http://www.i-sis.org.uk/DGHTF.php
Prof.
Henry Becker on the critical changes needed to avert the national health crisis
Like most Western
countries, and increasingly the rest of the world,
Not one title among the
40 discussion papers commissioned from scholars, policy analysts and experts
across Canada and internationally mentions prevention.
Although Romanow
acknowledges in his preface to the report that, "it is common sense for our
health care system to place a greater emphasis on preventing disease and on
promoting healthy lifestyles", only 7 out of 354 pages deal with
prevention, and the greater part of that on the evils of tobacco and on
vaccinations.
The report presents 47
recommendations, of which only three relate to prevention—one on reducing
tobacco use and obesity, another on promoting physical activity, and the third
on a national immunisation strategy. This projects and encourages, in my view, a
most unfortunate skewing of priorities that is not in the public interest.
The Canadian situation
has much broader relevance, as the diseases of industrial civilisation have
taken hold and health care systems are bending under the load nearly everywhere.
Significantly, a United Nations study in 1999 found the prevalence of overweight
and obesity—a strong predictor of chronic ill health and shortened
lifespan—to be increasing alarmingly in the developing countries as well as
the developed, and particularly among children. A worldwide epidemic of obesity
has been recognized, spread by globalisation and penetrating to the remotest
corners of the world.
The
nature of the beast
During the past
century, the common afflictions in Western societies have dramatically shifted
from infectious to degenerative diseases. Infectious diseases were subdued
largely by public health measures: improvement in housing, provision of clean
water and air, sanitary waste disposal, quarantine of the infected, etc. Rise in
living standards and education also helped. Medical interventions such as
vaccinations and increasingly potent drugs came relatively late, but in
today’s public imagination, they get the major credit for ridding us of
infectious diseases.
Infectious diseases
typically strike in unpredictable waves, or epidemics. Degenerative diseases,
however, have typically risen from small beginnings and grown nearly
exponentially to a level where much of the population is chronically afflicted.
Today these diseases are the major burden on our health care system, and their
proliferation the main cause of spiralling costs.
We
are what we eat
While some degenerative
diseases have occurred in various societies throughout history, those which most
vex us now, such as cardiovascular disease, inflammatory bowel disease, type II
diabetes, asthma and many cancers, were rare or virtually unknown a mere 80
years ago. Cases of myocardial infarction (heart attack), for instance, began to
appear in the 1920s and grew decade by decade to epidemic proportions. Most
degenerative diseases are not caused by disease vectors such as micro-organisms
or viruses. They are primarily due to ‘lifestyle’ factors of both the
individual and various layers of society and, as such, are highly preventable.
These factors include faulty food, dietary immoderation, abuse of harmful
substances, physical inactivity, disturbed biorhythms, environmental
deterioration, social breakdown and poverty.
The most important
determinant of health is food. Just as good nutrition is vital for a healthy
immune system, faulty food is implicated in the infectious diseases. In his book
The Wheel of Life, first
published in 1938, G. T. Wrench observed, "The inescapable conclusion is
that in a very large number of diseases faulty food is the primary cause. The
suspicion is that faulty food is the primary cause of such an overwhelming mass
of disease that it may prove to be simply the primary cause of disease [in general]."
Hippocrates taught,
"Let thy food be thy medicine". The corollary we must learn is,
"Let not thy food be thy
sickener!"
Let’s
remember
It’s important to
realise there were once whole populations—not just individuals here and
there—flourishing in states of robust good health and virtual absence of
disease. That is not a utopian myth, but well-established fact. The evidence is
compelling that our hunter-gatherer paleolithic ancestors who subsisted mainly
on animals supplemented with such wild plant foods as were available—tender
leaves and stems, roots, fruits and nuts, but virtually no grains—typically
had fine physiques and enjoyed remarkable freedom from degenerative disorders.
Sea foods appeared to be particularly valuable, and there is a growing school
that argues these were pivotal in the special development of the human brain.
