Preventive Medicine Column
Dr. David L. Katz
Which came first in what may prove to be the nation’s largest ever salmonella outbreak, the chicken, or the tainted egg?
Neither, in my opinion. Both are effects. We are the cause.
Any gardener knows that to solve a weedy problem, you have to get it at its roots. We in Preventive Medicine know that, too, or certainly should. Our eyes were opened to this enlightened thinking by Drs. J Michael McGinnis and William Foege in 1993. They were the first to note explicitly- in their seminal publication in JAMA– that the causes of chronic disease and premature death are not diseases, but the things that cause the diseases! Such as tobacco use, eating badly and lack of physical activity.
The evidence that they were right has accumulated ever since. I routinely invoke the relevant literature to note that feet, forks and fingers are the master levers of medical destiny, as regular visitors here well know.
Viewed differently, bad use of feet, forks and fingers are the major causes of chronic disease. But these are the proximal causes, not the root causes. The root cause is modern living. Everything about modern living that makes it modern — processed food, suburban sprawl, labor-saving technology, mass media marketing — is obesigenic, and conducive to the insalubrious application of feet and forks. More on that, however, can be a topic for another day.
For today, how about those eggs? Why is it that some 500,000,000 eggs have been recalled, and 1500 people have gotten sick in the U.S. due to salmonella contamination? Proximal causes have much to do with modern farming and food handling techniques, and something to do with FDA resource limitations. But what about the root cause?
And how about the worst drought in Russia in 50 years, leading to massive crop failure? Could it possibly be fed by the same root?
What of massive population displacement in Pakistan due to inundation, and similar if lesser upheaval due to flooding in China? And while we’re at it, can we trace the root to accelerated melting of the polar ice, with ramifications we are still just guessing at?
I think we can. The root cause that connects these dots — and many others besides — is global population growth. There are too many of us, and too many more each year.
This particular topic carries something of a wince factor for me – a father of five! I usually enjoy the comfort of practicing what I preach. But then again, former drug users often make the best addiction counselors and some of the top obesity experts struggle with their own weight. I suppose I can come clean about population pressures despite having done such a poor job of keeping my own genes to myself!
I raise the issue because it’s ominously absent from the discourse in preventive medicine, public health, and public policy. Mum’s the word about the global population in almost all discussion of global warming and climate change; modern industrial agricultural practices; and the propagation and transmission of both infectious and chronic disease. This is odd, and worrisome. It suggests either obliviousness, fatalism, denial, ideological intransigence, or capitulation — and none of these is good!
I was quite stunned when I spoke last year at the Imagine Solutions Conference in Naples, FL, that my fellow speakers addressing the trials and tribulations of the planet spoke about a rapid ascent toward a global population of 9 billion or more as a fait accompli. Even though it was the driving force behind the problem they went on to discuss — depletion of the oceans, climate change, deforestation, etc. — it was not discussed as a problem in its own right. I had a similar impression when last I participated in the Aspen Ideas Festival.
If the harms of excessive global population have become a taboo topic, I didn’t get the memo.
There are more than six billion of us here now. I am inclined to think there is no problem nine billion could solve that six-plus-billion can’t. However, nine billion may BE the problem that the six-plus-billion need to solve, if we are to solve any other. Because the growing horde of us consuming the resources of the planet- not to mention eggs- in uniquely modern fashion is the problem underlying many other problems.
The massive demands and ramifications of an ever-more-massive human population may be the root of the roots of many of our most urgent crises. Certainly, it is the reason that 500,000,000 eggs were laid, packed, and shipped at the same time in the first place. And like most of the perils that fall within my preventive medicine purview, it is something we can address by means at our disposal, but only if we are cognizant of it, and willing to talk about it.
So blame the eggs if you are so inclined. Or blame the chickens. But frankly, I think something else comes first. We have met the enemy, and in our ever-increasing, ever more modern, ever more voracious multitudes, it is us! While 500,000,000 seems a big number, we actually have nine billion things to start talking about- the sooner, the better.
Dr. David L. Katz; www.davidkatzmd.com