Around 1 a.m. on June 24, Iliana Monteagudo awoke in her sixth-floor condo in Champlain and noticed a crack forming in the ceiling, according to her son, Manny Frade. Ms. Monteagudo threw on some clothes, and ran, her son said. She didn’t take the nearest stairwell because she didn’t know about it. As she raced down a more-distant one, she heard the building crash down around her. Within seconds, her unit and dozens like it were gone—but the staircase she was in remained standing and she made it out (The Wall Street Journal).

Ms. Monteagudo escaped the shocking and deadly Miami Condo collapse that happened earlier this summer.

Investigation is still underway, but it appears that the foundation of the building failed due to a number of construction shortcuts and neglected maintenance. Supporting columns were too thin, the concrete slab was too shallow, water-proofing was not installed where it should have been, and the concrete may have been cheapened by leaving out gravel that would normally strengthen the mix. Rebar, the steel rods that form the structural lattice for poured concrete, most likely corroded from exposure to humid sea-air and standing water that couldn’t run-off due to improper grading of the driveway.

The concrete foundation had been cracking since 1996. In 2018, the building underwent its required 40-year-old inspection by Morabito Consultants. They inspected the foundation by drilling holes in the concrete and found that it was soft, and that inadequate waterproofing “is causing major structural damage.” Morabito warned that the damage would “expand exponentially” unless addressed (source).

The necessary repairs were estimated to cost many millions of dollars. But, because the building is a condo, and such expenses would have to be paid by condo owners, nothing was done.

"We have discussed, debated, and argued for years now,” Ms. Wodnicki, the condo-board president, said in an April letter to residents. Roof work began weeks before the collapse, but repairs to the steel-reinforced concrete hadn’t yet started (The Wall Street Journal).

Tragically, despite years of warning signs and expert recommendations, the building collapsed catastrophically and killed 98 people this past June, 2021.

As an emergency physician, I’ve seen countless people diagnosed with high blood pressure, diabetes, obesity, sleep apnea, and a myriad of other diseases that portend future disaster.

Both condos and people can be unlucky. Natural disasters like hurricanes, tornados, fires, and earthquakes can take down even the best constructed buildings. Even the healthiest people can have bad luck, but these are exceptions. The demise of buildings and people alike are often predictable. There are poignant parallels between the fate of the Miami condo and that of many people’s long-term health and well-being.

Law requires inspection of condos in Miami once they reach the age of 40. Similarly, most preventive health measures aren’t recommended until age forty or fifty years old, or until there are already signs of disease. The USPSTF (United States Preventive Services Task Force) recommends mammograms and colonoscopies starting at age 50 for most people, lung cancer screening at age 50 only for adults with a 20 pack-year smoking history, and osteoporosis screening in women age 65 and older. Colonoscopies are recommended at age 50, or 45 if you’re high-risk. Of course, if you have symptoms of colon cancer, they recommend evaluation right away. Healthy diet and physical activity is recommended only for adults with cardiovascular disease risk factors, but screening for these risk factors is woefully inadequate.

These are just a few examples of screening recommendations and how they fail to detect the earliest signs of disease. But, we can’t blame the USPSTF alone. Even if the USPSTF made more aggressive recommendations, many would not follow them. Even now, many of the existing recommendations are not followed.

As the lawyer for the Miami Condo board said of the Morabito inspection, “Nobody likes a special assessment.” She meant that people don’t like to know about problems because then it creates an obligation to address them. It’s easier to ignore those problems that lurk beneath the surface. A friend recently told me that he explained my preventive health services to his friend. In response, his friend advised him not to see a doctor because, “they always find something wrong.”

For some people, screening recommendations arrive too late. For the rest, the results of the screening tests are often treated as binary. You either have cancer or you don’t, you have osteoporosis or you don’t, you’re obese or you’re not, you have hypertension or you don’t. The implication is: if you pass the test, you can resume your life with no changes. If you don’t, it’s a catastrophe.

But, pathology is not discrete. Most diseases develop gradually. For example, it’s likely that every human has atherosclerotic plaque in their arteries by their fourth decade. A tumor doesn’t spring into existence from nothing. Similarly, osteoporosis progresses over years, as do obesity, hypertension, and cardiovascular disease. But, every screening test has a cutoff; a test threshold under which the results are considered “negative.” However, because of the progressive nature of disease, a negative screening test does not indicate absence of disease, and thus does not excuse us from maintaining our health.

But, repairs can always start tomorrow, right? Just like members of a condo-board are likely to argue within, it’s easy for people to "discuss, debate, and argue" with themselves for years.

I submit that we don’t want to depend on a lucky last minute stairwell escape à la Ms. Monteagudo.

So, what then? Should we become obsessed with our health and longevity; get a colonoscopy every couple of weeks?

Paradoxically, the way to avoid disasters is to ignore them and instead focus on building a strong foundation. This is what will prevent disasters. Besides, constantly worrying about death and disease is no way to live. I have brief periods of hypochondriasis now and again; it’s an occupational hazard, and it’s not fun. It’s more effective and more enjoyable to focus on being healthy, and yes, to have a personalized preventive care plan.

The foundations of health are a physically strong body and a healthy metabolism. The most trite medical advice in the book is also the best: eat properly, sleep adequately, and exercise. There isn’t a way around these health axioms, and it’s why I focus my medical practice on building these pillars of health. They are the pillars, the columns, that will hold you up in bad weather.

One final thought. I understand that for a lot of people, tending to nutrition, fitness, and preventive medicine is not enjoyable. It’s seen as a necessary evil at best. Everyone feels this way sometimes, myself included. I’ve found a way of reframing the inner dialogue that prevents many of us from taking action to build and maintain our health.

Instead of thinking about avoiding poor health, we can think in the opposite way. We can think of our health and fitness as a creative and productive project.

It’s possible to envision a future version of ourselves as a more robust, vigorous, and resilient person, and then to bring that person into reality.

-Steve