Since the Neolithic
(agricultural) revolution 10 000 years ago, many agricultural communities that
maintained a sufficient animal component (fish, meat, milk, cheese) in their
diets also achieved excellent health. Examples of healthy communities have
extended into our own time, though in rapidly diminishing numbers. They have
been scientifically observed and documented, most notably by Weston A. Price (Nutrition
and Physical Degeneration, first published in 1939), Sir Robert
McCarrison (Studies in Deficiency Diseases, 1921; Nutrition and national
health, in J. Royal Soc. of Arts,
1936), and Viljhalmur Stefansson (The
Fat of the Land, 1956; Food and food habits in Alaska and Northern
Canada, in Human Nutrition, Historic
and Scientific, 1958)
These lessons of the
past demonstrate what’s possible for human health, and what can be achieved
again. The foods eaten by healthy peoples of the past were perforce
"organic", as no others existed before modern industrialised
agriculture. They were whole, fresh and completely natural. The genius of
industrial civilisation has been to introduce a vast array of highly processed
foodstuffs that are anything but whole,
fresh or natural. Attention is paid to packaging, appearance,
presentation, palatability, uniformity, convenience, transportability, shelf
life and—it must be said—addictiveness, while almost wholly ignoring the
crucial issues of nutritional value. A gigantic middleman—the processed food
industry— now stands between the consumer and the primary producer (the
farmers, ranchers, fishers, etc.) and profits richly from
economic value added. The consumer buys these products, which are
typically heavily promoted, and pays the predictable price of nutritional
value subtracted, i.e., degenerative diseases.
The growth of
degenerative disease is an indubitable economic burden on society as a whole,
but enterprising parties have skilfully exploited that as an opportunity for
profit. This gave birth to the pharmaceutical industry, another mega enterprise
of our times. The main effect of the industrialisation of medicine on
degenerative diseases is palliative rather than curative, usually with many
adverse side effects.
As with processed
foods, the manufacturers’ interest is overwhelmingly the pursuit of profit.
Finally, the
"health care" system has come to rest on acceptance of degenerative
diseases as inevitable features of life and the medical treatment of symptoms as
the normal response to this grim reality. There is, to be sure, an ongoing quest
for "cures", e.g., the "war on cancer", but what it mostly
accomplishes is to produce ever more drugs that fall well short of the
ever-receding goal of cure but succeed at return on investment.
Physicians are
indoctrinated in and co-opted into this defeatist paradigm by their basic
training, and reinforced by their continuing education at the hands of the
pharmaceutical companies. Thus, the people we should expect to tackle the plague
of degenerative disease at its sources, instead act like firemen who have
strategically decided not much can be done to stop fires from happening, so
it’s best to downplay prevention and concentrate on fire-fighting.
Our
‘lifestyle’ failings
So how did we get here?
These are some in the long list of our ‘lifestyle’ failings:
Inadequate intakes
of various minerals, vitamins and other micronutrients.
What
to do
I shall limit myself
here to addressing nutrition, the single biggest determinant of health.
A paradigm change is needed in medicine
"Orthodox"
physicians have too long based their practice principally on knowing drugs. To
prevent or effectively treat the degenerative diseases, they must know food and
make it their primary instrument. These diseases are largely caused by
faulty food, and cures—to the extent possible—depend largely on the
prescription of the right food. The education of physicians has too long
neglected nutrition. Physicians should, in fact, be thoroughly acquainted with all
the lifestyle factors that promote health or precipitate disease. Although still
a minority, a growing number of physicians are already committed to prevention
and cure by lifestyle modification. Currently, their practice is commonly
referred to as "alternative", but it is time for them to become the
main stream.
Major changes needed in the field of applied
nutrition and nutritional goals
There are many things
very wrong today in applied nutrition and the nutritional goals set for citizens
by authorities such as Health Canada. Standards such as Canada’s Food Rules
and the USDA. Food Pyramid are badly skewed and need drastic revision. The
obsession with the alleged dangers of dietary saturated fats and cholesterol is
a proven but persistent and egregious folly. There’s nothing wrong with sound
natural fats. Nor is there anything wrong with beef and lamb, with all their
fat, if the animals are healthily raised and not dosed with antibiotics and
hormones. There are, though, truly bad fats that indeed do contribute to
degenerative diseases: synthetic fats; partially hydrogenated fats; oxidised and
rancid fats; and excesses of omega-6 fatty acids. Carbohydrates have been hugely
over-promoted; the healthiest amount of sugar is none, and white flour products
aren’t much better. Processed foods should be revealed for what they are:
mainly junk, dangerous to health, and never a fit substitute for whole, natural
foods. Synthetic foods, such as soft drinks, are typically slow poison. I can
hardly begin to list all the reforms desirable in nutritional teaching and
consultation. It is essential to get the story right
according the best knowledge of the facts, and to stay open to correction by new
findings. It is also necessary to get the story out
so the public is well informed, without kow-towing to industrial interests
(processed foods, agrobusiness).
