Friday, June 20, 2003

Healthy Living - If I was the Premier of PEI If I was the Premier sitting in cabinet and I was serious about Islanders becoming healthier what would I do? I would divide the issue into two. I would look at what Government could do directly and then I would look at how government could influence behaviour indirectly. At the core I would position the issue as being behavioural and I would focus the direct and indirect work on levers that influence our behaviour. The Direct Approach Sugar The research is in that sugar and simple carbs are the main culprit in both adding the pounds and in creating the addiction and system changes. The best analogy is tobacco. For years we all thought that smoking was cool. Now we know it is at the heart of our public health crisis. The same is true for sugar. We all grew up drinking pop. Smart parents gave their children juice in the bottle. As we became time- stressed, we relied increasingly on processed foods where a large ingredient is always sugar. It will be Government's job to help us all understand that sugar is possibly a larger threat to our public and personal health than tobacco. The irony is that we have done this job for fat but our fears have largely, not entirely, been misplaced. Low fat as an idea has been a goldmine for the food processors. I would start with getting agreement with the other Premiers who all have health systems that are groaning under the pressure, to begin the same type of information campaign about sugar as with tobacco - the objective will be to shift our perception that sugar is ok to that it is a risk. We would then nationally build a campaign using real people whose lives had been turned around by getting off a high sugar/carb lifestyle to tell us how much better they were. This would not be a campaign of experts but of neighbours. Key to the campaign would be mothers talking to mothers about the risks of a high sugar diet for their kids and giving them tips on the alternatives. The habits begin here. What failed in tobacco was the expert talking down. What worked was a neighbour telling us that we as smokers would harm not ourselves but innocent bartenders. With a shift in public opinion we would have the room to begin to act. School Kids are bused home on PEI between 2.30 and 3. Most parents work and do not get home until 5.30 - 6. Madness! I would set up a sports program for all kids that would extend until 5pm. There is no shortage of gyms, rinks grounds. The shortage is a universal program of sport for children that fits the school day and that fits the reality of the workday for parents. The objective is twofold to significantly increase the weekly rate of activity and to set the habit of taking exercise as a lifetime habit This strategy would be inclusive and broaden the effort from elite sports and elite players. It would still get behind the school teams but would offer a comfortable place for all types School meals - I would set up a healthy breakfast club at school. Many Kids miss breakfast - time pressed, no habit or worse no money. Breakfast is arguably the most important meal of the day. This meal would be billed to public health. This would be a real meal and would avoid Mr Kellogg and Mr Tim Horton. Ban soft drink vending machines - Coke has preyed upon poor school boards with deals on vending that are driven by volume. I would teach cooking and nutrition as part of the core curriculum especially for the younger kids. One of the reasons so many eat only processed or junk food is that no one knows how to cook anymore. Again we aim to create the habit of cooking and we teach nutrition not from a book but from learning how to cook well and to enjoy what we have cooked. Waste, Labelling & Taxation - A Counter Attack on Food processing As part of my communication partnership with the other premiers I would also get national agreement to push back at food processors. They have taken over food and they spend over 10 billion dollars a year in the US to persuade us to eat their products. I would move on two fronts. Packaging and labelling. - I would use the inventory management software of the distributor to track the items and I would give the industry 3 years to eliminate waste that could not be recycled easily and to reduce waste as a percentage. After three years I would double or triple the PST on packaging that failed this test. In other words I would push back at waste at the source. At the same time I would demand, as with tobacco, that health warnings be put on all processed food and in places that served it that contained high levels of sugar/Carbs/trans fats. So at MCD you would see a sign on your pop cup that told you that you were taking a big risk in drinking more than one of these a day. Your pack of Sugar Pops would have a picture of a person giving themselves an insulin shot and so on. Very significantly I would include formula in this program. Formula should have a large health warning linked to obesity. I would not change the tax rates for three years as so many are addicted and are poor and feel that they have no alternative. But then after the 3 year public relations war, I would bring in a series of significant tax hikes. Significant so that there would be no room for adjustment. Such a health tax might be a flat tax of say $2.00 an item so a can of pop would go up $2.00. I would also ban all ads everywhere that promoted high sugar/carb/trans fat foods  Of course the food industry will go nuts. This is why only a national agreement will work. The alternative is to pay for the costs of an obese nation. We are winning the war on tobacco - why not for food? Let's be clear here, the food giants are acting in their own interest and not ours.They are the main driver in the dietary problem that we face as a society. They can be part of the solution as well. The smart ones will take that root- our time pressure will not go away - there will be  a huge market for healthier alternatives The Indirect Approach Young Children - We have to change behaviour and to set new habits when we are malleable enough to respond. This means a focus on very young children and their parents. Most of the current effort on obesity and many other issues that are most plastic in early life, such as literacy,  are being tackled with a focus on adults where changing behaviour is most challenging. I think that this is because those that have set themselves up as the experts, such as the university and the Heart and Stroke folks, obviously live in a world of adults and would like to help their constituency. But if strategy is defined as making the best choices, then we have to shift our focus to young children and those that influence them most, their family, the school system and the ad budgets of the food processors Prenatal classes are an excellent channel. Parents are at the most ready to learn and have the most energy.  