of skin cancer. But let's go ahead and post a few more supporting links anyway: "Pale Skin Disorder" is a metaphor I have used before. At a minimum, I have posted it to Hacker News at least once and I used to write about it on Tagmax years ago. It also has appeared on probably at least two previous blogs of mine. So while you may have seen it before, as far as I know, I'm the inventor of it.