Misconception: Technology Can Save Us from Ourselves
David Katz, MD, MPH
Associate Professor Adjunct in Public Health Practice, Yale School of Public Health
Imagine how you would feel if you woke up tomorrow to the news that a brilliant scientist had figured out how to reduce the rate of heart disease by 80%. Or instead, if next Tuesday you happened to hear on the radio that a staggering scientific advance could reduce cancer rates by 60%. Or perhaps a week from Thursday you learn while watching the news that research has shown how to eliminate up to 2/3 of all diabetes.
I suspect you would feel you were living in a much safer world, and be glad for that. And you would, I think, be impressed with the power of these scientists to change our collective fate. You might well lend your support when the Nobel Prize committee calls to ask your opinion. But alas, there will be no Nobel Prizes for these astonishing advances. Why? Because they have already occurred, and no one seems interested. Well, hardly anyone.
The power to achieve staggering reductions in our individual risk for, and collective rates of, heart disease, cancer, and diabetes resides with us already. Putting into practice what we already know about diet, physical activity, and the avoidance of harmful substances such as tobacco—that’s the Nobel-worthy formula the Committee will never consider.
In the case of heart disease, crosscultural comparisons reveal that some societies succumb to heart disease all but universally, whereas in others it is all but unknown. Such studies have led specialists in heart disease to contend that heart disease is potentially eradicable. I have a foot in that camp.
Our information sources for cancer are comparable. Cancers prevalent in one society occur rarely or not at all in another. The differences in exposures and behaviors between such populations are the likely reasons for the remarkable differences in outcomes.
My pet peeve? Wasted opportunity. The misconception? That somebody needs to win a Nobel Prize to empower you to pursue a healthier destiny. The power resides with you, right now. Please—put it to use.
Misconception: Obesity is an American Problem
Derek Yach, MBChB, MPH
Professor and Head, Division of Global Health, Yale School of Public Health
Speeches by Heads of State at the recently concluded United Nations session in New York highlighted the need to address the Millennium Development Goals. Among these is a goal related to stunting in children. Resources are needed to address the 850 million people—mainly in sub-Saharan Africa and South Asia—who are undernourished. But this is not the only nutrition crisis the world faces. Today, 1 billion people are overweight or obese.
Tens of millions of people in China are overweight or obese. About a quarter of all health costs are used to treat the complications of obesity-related diabetes in Pacific Island states. From urban areas of India, to South Africa and Mexico, obesity has emerged as the major nutritional problem in settings where under-nutrition still exists and where infectious diseases remain relatively common. The consequences of obesity, together with tobacco use, have led to rapid increases in physical disabilities and deaths related to chronic disease.
The results are a loss of worker productivity, early widowhood and rising health care costs in countries where access to health care remains inadequate. The response to the global obesity epidemic remains paltry. Neither the World Health Organization nor the World Bank has invested seriously in prevention programs. UNICEF addresses only undernutrition despite evidence that obesity levels are rapidly increasing in children. And no major USA foundation has invested in obesity prevention in developing countries. Obesity is still seen as a mainly USA problem and one due more to human frailty then to complex societal and environmental changes. Failure to tackle the problem in countries undergoing rapid rates of urbanization and economic growth will ensure that the health gains won from rapidly declining levels of infectious disease will just as quickly be erased by increasing levels chronic disease.
All is not bleak. At the quadrennial International Nutrition Conference held in Durban September 19-23, delegates from governments, industry, NGOs and international agencies called for an integrated approach to dealing with under and over nutrition that recognized that both are often linked to poverty and that both are priorities for action worldwide today.