The whole issue of diet needs to be explored perhaps with the meeting taking place around a kitchen table as well as on the floor with pillows. All aspects of diet especially the breast/bottle issue need to be explored Family resource centres should be identified as the next channel as they influence parents right after they have their babies Day care should be examined to ensure that it is aligned as well. The point being that by the time children get to school in grade 1, there should be 7 years of focused effort on setting up good habits at home. This is a strategy. What do you think of it? 8:14:10 AM    comment []

How we eat - Changing the habit of a lifetime Is the PEI Healthy Living Strategy a Paper Tiger or will it help? The questions we need to ask are 1. What is the trend for obesity - frightening about 59% of Islanders are at least overweight 2. Is the trend accelerating or flattening out - accelerating exponentially 3. What is the potential impact now and in the future - one view would be to look at the incidence of type II diabetes and its related costs? Our health system will be overwhelmed. Type II diabetes has been normed from being a rarity to being on track to include 30% of the population. It has a myriad of poor outcomes and side effects and consumes a huge amount of system resources. It can be mitigated though by a radical change in lifestyle - giving up carbs and taking more exercise. Hard things to do until we have the motive of diabetes. But even then, many are so habituated that they cannot change. 4. What are the key factors for a lifestyle - habits! How and when are these set? Is this genetic or habit based?  What are the 2-3 habits that are most deleterious? I would look at the amount of sugar/carbs that we feed to kids - tests with rats show a high sugar/carb diet fattens like no other and creates addiction. After all we fatten cows on corn =sugar. The tests show also that a genetic switch is thrown and obesity/diabetes tendency will be embedded in the next generation. What is at the heart of our inactivity? Why do some kids stay active and others don't? What is different from the activity levels of kids 30 years ago and now - busing, TV sport etc. These are powerful questions which are not being looked at by the strategy. The healthy living strategy sounds good on the surface but is essentially flawed in my mind. How? They did not think about the deep reasons. The process behind it - let's all get together and shout more loudly that we should eat better and take more exercise. We can all say - we don't take enough exercise or we don't eat the right foods. We can all expose each other to more information about why we should change but without addressing the deep reasons why, we are wasting our time. Government do this all the time - they confuse intellectual heavy lifting with consulting the community. If the Heart and Stroke folks were doing such a good job, why are deaths from this area on the rise? A lesson for us all. If you see a problem and think that you will solve it by asking all the current "suspects" how to fix it - you will go no where. Why - because they are all inside the problem themselves and will only be able to see the the issues from the aspect of the problem Eating and exercise are habits. These habits have a powerful grip on us and are formed when we are very young. We will find the answers when we look at how we as parents set the habits at home and at the habits set at school. What do we habitually put on the table? Do we give toddlers lots of juice thinking that this is a good thing and not understanding that we are setting the palate. How big a role does pop play in our house? Do we all eat a lot of processed food especially breads, cakes and cookies? Do you eat margarine rather than butter? Is the TV the main baby sitting aide? How big a role is TV in our lives? Do we sit around at home and take little or no exercise? What is our habit for the kid's lunch box.? Does our local school have a deal with Coke and have a drink machine on the premises. What food is served at school. What exercise do our kids take as a matter of course at school? I have hardly mentioned the big bugaboo - fat. The evidence is in. The addictive substance and the substance that is at the core of the problem is sugar/carbs. You don't believe me? Then correlate the rise in obesity with the rise in the consumption of sugar/carbs. At the turn of the century the average American ate two pounds of sugar. Do you know what it is now? 160 pounds, and for many of us it's probably twice that. The human body didn't evolve to handle that kind of input. The pancreas works overtime to flood your system with insulin several times a day, every day. By the end of each day, it's completely exhausted and your bloodstream is still jacked up with dangerously elevated levels of sugar. Eventually your pancreas functionality is borderline to failure and you've got adult-onset diabetes. Eventually it fails for good and suddenly you're a diabetic. A study about a year ago got a lot of press. It showed that a child who drank two cans of soda a day WILL be overweight. That's two cans of soda, not "lots of high fat foods." At the turn of the century something like 2 or 3 percent of people were dying from heart attacks and stroke. What is it now? 70% and rising? You don't go from 2% to 70% with a slight decline in lifetime physical activity. But what about a typical lifetime sugar (carbohydrate) consumption increase of eight thousand percent? What do YOU think the connection is? 6:29:38 AM    comment []