Here is the second sports pages column. We hope you like the uniform. This month I find some guides to food insecurity in the USA and UK, learn that it can be best to stay fat, ask President Obama to pull his socks up, and deny that in the beginning was the fact. If you think that anything written here is unjustified or wrong, or that another point of view should be expressed, please write a letter for publication.
Public health nutrition
What are we all about?
Sometimes I hear that this journal is about nutrition, not politics. The response of the editorial board is yes, this is a nutrition journal and yes, public health in all its aspects including nutrition, is political. This, in two senses: being involved with public policy, and also shaping and being shaped by political ideology – particularly that of governments and other dominant powers. John Waterlow has said, of the prospects before us: ‘The outcome… depends on not science alone, but also on political and economic factors over which, as scientists, we have little control, but we can at least act as advocates’(Reference Waterlow1).
Food prices. Food security
How will we live now?
For most of us who contribute to or read this journal, my guess is that the sharp rises in prices of food commodities and staples is a calamity for them; whereas the collapse in the global financial ‘system’, wishfully thought to be leading to a general ‘recession’ rather than a slump, is, at least potentially, happening to us. This has a good aspect: we may now have more fellow feeling for people who are often or always insecure.
So how will we live now? The British novelist Margaret Drabble, when asked this question at the time of rocketing oil prices in 1973, said ‘make the best of what we’ve got’. She had stopped buying new records (those were the days of vinyl) and instead was dusting off and playing her old records. With this thought in mind, I have taken out of store and perused my small collection of guides to householders during past times of food insecurity. Do not smile at the language, we may come to need such advice more than we may now imagine.
Making ends meet
A US guide to dietetics published in 1920(Reference Willard and Gillett1) advises that when buying on a budget: ‘1. Buy in quantities as large as money, storage facilities, and keeping qualities will permit… 3. Ready-to-eat cereals are relatively expensive… 10. Very small prunes or very large prunes are relatively expensive (the latter because they command high prices, the former because they are largely stone)’. Then as the Great Depression was easing in Britain in the mid-1930s, an official Calendar of Cooking (Reference Heath and Cottington-Taylor2) tells the housewife that in February ‘If she is wise, she will start to experiment a little, and learn perhaps that to buy (and learn to deal with) a boiling fowl is not so extravagant as it may sound’. A guide given away with every Radiant electric cooker(3) gives a useful tip: ‘To boil cracked eggs without the loss of any of the egg, rub the crack well with common salt. The white of the egg will not ooze out, nor will the crack become wider’. Must try that.
Then came the Second World War, the attempted blockade of Britain by German submarines, and in the words of the Minister of Agriculture: ‘The cry for food and for food in increasing quantities, to defeat the menace to our shipping and to replace supplies from territories overrun by the enemy’. Dig for victory! This is from a wartime guide to home gardening(4). The Minister also said: ‘The aim of the amateur gardener should be to supply his household with vegetables all the year round’. A Penguin guide to home farming and gardening(Reference Carter5) states that the number of British allotments meant to be big enough to grow vegetables and fruits for a family, then usually easy to obtain from local authorities, had increased from two million in 1914–18 to three million, towards the target of five million. Urban and suburban food gardens are not a new idea.
The British Medical Association produced a booklet with the splendid title ‘The Doctors tell you what to eat in wartime’(6). One tip definitely has not aged. ‘Plenty of vegetables should be included in the diet at all times… The French serve many of their vegetables as a separate course. In this, as in many other things, we should imitate them’. A cookbook given away with gas cookers(7) includes a recipe for onion soup: ‘This is splendid for bad colds, cold nights, or any feelings of depression or discouragement. Paris taxi-men thrive on it’.
An official cookbook issued after the War(8), when many foods were still rationed, advises: ‘The less money there is to spend on food the more important good meal planning becomes. The temptation is to buy only the cheap foods, regardless of their food value and the body soon becomes badly nourished’. Its preface states: ‘Proper feeding can go a long way towards ensuring clear eyes, glossy hair, skin that is free from blemishes, just as your resistance to infection is largely determined by the food you eat’. As with pets, so with people.
Using less money
Where I live in Brazil, country people usually do not trade just in money. One family may grow plenty of fruits and give most of them away to neighbours. Another family may produce enough corn for the community and barter it for other goods. Tonight we enjoy a soup of quinoa and greens, and I look out at the back garden. Could this patch supply enough vegetables for the family? Maybe it better had. And chickens? No, the metre-size lizard and the raccoons that live in the forest behind our house would eat the eggs and chicks. Suppose we had a goat… no, too much ecology…. But it is time for us all to get ‘undeveloped’ in the sense of using less money. That’s the kind of recession that will help to make the world a saner place. Maybe I’d better start giving English lessons to a local chicken farmer’s daughter. Or son.
Physical activity, adiposity, morbidity, mortality
When is it OK to be fat?
Steven Blair may be the most influential advocate of regular vigorous physical activity. Now at the University of South Carolina (Columbia), then with the Institute for Aerobics Research founded by Kenneth Cooper in Dallas, Texas, he was the senior scientific editor of the magnificent 1996 US government report on physical activity and health(1).
Based on impressive consistent evidence, the report concludes that all people will do well to build activity into their everyday lives, that the benefits of physical activity fade rather quickly after resumption of sedentary habits, and also – somewhat against the grain in those days – that there is no ‘threshold effect’. While half-an-hour a day of moderate activity is sensible advice for unfit sedentary people who are not about to train for triathlons, there is greater benefit in longer periods of activity and in vigorous activity.
