Health: I don’t recall seeing any mention of a Sha’as Had’chak, but I will admit that I haven’t looked at it in years. It could be he thinks it’s Muttar even when easily avoidable. In fact, that makes the most sense. Negiyah Derech Chibah is Yeihareg V’al Ya’avor. We wouldn’t be Mattir it just for convenience. This is a case where it’s either Muttar Lechatchilah or Assur B’dieved and there can’t be a middle ground.
And some of us follow the Torah because it’s what HKBH wants from us, not to get a reward in an afterlife.