Preventive Medicine Column

Dr. David L. Katz

I should probably warn you right away: this is an audience participation column, or at least I am hoping it will be.  If unintimidated, please read on!

You may already know that I favor two analogies, or metaphors, for confronting the health threats that prevail in our society: levers, and levees.  Archimedes famously said “give me a lever long enough, and I will move the whole world.”  As we confront the challenge of shifting away from ourselves and our loved ones the massive threats of chronic disease and obesity- we do have at our disposal Archimedes’ lever.  In fact, we have three such levers: feet, forks, and fingers.

A repetitive drum beat of research conducted over a span of 20 years or more has told us decisively and compellingly that the leading causes of premature death and chronic disease are tobacco use (that’s where the fingers come in); poor diet (i.e., less than optimal use of forks); and lack of physical activity (i.e., inadequate use of feet).

The good news is that the reciprocal findings are virtually as conclusive and clear: avoid holding cigarettes with our fingers, improve the food choices at the ends of our forks, and put our feet to consistent use, and we can reduce our risk of all major chronic disease by as much as 80%, and even change the behavior of our genes.  So I rest my case: feet, forks, and fingers are the master levers of medical destiny.

The trouble, though, is that while we as individuals practice the behaviors involving our feet, forks, and fingers, we are in turn practiced upon by forces larger than we.  We did not choose to be born into a modern, obesigenic world- but here we are.  We did not choose to find ourselves in a world awash in highly palatable, energy dense, convenient, ubiquitous, and by all historical standards very inexpensive food- but here we are.  We did not choose to be among the first generation of Homo sapiens who could count on technology to do everything that muscles used to do, from work to recreational diversions, but here we are.

Where we are, in fact, is up to our necks in a flood of factors that foster and facilitate overeating and under-doing.  Factors that are the root causes of epidemic obesity and diabetes and all related chronic disease.  A flood washing away both years from our lives, and to an even greater extent, life from our years.

Which leads us to the second application of my poetic license, and the levee metaphor.  If you want to stop a flood, you need a levee to contain it.

The levee analogy has a few important implications.  First, while a sandbag is the building block of a levee, no one sandbag can do what the whole levee does.  Similarly, no one program, or policy, or practice can contain and divert the influences of modern living that are adverse to health.  One of the mistakes I often see in the research literature is the tendency to measure change in weight or health status with one targeted intervention.  That’s a bit like testing the dryness of the riverbank after putting down one sandbag.

It doesn’t matter how good a sandbag is, it needs to be in good company to turn the flow of a cresting flood.  Similarly, when so much about modern society is obesigenic and conducive to chronic disease risk, it really doesn’t matter how good any one school-based, or worksite-based, or clinic-based, or church-based, or family-based program is; it is just about guaranteed to fail if expected to stem the tide on its own.  If, however, a variety of good and useful programs start to populate all such settings, our defense becomes more and more robust.  Stack enough sandbags, and you have a whole levee- and a whole levee absolutely can contain a flood.

This perspective has been guiding our work at the Yale-Griffin Prevention Research Center, and at my non-profit, Turn the Tide Foundation, for some time.  We have been developing programs- as many as possible available for free- to support the levee building mission described above.  I like to think, in fact, that this stage of my career is all about manufacturing, testing, distributing, and stacking sandbags.

But building a levee is a big job, and we need all of the strong backs and strong commitments we can rally to the cause.  I believe that many people- parents, teachers, employers, pastors, principals, etc.- would gladly help build the levee if only they knew how.  If only they knew where to grab a sandbag.

Which brings us back to audience participation.  With the help and active involvement of all of New England’s state health commissioners, our regional assistant Surgeon General, and others, we have compiled a fully searchable, on-line inventory of proven and promising health promotion programs for diverse settings.  We call the project PHINDER (Promising Health Interventions Inventoried by a Network of Diverse Experts for Regional Application) because it is intended to help people of good will find a sandbag they can use, and get to work.

So, please visit and search the PHINDER site-

and if at all possible, grab a sandbag and add it to your community’s levee.  If you are not in a position to help build the levee yourself, perhaps you can pass the information along to someone who can.

I am genuinely confident we can turn the flood tide of chronic disease, and ‘phind’ health together.  But here’s the catch: we can only do it together.  So please join in!




Dr. David L. Katz;