Essentially, within the limits of the musculoskeletal system, more energetic you are the better you will feel, and the more protected against a great range of major chronic diseases. A charming feature of the report is its respect for historical observation. It quotes from an early 19th century handbook for the pioneers whose wagons crossed over the Cumberland Gap to win the West. ‘Were training introduced into the United States, and made use of by physicians instead of medical drugs, the beneficial effects in the cure of many diseases would be very great indeed’(Reference Gunn2).
This is by way of introducing Steve Blair also as a contrarian. He insistently claims that fit people are protected against disease irrespective of their degree of body fatness. To quote a recent study of men over 60 of which he is co-author: ‘Fitness was a significant mortality predictor in older adults, irrespective of overall or abdominal adiposity’(Reference Sui, LaMonte, Laditka, Hardin, Chase, Hooker and Blair3). If the findings of this and other studies hold generally true, this means that as long as you are able to be and are physically active, and if your concern is risk of chronic diseases, it seems not to matter how fat you are, as long as you remain fit.
Steven Blair is media-friendly, and jokes about being short and bald, and also fat despite having clocked up many tens of thousands of miles as a runner; and he goes further. He says that death rates of people who are thin and unfit are at least twice as high as those of obese men and women who are fit, and that the current orthodoxy that overweight people need to reduce weight irrespective of their fitness level is just plain wrong.
What do colleagues from the USA think of Steve Blair? So far the answers I have had refer to him having had a heart attack, as well as being fat (and by implication biased), but don’t address the science. Yes, I know there are other studies that contradict his. Let’s have some letters for publication, please.
Public health in the USA. Political causes of inequity
What President Obama can do
Presidents of the USA may in their time of office be the most powerful people on earth, but their personal powers are circumscribed. There are though some areas in which they have unusual freedom of action. One is starting wars. Another is shaping and changing national and international moods.
Barack Obama began his first term as President of the USA last month. What he can do now, is set up a President’s Commission on the condition of the people of the USA, and the place of the USA in the world. This will be rather similar to the ‘truth and reconciliation’ commissions established in southern Latin American countries and in South Africa after the ending of savage dictatorships. The US commission can be charged to publish its findings, and its recommendations for policies and actions, say within a year, in a report of manageable size, with what no doubt will be voluminous annexes. Those responsible for the Commission will need to know that they will have full powers of investigation and that their findings will be published without interference.
The state of global public health nutrition
One sub-committee, and one chapter of the report, will be concerned with US and global public health and how this has been affected by the economic, social, political and environmental policies of the US government and associated countries in the 20th century and particularly since 1980 and then since 2000. Public health nutrition will be one part of this charge.
As always, the most crucial decisions will be selection of the leaders of the commission. As chair in our field? That’s easy. One person has pre-eminent distinction, independence and judiciousness. This is Malden Nesheim, now retired as Provost of Cornell University.
Notwithstanding the unparalleled international capacity of Cornell, there needs also to be a co-chair who is not a US citizen. This part of the task is to anatomise the impact of US policies on the state of public health nutrition on the rest of the world, and to make recommendations for policies and actions designed to restore and maintain equitable and sustainable adequate and nourishing food systems and supplies throughout the world. Here the best choice may well one of the scions of John Waterlow. In which case, my gender-imbalanced short-list is George Alleyne, Terrence Forrester, Alan Jackson, Philip James, Prakash Shetty and Roger Shrimpton. Of these, for his sagacity, passion, experience, quality as a scientist and ability to cut to the quick, I select Alan Jackson.
You think this is fanciful? Forty years ago another US President commissioned a White House conference on food, nutrition and health(1). With Jean Mayer of Tufts University as special consultant to President Nixon, one of the findings of the conference was confirmation of the extent of poverty within the USA(Reference Harrington2). At least six people associated with the conference – Johanna Dwyer, Jules Hirsch, Michael Latham, Nevin Scrimshaw, Noel Solomons and Albert Stunkard – remain active and well-known to this column.
Can President Obama make a difference in the world, and by direct example and action improve the state of population health and nutrition in the USA and throughout the world? Yes, he can. And if not? Well, in our field the World Public Health Nutrition Association can do the job for him.
Philosophy of science. Induction and deduction
In the beginning is the idea
Here is a trailer for next month. The basis for all organised human activity, whether governing a country, changing a job, or undertaking a randomised controlled trial, is not facts. It is ideas that drive us(Reference Popper1). Thus, the proposal that randomised controlled trials are superior to all other current methods of investigation in the biological sciences is ideological. Facts make sense only as material for ideas.
Acknowledgements
Sources of funding: Green again this month.
Competing interests: John Waterlow gave me a copy of the book that includes the paper from which I quote here. I am also a fan of Malden Nesheim and Alan Jackson (and of some others mentioned), with good reason. The World Cancer Research Fund/American Institute report on public policy and action implications of the 2007 WCRF/AICR diet and cancer report is out and downloadable this month (http://www.wcrf.org) but since I don’t mention it in the text I guess this here is not an interest that competes…. The spiral symbol of the New Nutrition Science project that appears at the front of this column signifies my commitment to its precepts.
Authorship responsibilities: My awareness of the relevance of history comes partly from Caroline Walker, who hoarded some of the food guides of yesteryear, and also from Claus Leitzmann, who gave me the copy of the White House Conference report.
