Philip Alcabes discusses myths of health, disease and risk.

Life Expectancy Goes Up but Risk-reduction lectures Continue

Bravo! to Rob Lyons at Spiked. Since it’s now apparent that life expectancy has increased almost everywhere and is at historic high levels in much of the developed world, Lyons asks the logical question:  why is the public health system still scolding everyone about what people eat and how fat the average person is?

A paper by David Leon in this month’s International Journal of Epidemiology showed the dramatic increase in life expectancy — the median age at death, that is.  It has reached over 85 years for women in Japan, but it’s high even in countries where longevity was relatively low a generation ago.  Cheeringly, US life expectancy at birth is now 78 years; in the UK it’s 80.  And it’s even higher in some countries of western continental Europe.  Here are the graphs for different parts of the world from Leon’s paper, showing trends since 1970:

Life expectancy since 1970

Lyons has gone after the anti-obesity crusaders before (as well as related topics at his smart blog on contemporary food confusion, Panic On A Plate).  Now, he’s particularly disturbed by the sermonizing about eating. “You can’t even have a pie and a pint without someone telling you it will kill you, it seems,” Lyons writes at Spiked.

And, really, it’s even worse than that — because it’s not just eating that’s the subject of the lecturing.  It might be true that you will live longer if you give up smoking, cut your salt intake, drop your BMI down to 24.99, exercise four times per week for at least 20 minutes each time, get immunized against flu and human papillomavirus, drink in moderation, and take naps.  But unfortunately there’s not a bit of evidence that any of that — apart from the decline in smoking — has contributed to increasing longevity.

And of course, even with smoking cessation, there’s no telling whether it would make any difference to you — only on average.

So why are the public health messages so far away from what really matters — basically, prenatal care, postnatal care, and wealth (with its concomitant, standard of living)?  Well, there’s a puzzle.

What’s the point of having an industry whose main aim is to make sure that people are constantly in fear that they are doing something that will kill them — even as it becomes apparent that most of what people do is only making us live longer?   Lyons calls it Good News Omission Mentality Syndrome (GNOMES).

I ask you:  could it have something to do with control?  And the desire to sell products?

Putting Obesity in Perspective

Michael Pollan’s essay in this week’s NY Review of Books offers a framework for looking at modern food and eating.  If public health advocates took Pollan’s perspective, the vitriol of their anti-obesity crusade could turn into a force for real social reform.

Reviewing five books on what he calls the “food movements,” Pollan notes the widespread discontent with contemporary industrialized food production (I’ll call this “American eating,” although its dominance is increasing around the world).  And he suggests that its common theme is cultural discomfort. The food movement, Pollan argues, has “set out to foster new forms of civil society”:

It makes sense that food and farming should become a locus of attention for Americans disenchanted with consumer capitalism.  Food is the place in daily life where corporatization can be most vividly felt…  The corporatization of something as basic and intimate as eating is, for many of us today, a good place to draw the line.

This is a refreshing insight.  It’s thankfully broad, taking  the focus away from health, and therefore from the anti-obesity crusade and the “toxic food environment” view promoted by health advocates.

But Pollan’s perspective is especially refreshing because it renews the conversation about our private lives — particularly the extent to which we’ve ceded our innermost values to the demands of corporate profit and government policies.  And those demands, as Marion Nestle often points out (recently here), are generally linked.

Pollan reminds us that our innermost values are literally innermost:  they have to do with what goes into our stomachs.

I’ve already stated my argument that the anti-obesity crusade is really about control, not health (see here and here).   The crusaders do cite “public health” as a rationale for the war against obesity.  But when they describe what’s wrong, they do so in terms that are sometimes medical (diabetes, hypertension), sometimes technical (serving sizes, calorie counts, the infamous toxic food environment), and sometimes medieval (gluttony, laziness).  Their inability to articulate the source of the problem is a signal that they’re sure something is out of control but unsure exactly what.

The public health approach to obesity is a failure.  It doesn’t let us talk about what needs to be reformed.  And it’s often allied with efforts to make sure the poor stay poor — even though wealth inequality is surely part of the problem in the first place.  The public health industry’s demands for additional regressive taxation in the form of increased “fat” taxes on sugary beverages or high-calorie foods reveal its preference for the status quo.  Make the poor pay more for their soda and fast food; that will make them think twice about supporting industries that are making us fat.

Even well-meaning public health professionals who advocate government intervention against low-price-but-low-nutrition food  as a way of curtailing obesity ignore the central role of food and eating to liberty and happiness — they’re interested primarily in how many additional years of life (however unhappy) could be purchased by trading in the fries in favor of broccoli.  Or, worse, they’re interested only in the dollar costs to taxpayers — in terms of hypertension and heart disease — of tolerating obesity.

