Friday, March 07, 2008

Fat Not Fit: The Need for a Better Public Health Policy

In today's NY Sun, James Knickman, the CEO of the NYS Health Foundation writes about the epidemic of diabetes in NYC: " In the last decade alone the number of people with diabetes in New York State has more than doubled. Right now, 1.5 million New Yorkers — roughly 7% of the state's population — suffer from some form of the disease. Diabetes now stands as the fifth leading cause of death among adults between 45 and 64 years of age. More disturbing is the fact that diabetes is the only chronic disease that continues to grow in prevalence, and at a faster pace than both heart disease and cancer."

What's clear from all of the research is that the diabetes prevalence is a direct result of increasing rates of obesity-and in both cases there are remedies available that involve prevention and social intervention strategies: "Type 2 diabetes is preventable and brought about by poor nutrition, lifestyle choices, and environmental factors that can be controlled. Most experts believe Type 2 diabetes is becoming more prevalent because our lifestyles are becoming ever-more sedentary and our diets are evermore dominated by high-calorie, high-fat, and convenient food choices."

But while we know that lifestyle is a key variable, we're not sure to what extent some of the various intervention strategies suggested make sense; that's where good public policy analysis is needed. For instance, Mr. Knickman suggests that, "We can no longer deny the effects of junk food and fast food that are the sad staples of the American diet — especially in low-income communities. Yet, the battle to curb the obesity and diabetes epidemic cannot be fought solely at the dinner table."

In response, Health Commissioner Frieden has devised a number of public health interventions that we find to be questionable-falling apart as soon as a decent immanent critique is offered. Certainly, the proposed use of calorie postings at fast food restaurants is a case in point; it sounds like a good idea until it is revealed that the methodology makes no sense and the efficacy of posting calories has no backing from any public health research.

That doesn't stop the Friedens of the world from plowing ahead, utilizing the real seriousness of the public health issues to bogart any reasonable gainsaying. Case in point was the resignation of Dr, Allison from the presidency of the Obesity Society when he had the gall to suggest that the emperor had no clothes-and there's no evidence in support of the efficacy of calorie posting. Supporting public health orthodoxy is more important than actually devising effective public policy.

Which brings us to another initiative-the promotion of fruit and vegetable peddlers. As Mr. Knickman points out; "True prevention requires much more than good lifestyle choices. It involves the social will to create environmental conditions that support healthy living. Our governments and employers can be more health-friendly by creating places to safely exercise — walking paths and bike paths — and by ensuring that healthy food choices such as fruits, vegetables, and low-fat foods are available in our schools and neighborhood groceries."

Putting peddlers in the street is simply no substitute for insuring that the city's neighborhoods have a plentiful supply of good food retailers-and in fact it can be seen as a real impediment, since no overhead peddlers compete with small produce stores and bodegas and diminish their profitability. The real solution in this area is the development of a policy that promotes the profitability of supermarkets and produce retailers in all of the city's neighborhoods.

This is a matter of public health and it deserves to be made a centerpiece of the mayor's final 18 months in office. With rents forcing out existing neighborhood markets, and development policies ignoring the central role of supermarkets in providing access to healthy foods, the city is facing a crisis.

We need to have public hearings on this, and the Central Labor Council, active on accountable development issues, needs to elevate supermarket siting to a central place in its development platform. But we can't stop there. We're at the crossroads of the "you can lead a horse to water, but you can't make it drink," dilemma.

Providing access to healthier foods and exercise venues doesn't mean that folks are going to change their behaviors. We need an aggressive social marketing campaign that goes right after the hearts and minds-something that has been started by Dr. Oz's HealthCorps, a Peace Corps variant that is currently in 28 city high schools.

Public policy must be supplemented by good grass roots awareness efforts-and everyone needs to be enlisted in a campaign to generate healthier lifestyles in the city. Policy edicts that aren't accompanied by social marketing campaigns will not have the desired impact. Public health professionals need to collaborate with food businesses and community leaders in a campaign that addresses the city's serious health issues. It's about time that we all rowed together.