Taking Public Health to the Moon

By rallying to the mandate of the evidence-based, consensus-based fundamentals of health promoting, sustainable living and eating -- I believe we can accomplish something for public health and the human condition that is, quite simply -- out of this world
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I was privileged this week to participate in the Lake Nona Impact Forum, taking the stage with colleagues Dr. Richard Carmona and Dr. Dean Ornish, and joining a cast of notables, such as Dr. David Satcher, and Dr. Sanjay Gupta.

Here, more or less, is what I had to say, adapted a bit to suit this medium.

If among you there are any Star Trek fans, and among those any who extend the love to Jean-Luc Picard and the Next Generation crew; and among those, any who recall and appreciated the episode involving a population that spoke entirely in metaphor -- you are most apt to discern the method in my own poetic madness.

My friends, we all have miles to go -- and promises to keep; arguably, the most luminous promise in the history of public health: an 80 percent reduction in the total global burden of chronic disease. The addition of years to lives, and life to years, for millions upon millions around the globe.

It was 23 years ago that McGinnis and Foege revealed the obvious: the chronic diseases cited on death certificates are not CAUSES, they are effects. Their analysis showed us: effects of what? The answer was then, as it is now, a list of ten underlying, modifiable factors. Some items on the list are behaviors any one of us might change on our own. Others are exposures we can best, and perhaps only, change together. Sometimes the best, and sometimes the only, defense of the human body resides with the body politic. But alone, or together, everything on their list is modifiable by knowledge not only accessible to us now -- but accessible to us those 23 years ago.

The mandate for action is even more compelling when we consider that just the first three items on that list account for roughly 80 percent of the premature deaths in our country each year, and those three are: tobacco, poor diet, and lack of physical activity. Or, as I like to call them, bad use of feet, forks, and fingers.

Bad use of feet, forks, and fingers accounts for nearly 80 percent of premature deaths and about that much of the global chronic disease burden. A repetitive drumbeat of peer-reviewed publications since McGinnis and Foege affirms this, and supports the converse as well: fix these, and some 80 percent of all chronic disease goes away. We have the knowledge to add years to lives, and life to years, for millions upon millions around the globe. That, then, is the promise -- and it is ours to keep or break.

To keep it, we clearly have miles to go -- and all the more so for having stalled in the dark wood of modern epidemiology these 23 years.

My contention here this morning is simply this: if we are to go the miles, and keep the promise, we must escape the dark wood. To do that, we must first see the forest through the trees.

Or, to switch metaphors: if we are to advance, we must navigate past the proverbial elephant in the room. And that is famously easier said than done!

I fear we are prone to much the same tendency in epidemiology, nutritional epidemiology in particular. Where, then, does it leave us?

Science, Sense, & Elephense By David L. Katz

Speaking of elephants, in rhyme no less... thoughts turn to one of history's great doctors. Namely, Dr. Seuss.

In his seminal, peer-reviewed paper, "Horton Hears a Who!" Seuss gave us the curious case of a pachyderm with extraordinary auditory acuity- or, possibly, uncompensated schizophrenia. He gave us as well a dust-speck world populated by Who's (real or imaginary), facing genocidal annihilation in a boiling cauldron of beezlenut oil. For further plot details, confer with colleagues.

In any event, the Who's circumvented their grim and greasy fate through the expediency of a choir. Specifically, they pulled together, pooled their voices, and at just the same moment, every last Who shouted out: WE ARE HERE! They were heard, they were saved, and the rest is history.

We do not face annihilation in beezlenut oil, although endless bickering over what kind of oil we should eat has some potential to cook our goose. Nor is there any doubt that we are here. We are a noisome, boisterous horde; everyone knows we are here!

What they don't know is that we agree. They don't know that we agree about the fundamentals of healthy living, including healthy eating. They don't know that we truly are NOT clueless about the basic care, OR feeding of Homo sapiens! We agree -- and I have proof.

My modest contribution to these proceedings -- the forest through the trees -- takes the form of the True Health Initiative, a new, global campaign devoted to turning what we have long known about the promise of lifestyle as medicine into what we, at long last, do with it.

The Council of Directors of the True Health Coalition is, at present, about 300 strong -- it grows weekly. It represents some 30 countries. It is a Who's Who in nutrition, lifestyle, health promotion, preventive medicine, public health, sustainability, the culinary arts, and even biodiversity- banding together to say: we AGREE about the fundamentals of healthy, sustainable living, including diet.

When I say a "Who's Who," I mean a membership worthy even of this assembly. In fact, I mean a membership not just for, but of and by this very congregation. I mean Dr. Richard Carmona; I mean Dr. Dean Ornish; Dr. David Satcher; Dr. Sanjay Gupta; Dan Buettner... and other luminaries, from Walter Willett to Alice Waters.

And perhaps more impressively still, I mean unity across seemingly impassable ideological divisions. On this Council, there are some of the world's most prominent advocates for a vegan diet: T. Colin Campbell; Caldwell Esselstyn; Neal Barnard. There are also some of the world's best known experts in the Paleo diet -- Mel Konner, Loren Cordain, Boyd Eaton -- willing to stand together and be counted. Willing to acknowledge: we agree, far more than we disagree. Our diets look more alike than different. And our diets are much more like one another than any is like the typical, glow-in-the-dark, American diet.

My simple contention this morning is that only in unity is there the strength to affirm what we know, and turn it into what we do. I am not only submitting that concept to you, I am inviting you to support it. Please visit truehealthinitative.org, and sign up to join us. Add your voice to the growing, global chorus. In our unity there is unprecedented strength to go the miles, and keep the promises.

We began in space -- the distal reaches of Star Trek fantasy. We end in space -- the proximal reaches we have traversed in reality.

We have gone the miles between us and our celestial neighbor, the moon -- and she wears our footprints and flag in testimony to that achievement. So far as I know, we got to the moon for 3 reasons, and 3 reasons only: (1) we wanted to go; (2) we are an ingenious and pertinacious species; and (3) we knew exactly where "there" was.

I believe one of the salient reasons we have remained mired in the dark wood of modern epidemiology, mired in unnecessary chronic diseases, unnecessarily surrendering years from lives and life from years -- is the failure to affirm that we know where "there" is. We do.

I am not suggesting knowing where "there" is -- is enough. The miles getting there may still prove arduous. But I am suggesting it is necessary. It is prerequisite. Hard or easy, you simply can't get there from here -- if you don't know where "there" is.

With regard to the promise of lifestyle as medicine, as luminous as any light ever tossed our way by our lovely satellite -- I'm sure we all WANT it. I believe everyone wants to add years to lives and life to years -- perhaps their own in particular. I certainly believe every loving parent and grandparent wants to bequeath to our progeny a world in which 8 times in 10, chronic disease simply does not occur. That satisfies the first criterion.

As for the second, we remain an ingenious and pertinacious species.

There is, then, only the third: affirming the destination. I submit to your kind attention a new, global force of unity to point the way.

We truly do know the formula for eradicating some 80 percent of the global burden of chronic disease. We know what is needed to add years to lives, and life to years. By rallying to the mandate of the evidence-based, consensus-based fundamentals of health promoting, sustainable living and eating -- I believe we can accomplish something for public health and the human condition that is, quite simply -- out of this world.


Director, Yale University Prevention Research Center; Griffin Hospital

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