Color, rather than shape, is more closely related to emotion.
I think basic disease care access and basic access to health care is a human right. If we need a constitutional amendment to put it in the Bill of Rights, then that's what we ought to do. Nobody with a conscience would leave the victim of a shark attack to bleed while we figure out whether or not they could pay for care. That tells us that at some level, health care access is a basic human right. Our system should be aligned so that our policies match our morality. Then within that system where everybody has access, we need to incentivize prevention, both for the patient and the provider.
Balanced, sensible nutrition: eat food, not too much, mostly plants, a healthy diet ala Michael Pollan, modern physical activity on a daily basis, modest weight loss - translated into a 58% reduction in the occurrence of diabetes. A clear indication of the power of lifestyle over health. The challenge now is the development of the community-based programs that will translate what we learned in the diabetes prevention program and put it to work in every town in America.
The metaphor I routinely use is polar bears in the Sahara desert. You take creatures adapted to the cold and put them in the heat, the very traits that allow them to survive in one environment will conspire against them in the other. We are polar bears in the Sahara with one important distinction: we are smarter than the average bear. Once we identify the nature of the problem, we can think our way out of it. But it begins by acknowledging you didn't fail because you couldn't succeed. Because you didn't even know what the scope of the problem was. It's not your fault.
We are creatures. We have a link with a native habitat just like every other species. Throughout most of human history, physical activity was unavoidable, calories were scarce and hard to get. In the modern era, calories are unavoidable, physical activity is scare and hard to get. The traits that allowed our ancestors to survive, and let's face it, the survival of our ancestors is the reason that we're here because the people who don't survive and make very crummy ancestors, are our traits. But they're very much at odds with the modern environment.
We have literature indicating that overwhelmingly, health is influenced by a very short list of modifiable behaviors topped by three: tobacco use, physical activity and dietary pattern. You could modify those three things; you can change people's fate. I wanted to change those. Smoking cessation, important but relatively simple - a lot of people are working on that. Physical activity: important to me, important to health but also relatively simple. I like nutrition. It's complicated; you really need to learn a lot of stuff to be an expert there.
Epidemic obesity is an enormous problem. It's a pendulum that's swung too far. We have to swing it back. So it should come as no surprise that solution must be built from the ground up on the banks of this flooding river and it must be raised to a height higher than flood waters. Now what does that look like? It looks like policies and programs that cultivate healthy levels of physical activity, healthy dietary patterns in homes, in schools, in supermarkets, in neighborhoods, in clinics, in churches, in workplaces, throughout our society, every place we can reach people.
We have a society that monumentally conspires against the pursuit of health. We have wave after wave of labor-saving technology that says don't ever use your muscles for anything, along with messages that you should be more physically active. We have, every year, the introduction of hundreds, if not thousands, of new highly processed foods, the majority of which glow in the dark. At the same time we're telling people: eat foods closer to nature. We have schools where we teach children to sit still all day long so they can become adults we can't get off couches with crowbars.
We don't control everything. There are genetic influences. There are environmental exposures we don't control. I cannot guarantee anyone I counsel that by following what I hope is the good advice I offer them, they will live long and prosper. That's what I'm hoping for but I can't guarantee that. What I can tell them is this: "Look, I can help you firmly grip the wheel, and you can steer the ship. You're never going to control the winds and you're never going to control the seas. But if you sail well you can get through just about anything."
There's an awful lot about our society that is at odds with the basic message of "don't smoke, be active, eat a healthy diet, and by the way control stress and get enough sleep." We don't make those things easy. We ideally would make health lie along the path of least resistance. But if not the path of least resistance, there at least needs to be a path so you don't have to bushwhack your way there.
My view of chronic disease prevention of fighting epidemic obesity and diabetes, of turning the tide, is that it is the job of professionals to pave the way and to cultivate the will; to stir people up so that they understand the stakes, so that they recognize that adult onset diabetes stalking children is a clear and omnipresent danger. The wolves are at the door. You must defend hearth and home. And here are the means to do it: we must provide programs, policies, tools and resources so that everybody can do the job.
When I went to medical school, I was taught about two basic kinds of diabetes: juvenile onset and adult onset. From the time I did my training in medical school to the end of my residency we were already seeing the transformation of adult onset diabetes into Type II, which is what we call it now, which from my perspective is a euphemism we have draped over this condition to conceal the fact that what was a chronic disease in midlife is now epidemic in children. Frankly, Type II diabetes in a seven year old is adult onset diabetes. We just don't want to confront that unpleasant fact.
There is one thing that very reliably try to trumps the food supply and that is food demand. At the end of the day, the business of business is business and they are just trying to keep the customers satisfied, it depends what we want. The problem in our current mess is we want all the wrong stuff. Why do we want the wrong stuff? Because taste buds are very malleable little fellows. They learn to like what they know. We're bathing our taste buds in too much sugar, too much salt, too much processed food all day long. That's what they know and crave.
What we need to do now is recognize that it is the sum total of human ingenuity that is responsible for the epidemics of chronic disease. Throughout most of human history, calories were scarce and hard to get, and physical activity unavoidable. Calories are now abundant, and physical activity is hard to get. We took an unstable, uncertain food supply and fixed it. What now passes as exercise and requires specialized footwear used to be called "survival." You had to do it. Now you never have to do it. We solved it too well. Now we don't need our muscles for anything.
We are facing a flood tide of factors into our daily lives and the lives of our children that conspire against weight control, and for that matter, health, any single policy or program we use to turn the tide is like a single sandbag. You put down the sandbag on the banks of the river. You could ask the question: Have we held back the flood? A sandbag isn't designed to hold back the flood. A sandbag is designed to be part of a levy to hold back the flood. It doesn't matter if it's a good sandbag, maybe a perfectly good sandbag. By itself it can't fix the problem.
My view is, in between environmental determinism and personal responsibility, we say, "where there's a will there's a way." It's not true. You really need both and they're somewhat independent. We must both cultivate will and pave the way. If you inspire an impassioned people so that they have the will but there's no way, all around them are walls with no doors or windows. It's terribly frustrating. On the other hand, if you put a very nice way at their feet and they have no will to follow it, that doesn't produce anything very good either. Will is not way. You need both.
I naturally gravitate toward the big picture which isn't necessarily advantageous when you go on to a career in research because successful researchers usually choose a pretty narrow channel. So having tunnel vision actually helps you stay where you are supposed to stay. The big picture in medical care was looking at the underlying causes of all of this pathology. I really wanted to do something about that and play a meaningful role in changing the trajectory of people's lives and their health and by changing their health, changing the quality of their lives.
