A call to change the societal approach to human and environmental health
Without action, inequality in health is going to increase exponentially together with global warming and environmental degradation.
Many parts of the world are currently under restrictions to prevent unmanageable strain on hospitals and health care systems. However, experts argue that even without COVID-19 a series of catastrophic events are unavoidable in the long term unless we change our approach to human and environmental health.
In a perspective published in the prestigious journal PLOS Medicine, an international team of leading scientists write that: "Waiting for millions of people, who eat unhealthy food and engage in harmful lifestyles, to end up in out-patient clinics or hospitals with symptoms of chronic diseases is unethical, and financially and environmentally unsustainable."
According to the World Health Organization, at least 80 percent of cardiovascular disease and diabetes and at least 40 percent of cancers along with many other common metabolic and inflammatory diseases are preventable—yet, the authors say our health care system continues to operate on a 'sick-care' operational mode that is not efficient, equitable or even viable.
Lead author Professor Luigi Fontana, Leonard Ullmann Chair of Translational Metabolic Health at University of Sydney's Charles Perkins Centre uses the analogy of buying a new car without instructions to describe how we currently manage health.
"If you buy a new car without any instructions on how to maintain it, at around 15,000 km you will start to have problems because your engine oil is gone or your tires and brake pads are worn. When your engine fails or you have an accident, you call the mechanic and ask how bad the damage is. Then, the car repair specialists will try to fix the problems as best as they can, just like we are getting very good at finding health problems like heart disease and cancer and fixing them with stents, surgery or chemo," said Professor Fontana.
"A well-maintained body, just as a well-looked-after car, is going to last much longer."
"A system that works primarily on finding a new drug to treat each disease is also inherently wrong, financially and socially, and is unsustainable. What is happening to all of these medicines that millions of people are consuming on a daily basis? We are finding traces of these pharmaceuticals in our fish and in our water."
Professor Fontana stresses that a new approach involves acknowledging that chronic diseases are complex and multifactorial, and start very early in life, but clinical medicine usually intervenes in late stages when therapeutic options are limited and chances of cure are highly decreased.
"It's very much the same principles that underpinned the establishment of the University of Sydney's Charles Perkins Centre in 2012. An understanding that as well as the biology, we must look at the wider psychological, societal and environmental contexts of chronic diseases such as obesity and diabetes and it's here, through collaboration, that the answers will lie."
What is the answer?
The group propose a number of solutions that require urgent attention. The one that Professor Fontana is most passionate about is improving health literacy.
The authors write that "integrating health literacy as soon as possible into education is key because it shapes health and wellbeing across people's lives. However, despite the wealth of mechanistic knowledge linking nutrition, exercise, sleep, cognitive training and health, these topics receive little or no attention in primary, secondary, and tertiary education, including medical schools."
Other strategies they propose include:
- Lowering taxes and health insurance premiums for people with healthy lifestyles and taxing not only carbon but also animal and ultra-processed foods and beverages. Diets rich in refined and animal foods have not only deleterious effects on humans but also on environmental health. Industrial animal farming accounts for about 15 percent of greenhouse gas, 20-30 percent of particle pollution (PM10), deforestation, top soil destruction and water pollution with pesticide and chemical fertilizers.
- Nutrition focused strategies such as restricting the advertising of unhealthy foods to children, implementing front-of-package nutrient labels and enhancing food quality in schools to help curb childhood obesity. Making healthy foods more affordable than less healthy food is also an important strategy aimed at reducing health inequality.
"The wealthy will be able to afford expensive health care but the middle class and the poor are going to be waiting for months, the health system will be overwhelmed."
"We need to bring together the best minds to design a world that takes advantage of our scientific knowledge and technology. This accumulated knowledge should aim at promoting human and environmental health, eradicating poverty, creating sustainable peace and a global economic and human development plan that re-orients the present unsustainable economic systems from an individualistic ethic of 'growth' towards an ethic of 'care' and sustainability. However, these changes, will only be triggered by the choices of aware and well-informed citizens."