The American Cancer Society
recently released new guidelines on nutrition
and physical activity for cancer prevention. It
concluded that only by creating a "social environment
that promotes healthy food choices and physical
activity" can the nation whittle away at the nearly
170,000 of 500,000 annual cancer deaths linked
to obesity, junk food and a lack of exercise.
On Oct. 6, the American Heart
Association and the Clinton Foundation announced
an agreement with Campbell Soup Co., Dannon, Kraft
Foods, Mars and PepsiCo to adopt the nutritional
guidelines for snacks sold in schools.
These groups are taking action
because it has become clear that nagging people
to exercise, stop smoking and "eat an apple a
day" hasn't had the hoped-for impact in a nation
where baby boomers and many children are fueling
overlapping epidemics of obesity, high blood pressure,
diabetes, heart disease and cancer.
Aim: Healthier place to
live
Many experts attribute this
not to weak willpower but to easy access to unhealthful
foods and busy lives that squeeze out exercise.
The best remedy, they say, is to make the world
a healthier place to live.
If the goal seems ambitious,
it's not without precedent. Public health experts
achieved just such a triumph in the 1800s when
societywide measures such as water purification
and sewage treatment banished many infectious
diseases, the big killers of the day. Today's
plagues are chronic diseases.
Most cancer treatments buy
patients a few more years, at best. Over the past
25 years, they say, five-year survival rates for
cancer have risen from about 50% to just over
60% with most of the gains coming from early detection
and surgical removal, not high-tech medicine.
Highly touted cholesterol-lowering drugs reduce
the death rate from heart attacks by just one-third,
research shows.
Personal responsibility
"The underlying assumption
is that medical care not only works, it's virtually
magic," Farley says. "If we only had a little
more money and research time we could find a cure
for everything. That story is repeated so often
that people have come to believe it. The reality
is that medical care doesn't produce health, and,
while it definitely has benefits, it also has
its risks."
No one questions that prevention
is the solution, but the costs of taking care
of the sick consume roughly 96% of the health
budget, leaving about 4% for prevention. In practical
terms, that means most people are floundering
without the support they need to live healthier
lives, says Allan Brandt of the Harvard School
of Public Health.
"It's easy to say we should
all be on a good diet, stop smoking, start exercising
and stop taking risks," such as not wearing a
bicycle or motorcycle helmet, Brandt says.
"How can we help people achieve
a higher level of personal responsibility? It's
not by moralizing and telling people what they
should and shouldn't do.
"Tobacco's a great example.
I do think people should stop smoking. But what
do we know about tobacco? It's highly addictive,
it's weakly regulated, and there are powerful
social forces that encourage young people to smoke.
And when you've been smoking for years, it's very
difficult to stop."
Brandt says cajoling people
to stop smoking didn't work very well even after
the release of the first Surgeon General's report
sounded the alarm in 1964.
Smoking rates only began
to drop in the 1980s when governments passed laws
restricting cigarette advertising, raising cigarette
taxes, limiting smoking in public places and making
it harder for children to get cigarettes.
The Arkansas experiment
Arkansas Gov. Mike Huckabee
didn't become a prevention hawk from studying
statistics. Once 110 pounds overweight, he says
his awakening came in 2003 after his doctor informed
the governor that he had diabetes and "scared
the daylights of me."
But even Huckabee found he
couldn't go it alone. He quickly enrolled in a
program at the University of Arkansas School of
Medicine, substituting protein shakes for many
of his meals and beginning an exercise regime
that includes a morning jog.
Since then he has managed
to push a package of preventive measures through
the state legislature banning smoking in workplaces,
restaurants, bars and any car in which a child
is restrained in a car seat. Three years ago,
the state began requiring schools to measure each
student's body mass index, a formula that uses
height and weight to calculate whether a person
is verging on obesity.
A whopping 38% were. Letters
were sent home to parents, who apparently took
notice and tossed out the Twinkies and catapulted
kids off the couch.
"When we looked back, it
became clear that we had halted the state's childhood
obesity epidemic," says Arkansas Surgeon General
Joe Thompson.
Huckabee also backed a health
assessment for the 110,000 members of the state
employee health plan, which provides coverage
for stop-smoking programs, nutritional counseling,
dietary assistance, even gastric bypass surgery.
People who cut their health risks can earn $20
an adult a month off the cost of their family
health plan.
Not every effort is sponsored
by government. In Minnesota, Blue Cross Blue Shield
is investing at least $20 million in proceeds
from a landmark, decade-long lawsuit against the
tobacco industry in an effort to get Minnesotans
to stop smoking, eat better and exercise.
The University of South Carolina
Prevention Research Center is studying Sumter
County, population 100,000, to figure out what
it takes to get people to exercise.
And Farley would like to
turn the Prescription for a Healthy Nation
into a prescription for rebuilding Katrina-ravaged
New Orleans. Before the hurricane a year ago,
Farley had begun working with the residents of
the Upper Ninth Ward to provide them with more
opportunities to exercise. Then came the flood.
"I immediately saw the hurricane
not just as a tragedy but as a once-in-a-lifetime
opportunity to reshape an entire city in ways
that would promote health," he says. "Make sure
we build sidewalks, bike lanes, parks and playgrounds
so people can be physically active. Build supermarkets
that sell healthy items."
Farley recently played host
to John Weidman of Food Trust, who spoke to state
public health officials, Tulane's public health
department and representatives of the Louisiana
obesity council about the program's successes
at introducing grocery stores to inner-city neighborhoods
in Philadelphia.
"I'm not a businessman,"
Farley says. "I don't know how to turn a profit
in these neighborhoods. If there is a way, and
they could teach us, that would be huge."
