Prevention

Demography is not destiny, as is sometimes claimed. The human race could be wiped out by a plague or an asteroid, or transformed by some new technology. But no matter what, today's patterns of fertility, migration, and mortality fundamentally determine how much society will or can change for many generations to come.

Two weeks ago, American Beverage Association President Susan Neely took issue with Mark Bittman’s New York Times Magazine article, in which he advocated taxes on soda and other unhealthy foods. Bittman’s justification was that raising the prices of those unhealthy foods relative to more nutritious foods would encourage people to eat more healthfully, and so help combat the national obesity epidemic. Neely said in her response, “Obesity isn’t about “good” and “bad” foods. It’s about an imbalance between calories consumed — from all foods and beverages — and those burned through physical activity.”

She’s right, of course: many factors contribute to obesity, but the problem isn’t as simple as “eating bad foods makes you obese.” The thing is, that’s not what Bittman was saying, either. The ultimate goal of his tax proposal is to change the food environment in which we live.

Public health advocates believe that Americans live in an obesogenic environment: not one where anyone is forced to eat unhealthily and become obese, but an environment with forces that encourage overconsumption of calorie-dense, low-nutrition foods.

Vikas Saini, M.D. is a clinical cardiologist and researcher at Harvard Medical School and Harvard School of Public Health and president of the Lown Cardiovascular Research Foundation in Boston. This article is cross-posted in the Lown Foundation's Prevention India column. For another perspective on avoiding avoidable care, check out Shannon Brownlee's accompanying piece entitled, "Less is More."

We need to reduce overdiagnosis and overtreatment and use the costs associated with them to pay for prevention.

Prevention works, but prevention costs money. Some prevention can be practised at the individual level as is emphasised by the content of this magazine. Much of the prevention opportunity lies at the social level—whether in the provisioning of parks and recreation areas for exercise, or regulation to make food safe and healthy. But all of this, whether at the individual or social level, costs money. In a world of constrained resources, where will the money come from?

NUMBER OF THE DAY: 27.6%

27.6% of American adults are obese -- a new record high, and almost 12 percentage points higher than fifteen years ago. This indicator is only one of many in a disturbing trend worrying public health advocates.

Also troubling is the adult obesity rate in Colorado -- the slimmest state in the country. Until last year, Colorado had never had adult obesity over twenty percent. In 2010, it finally crossed the line to 21.4 percent.

The thinnest state in 2010 would have been the fattest in 1995.

In 1995, Indiana was the most obese state, at 20.1 percent. It was the only state above twenty percent. The fittest states had obesity rates barely above 10 percent.

Perhaps the most upsetting statistics come from Alabama and West Virginia, where obese adults outnumber their normal-weight counterparts. In Alabama, 33% of adults are obese compared to only 30.1% of normal weight. In West Virginia, it’s 32.9% obese and 32.1% normal. The public health implications of such widespread obesity are significant, and we don’t even know what the effects of long-term obesity are. As childhood obesity rates climb, we need to be thinking about and enacting solutions. A significant body of research suggests severe long-term health problems result from an overweight youth:

A number of long term adverse effects of childhood obesity are now well established. The socioeconomic impact of obesity in adolescence/young adulthood is considerable, but little known. Obesity in childhood tends to persist into adulthood. Cardiovascular effects of obesity in childhood persist and this predicts a strong link between childhood obesity and morbidity/mortality in adulthood, which should be  reflected in increased cardiovascular morbidity in future, as the current generation of obese children become adults. Taken together, this evidence makes a strong case for greater efforts directed at the prevention and treatment of childhood obesity. (J J Reilly, et al., Systematic Review: Health consequences of obesity)

We’re going to be looking at obesity a lot in upcoming blog posts. We’ll look at the way it fits into our health care delivery system and what insights might be gleaned from thinking about it. Understanding how to deal with behavioral health issues is going to be crucially important to fixing our cost growth and designing a more holistic, integrated, cost-effective delivery system.

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Innovation isn’t necessarily a word most people associate with aid programs.  The popular image is of aid organizations too often just building one darn road after another - or sending off armies of consultants to offer irrelevant and unheeded advice.

But, thankfully, there’s a lot more to aid agencies than stodgy bureaucrats shoveling money out the door.  One recent example is called the advanced market commitment, and it is helping to develop new treatments for diseases, which kill millions in Africa, Asia and Latin America.

Los Angeles doctors are plentiful, and Angelenos have some of the highest rates of visits to doctors and specialists in the nation. So you’d expect Angelenos to get the very best health care. But do they really?

In 2009, veterinarians at the U.N. Food and Agriculture Organization made a remarkable announcement: Rinderpest, a livestock-borne disease, would soon be eradicated. OK, so maybe it wasn't front-page news, but rinderpest -- which causes animals to develop fever, followed by diarrhea and (frequently) death -- has over thousands of years been a recurring plague on human civilization.

Just 18 months after the health reform debate killed the potential for a national “public option” in health care, one of the 50 U.S. states is poised to breathe new life into government-run insurance systems. Despite its fiercely independent reputation, the State of Vermont is forging a path towards single-payer health care, and its newly elected governor is determined to succeed.

“Everyone else in the developed world has done this, and we haven’t,” Governor Peter Shumlin (D-VT) told an audience at a recent health care forum sponsored by The Atlantic. The event brought together health care leaders, policymakers, and representatives from dozens of DC policy shops for a daylong discussion of the “next steps” during implementation of the Affordable Care Act (ACA).

In 1938, a biological expedition under Richard Archbold arrived in western New Guinea to survey the area by air. On June 23, after hours of flying over near-impenetrable jungle, Archbold's plane passed over the Grand Valley of the Baliem River. The valley was occupied by 50,000 Papuans, until that point unknown to—and unknowing of—the outside world. After six weeks, patrols from the Archbold expedition finally met with the inhabitants. That was the last substantial first contact ...

This Saturday marks the 40th anniversary of Bangladesh's war for independence from Pakistan. Given how bloody the war proved to be, and how limited development progress in the country has been since then, it might seem like a dubious occasion for those of us far from Dhaka to celebrate. But the war does have one unambiguously positive legacy: It gave the world an approach to dealing with cholera and other diarrheal diseases that has since saved many more lives than were lost during the fighting.