Wave, July / August 2012
It's well understood that a healthy diet is an important driver of good health.
A Mediterranean diet, for example, that emphasizes fish, fruits and vegetables has been shown to reduce deaths from heart disease and cancer, as well as decrease the incidence of neurodegenerative conditions such as Alzheimer's disease and Parkinson's disease.
It's also well understood that there is a mismatch between what many of us eat and what we should eat, and that this mismatch is an important contributor to a number of chronic diseases.
What's less well understood are some of the underlying reasons for this mismatch, and what we could be doing to address it.
That was among the messages delivered recently by Olivier De Shutter, a United Nations official who toured Canada talking to various groups about the state of our nation's collective refrigerator. De Shutter generated national headlines last spring when he suggested that too many Canadians were "food insecure," meaning they have less access to a sufficient supply of safe and nutritious food. The UN official was criticized by some who thought it wasn't necessary to talk about food insecurity in a country as wealthy as Canada. Nonetheless, De Schutter's comments provide some food for thought.
Food insecurity is a complex issue. In some cases, it may result in a family going hungry because they can't afford to buy the food they need. In other cases, it may mean buying less expensive foods low in nutrients and high in sugars and fats - the kind of diet that leads to obesity. In all cases, it is a recipe for individual health problems, and additional costs for the health-care system.
Over the years, there have been many attempts to improve nutrition at a population level by educating the public on how to make better food choices. But while education is important, it is not the most effective way to make large-scale improvements in population health.
Societal forces create environments in which it is easier, and often more appealing, to eat poorly. One example can be found in research indicating that the less families sit down to eat together - which is a function of a number of diverse social factors - the worse the health outcomes. Eating patterns of adolescents, especially girls, appear to be better for those who more frequently dine with their families.
To counter these forces, comprehensive plans are needed to address the broad range of social and environmental factors that help determine what and how we eat. A look at other jurisdictions reveals some interesting examples of this type of public policy approach at work.
In New York, for example, Mayor Michael Bloomberg has recently been in the news promoting that city's plan to ban oversized sugary drinks. In the United Kingdom, where a recent study reported that 30,000 cardiovascular deaths per year could be prevented with better food policy, the government is working with companies to decrease the amount of sodium in their foods. (Dietary sodium is found at excessive levels in many Western diets and is an important contributor to high blood pressure, heart disease and stroke.)
The corporate world is also taking bold steps. Recognizing the impact of advertising on eating habits, The Walt Disney Company recently announced a ban on ads intended for children that do not meet nutritional standards - an initiative that U.S. First Lady Michelle Obama, an outspoken champion of healthy eating, called "a game changer."
In addition to policy options that steer people away from poor nutrition choices, other initiatives are being launched to help facilitate access to better and more affordable sources of nutrition. School breakfast and lunch programs help to provide children with the nutrition they need to learn. Some remote communities in Manitoba have created community freezers stocked with locally-sourced food that is available to a broad range of community members. These are both examples of initiatives that can help in areas where healthy, affordable foods are more difficult to obtain.
The debate over which of these specific interventions is most effective is ongoing, but they all reflect the type of broad thinking that has proven effective in other areas of public health policy, such as tobacco reduction.
The health of a population depends in part on what it eats and drinks. While individuals have a responsibility to make healthy choices, we live in a society where the healthy choice is often not the easy choice. Many factors go into the choices people make around what they eat, and addressing the problem of poor nutrition requires a broad approach that recognizes these factors - and the fact that blaming poor decisions on individuals isn't effective. If we as a society can come up with a better "recipe" for providing and promoting healthy eating choices, the better our individual and collective health will be.
Dr. Michael Routledge is a Medical Officer of Health with the Winnipeg Health Region. This column includes files from Dr. Michael Isaac, a public health resident with the University of Manitoba.