I say Epidemic – You say Fear Mongering

By Ted Bruce

Debates on public health issues are a staple of life. Unfortunately, they often involve a false dichotomy. Those promoting individual choice argue that public health advocates are “no fun” trying to create a “nanny state” by banning all those tasty treats and indulgences like cheap happy hours and supersized pop. On the other hand, those seeking regulation may too readily use scare tactics in support of their arguments. I’ve been known to demonstrate this tendency myself. For example I may have been a bit over the top in arguing that those in favour of the new alcohol regulations in BC think that there’s nothing wrong “with a couple cheap double rum and supersized cokes after work to set you up for the drive home from work”. Who needs evidence when you can undermine your opponent with an “insightful” analysis like that?

When we get beyond the rhetoric though, these debates are critical as they force us to bring evidence to bear on an issue and help to educate the public about the need for important public health measures. A good example at the moment is the current debate on electronic cigarettes and whether they are actually a good thing because they may help some people reduce their addiction to tobacco. It is actually a critical issue and is becoming a well informed debate with better evidence and clearer arguments on both sides.

What we sometimes forget, however, is the importance of stopping long enough to recognize our past accomplishments and highlighting these. By demonstrating the value of population health interventions we can better help people understand the need for public health policies. This is especially important when pejorative statements like “nanny state” or “government paternalism” are used to counter public health evidence. The image of public health is an important commodity in winning the public over to effective interventions. In the electronic cigarette debate, actions to restrict electronic cigarettes may move quickly because of the credibility of public health that comes from the tobacco story we tell. The Canadian Public Health Association’s campaign on the greatest public health accomplishments is a good example of building trust in public health.

obesity report

A recently released report by the Fraser Institute on obesity in Canada has been slammed by many in the public health community.

The importance of celebrating our successes and using these in shaping a case for public health interventions was brought home to me by the recent Fraser Institute report on obesity in Canada. They analyzed a very selective data set on weights to suggest that there is no need for public health interventions that they describe as “government paternalism” – yes they invoke that language to shore up their case – to deal with what they argue is not an epidemic of obesity. (It is worth noting that in the report they also characterize Canadian anti-smoking efforts as an “increasingly draconian war on the tobacco industry”.) There are many available critiques of the Fraser Institute report discrediting many of the arguments they put forward but an important one was by the Canadian Public Health Association and the Dieticians of Canada. Notable in this response is the comment on the success in combating obesity and the need to do even more.

It would be easy to rant about the Fraser Institute report being biased. It is important to critique their arguments and evidence to show where it is wrong. But as importantly, we must reinforce the successes of population health approaches to build confidence and trust in the voice of public health. Rhetoric is loud and can hide the evidence the public Ted Profileneeds to consider. Public health builds a credible voice by speaking out on its successes and demonstrating its value. It is this credibility that helps the public take the time to examine the evidence and draw sound conclusions. Sometimes it is important to brag a little.

– Ted Bruce is the past-president of the PHABC

Further Reading:

Obesity is a Public Health Concern | Dieticians of Canada – News Release | April 28, 2014 | http://www.dietitians.ca/News-Releases/2014/ObesityPublicHealth.aspx

12 Great Acheivements in Public Health | Canaidan Public Health Association | http://www.cpha.ca/en/programs/history/achievements.aspx

Obesity in Canada: Overstated Problems, Misguided Policy Solutions | The Fraser Institute | April 28 2014 | https://www.fraserinstitute.org/research-news/display.aspx?id=21119

In the News:

Canada’s obesity ‘epidemic’ exaggerated and the health risks overstated, Fraser Institute says | By Sharon Kirkey | The National Post | April 28 2014 | http://news.nationalpost.com/2014/04/28/canadas-obesity-epidemic-exaggerated-and-the-health-risks-overstated-fraser-institute-says/

Cancer Prevention Works – Time for a New Health Care Paradigm

By Ted Bruce

The cancer community has done a remarkable job of documenting the importance of prevention. They estimate that 50% of cancers are preventable and have an active campaign to encourage provincial government action on prevention. Learn more via the Canadian Cancer Society’s (BC & Yukon) Cancer Gameplan Election website.

Think about that number: 50%. Compare it to the 3% of health care we devote to public health preventive efforts.

The cancer community’s understanding and commitment to prevention is likely influenced by the remarkable story around tobacco reduction. A public health approach to tobacco reduction is a model that we can use to tackle a range of deadly and costly chronic diseases. But it comes at a price. The victories in the battle against smoking related diseases did not solely come from anti-smoking awareness and public education campaigns. In fact the amount of funding available for these types of campaigns is almost laughable compared to what industry spends marketing what we know are unhealthy products – a great deal of this marketing aimed a kids. Although we have seen prohibitions on advertising cigarettes in Canada, the food industry provides an example of the marketing battleground. The Ontario Healthy Kids Panel report No Time to Wait was unable to calculate the actual expenditure on food advertising aimed at children but they quote one study showing that “ four food ads per hour were shown during children’s peak television viewing times and six food ads per hour were shown during non-peak times. Approximately 83 per cent of those ads were for “non-core” foods and 24 per cent of food ads were for fast food restaurants.”[1]

The Prevention Institute, a non-profit organization in the US, quoting a Federal Trade Commission Report states that the fast food industry spends more than $5 million every day marketing unhealthy foods to children. A full fact sheet on marketing foods and beverages to children is available on their website.

The tobacco battle has shown us that effective prevention programming incorporates a variety of strategies including taxation to affect price, marketing regulations, enforcement and efforts to change the environment to deter consumption. The National Collaborating Centre on Healthy Public Policy has an informative interactive timeline that is worth a look to see the long and hard fought battle over tobacco.

It is most important to understand, however, that tobacco reduction efforts required human resources for leadership, advocacy, policy development,  program development and program delivery. And there are just not enough of these resources available in the public health system to do the job for the chronic disease epidemic we are facing.

Is the battle against smoking related disease and death over? Not by a long shot. Smoking rates may have come down but we know they can go lower. And sadly in some populations smoking rates are still at very high levels with estimates that some groups smoke at 2 to 3 times the overall rate. Learn more through Health Canada’s Canadian Tobacco Use Monitoring Survey.

We need to shift our thinking to support the cancer community’s prevention efforts. And we need to realize that cancer prevention is about more than tobacco. Chemicals in our environment, sedentary behaviour and poor diets are contributors to cancer. The time is overdue for a comprehensive prevention effort. Our political leaders need to have a vision for the future. Why is it good enough to prevent children being exposed to tobacco yet we tolerate an “in your face” obesity promoting environment for children. It is time to dream big and to put in place the human resources we need to realize that dream. We can all take a lesson from the efforts to prevent cancer. We need to shift to a new health and health care paradigm built on prevention.

–  Ted Bruce is the past-president of the Public Health Association of British Columbia.

[1] Kelly B, Halford JCG, Boyland E, Chapman K, Bautista-Castaño I, Berg C, et al. (2010). Television food advertising to children: A global perspective. Am J Public Health. 2010;100(9):1730-5