Optimum nutrition must be our aim
Optimum nutrition is
especially crucial for good outcomes during conception, pregnancy, infancy and
childhood, the whole process in which new humans are moulded for better or
worse. Canada should be vigorous in providing parents with supportive
information, programmes, resources and assistance. Lifelong good nutrition is
the foundation of a healthy and happy old age. But even when many years have
been lived in poor nutrition, appropriate changes in diet can still ameliorate
much of the damage done and greatly diminish needs for medical treatment. The
nutritional quality and adequacy of food served in homes for the aged should be
a matter for public concern and government attention.
Optimum nutrition is not uniquely defined,
diversity and individuality must be respected
Canada has citizens
with ancestry in all regions of the world: central African and south Asian,
Mediterranean, North European, and from recent hunter-gatherer to 10 000-year
experience of agriculture. Thus there is a broad range of food tolerances and
intolerances that should be taken into account rather than prescribing a
one-size-fits-all. The case of Canada’s first nations is especially notable
for suffering from the foods of industrial civilisation in high rates of type II
diabetes, cardiovascular disease, etc. Generally, everyone is an individual with
characteristics that may deviate substantially from the average and merit
special attention. One of the jobs of the enlightened physician will be to
discover those individual vulnerabilities and needs and help the patient make
due adjustments.
Public institutions must set an example
Publicly funded
hospitals and institutions of education, and cafeterias and restaurants in
government buildings, should lead by behaving as models of excellence in the
foods offered on their premises. Currently, a minority of schools, colleges and
universities offer their students healthy food and drink. Many, however, have
admitted fast food outlets to their halls, with monetary benefit to the
institution but a great disbenefit for the health and food habits of students
and staff. Utterly scandalous are the deals with cola companies.
Huge reforms needed in agriculture and animal
husbandry
A return to wholly
organic operation is needed to put an end to the incidental poisoning of land,
water, air, people and most other life forms. Today’s high-input
"modern" agriculture is simply mining the land, sapping future
productivity for the sake of temporary monetary gain. It’s not sustainable.
Further, the concentration of animal production on factory farms should be
stopped and production redispersed over the land. Animals should be raised
humanely and in such a way that they are naturally healthy. Grazing animals
should be raised largely by grazing; it is part of what gives their meat and
milk high quality. Much greater attention should be paid to raising the
nutritional quality of farm, ranch and market garden products.
Government must ensure quality in food supply
Government should not
hesitate to use its powers of regulation, inspection and stimulation to ensure
high quality in the food supply. Programs to recognise and promote quality, such
as is happening with Canadian wines and Québec cheeses, should be expanded to
other products. Quality production should be encouraged. The nutritional
implications of any food processing should be evaluated by competent agencies
and adjustments required to ensure acceptable nutritional outcomes.
National and provincial laboratories need to be
reinvigorated
They should be given a
new mandate and funding to effectively serve the public interest with
appropriate research in nutrition, testing of foods and drugs, etc. Their
primary concern should be protecting and informing the public, rather than
assisting industry and promoting business. The government should also
fund a number of university research Chairs and/or Institutes specifically to
work on questions of food and nutrition that are of significant national or
local importance.
Conclusion
In order to deliver
health, we must deliver good food through implementing sweeping changes in
medical education and goals, food and agriculture and government policies. We
may still need as many physicians, if they indeed become guardians of our health
rather than managers of disease. Economies will result
primarily from vastly
reduced demands for diagnostics, hospital care and other patient services, and
medical therapies (medications, radiotherapy, etc.). Sales of pharmaceuticals
may plummet, but the sacrifice of this economic activity will be happily endured
as part of the price of better health. The same may be said of major sectors of
the processed food industry.
The many people who
regard degenerative disease as an inevitable feature of living are wrong.
We’ve seen these diseases proliferating and appearing earlier and earlier in
life, so young children are now succumbing to obesity, Type II diabetes and even
cardiovascular disease. However, if the needed reforms are made, onset of such
diseases can be retarded and relegated to extreme old age, and indeed most of
these diseases need not be commonly experienced at all. The choice is ours.
The author is Professor Emeritus of Chemical Engineering, Queen’s
University, Kingston, Canada. This paper is based on his submission to the
Romanow Commission and a forthcoming book.