Pollan, today’s most thoughtful and insightful philosopher on the subject of food and eating, offers a more satisfying view.  Sure, you may want to change American eating because you think obesity is bad for people’s health.   But you might want to change eating simply because the food scene is distressing, because it crystallizes and exemplifies the many ways that we give over our private (innermost!) moral decisions to the influences of corporate/consumerist thinking.  You might want to change it because, as Pollan reminds us (in regard to a new book by Janet Flammang), the dominance of American statecraft by corporations allows the preparation of food to be relegated to the least valued, least powerful, and lowest paid workers.  You might want food to taste better — valuing pleasure over longevity.

With Pollan’s broad view, you  don’t have to join the anti-obesity crusade.  You don’t have to speak the technical language of risk.  The common language of freedom, desire, and pleasure will do.

Cookie Crisis: Toxic Food Environment or World Food Shortage

One by one, the foods that seem most American are turning out to cause illness.  Last year, people got sick from Salmonella St. Paul in fast-food tacos (the jalapeño peppers were contaminated) and then others from Salmonella typhimurium in peanut butter (back in 2006-7 there had also been an outbreak of salmonellosis associated with eating peanut butter).

And now it’s Toll House chocolate chip cookies.  The dough has been recalled by Nestlé because some batches contain E. coli O157:H7, a potentially dangerous strain, with at least 66 cases in 28 states.  There have been 7 severe cases of hemolytic-uremic syndrome, although no deaths.

At the Center for Science in the Public Interest, food safety lawyer Sarah Klein says “If there was anyone left in America who didn’t realize we need to reform the food safety functions at the Food and Drug Administration, this latest recall of Nestle Toll House Cookie Dough provides a sobering wakeup call,” telling the NY Times that “If there was ever any doubt that we’ve reached a crisis, this should provide the proof.”

But crisis of what?  The FDA itself isn’t sure how the bacteria got into the dough, and CDC is still investigating. What are we supposed to wake up to?  Is it toxicity?

According to research recently reported in the Milbank Quarterly, the metaphor that Americans most commonly hold responsible for obesity is a toxic food environment. — over 75 percent of respondents subscribed to this view of the obesity epidemic.

With foodborne disease, it isn’t obesity that’s at stake, but it seems that the same view of American eating shapes responses.  That the foods recently associated with bacterial outbreaks are so quintessentially American helps.  So does awareness of the tortuous journey that many foods take to market now, which is what makes it hard to know exactly how, where, and when contamination might occur.

But surely the U.S. doesn’t face a food crisis of the sort that the impoverished countries of the world do — a crisis of environmental change, political struggles over land use, access to clean water, and food shortage for a billion people worldwide.

Americans generally manage not to talk about the lives of people for whom food crisis means dirty water and the questionable availability of cassava flour or cornmeal mush, but are pleased that our own food crisis does not involve such deprivation.

At the same time, a lot of people here feel suspicious of the technical apparatus that has afforded us our cornucopia.  They are suspicious of the ways Americans (or most Americans) have access to the modern groaning board without our having to hunt, scrape the soil, haul water, or collect firewood – just park the car, enter the store, and take out cash or a debit card.  It seems too easy.  It isn’t traditional, natural, organic.

The occasional news story on food contamination validates those concerns, tells anxious people that they were right to be suspicious – that American food producers are poisoning us all.

To say that an event (cookie-related or other) is a wake-up call is to demand surveillance and control.  It says that someone has done something wrong (CSPI doesn’t need to tell us who that is – they mean the usual suspect:  big business, aided by lax government).

If someone has done something wrong, then surveillance – better food-plant inspection, for instance – and control will fix the problem.  But the wake-up call doesn’t really wake anyone up to the larger problem, or its nuances.

We’d like everyone worldwide to have enough to eat.  And not just enough rice or roots – we’d like everyone to be able to eat a diverse and nutritious diet.  We’d also like to be able to have chocolate chip cookies and other tasty processed food, at least from time to time.  We’d like all that to happen with a minimum of suffering caused by the food itself.  It’s unreasonable to think that nobody will ever get sick from contaminated food — but we’d like foodborne disease to be limited.

The technology and the transportation know-how exist to make that future possible.  But people concerned about food content, food safety, and food plenty have barely started the sort of conversation that would allow all the many pieces to be fit together globally.  The way to make such a vision of food adequacy and diversity possible still isn’t clear.  To argue for better surveillance and oversight of American food production is fine – but it doesn’t move us far along the road to solving the larger food crisis.  It’s going to take more than FDA inspection to get us there.