Health Justice: Sugar-free, Please!

Recent moves by leaders in New York City and Richmond, California, to address damage caused by the dominance of sugar-laden beverages represent brave steps toward addressing mounting health injustice and should be applauded by everyone who supports good health in America.  

On May 30, New York Mayor, Michael Bloomberg proposed to ban sodas and other sugary drinks in containers 16 ounces or larger.  Municipal leaders in Richmond, Calif., also announced a November ballot initiative for a one-cent-per-ounce tax on sugar-sweetened beverages. Both measures aim to stem the growing incidence of obesity, diabetes and other ills linked, in part, to the flood of sugar poured by an industry, some are now calling Big Soda.

As in the case of Big Tobacco, proposals to improve the public’s health with awareness campaigns, bans or taxes have prompted the same old defense strategies among soft-drink-industry giants. They typically respond by offering one or more of the following:

  1. The Corporate Freedom Argument – Let market forces meet the public’s needs.
  2. The More Research Is Needed Argument – Where’s the evidence of negative health effects?
  3. The Affront To Personal Freedom Argument – Get the nanny-state out of the public’s way.
  4. The Class Warfare Argument – The poor are overburdened by such interventions.

While these arguments may hold some sway–with government trust at historic lows and faux science in vogue–they are invalid at best and at worst, represent willfully deceptive diversions.

Regarding business leadership on health, in the faces of growing pressure to contribute to the anti-obesity movement, the fast food industry has mostly made self-protective gestures. For example, while McDonald’s now offers a variety of salads and added apples to their Happy Meals and oatmeal for breakfast, their core menu remains high in fat and calories. The movie concession vendors push their version of value with soda sizes ranging from a “small” 16 ounce to “upgrades” all the way to 44 ounces (with 550 calories or more). And 7-Eleven’s 1.5 liter Double Gulp fountain drink (a repackaged version of the Extreme Gulp) holds up to 800 calories.

In terms of the research, the link between high soda consumption and negative health effects is overwhelming. And there’s a growing body of evidence that show price policies and attention to portion size can and do reduce consumption of sugary sodas and other beverages, which can play an important role in reducing rates of obesity and related conditions like diabetes.12345

Finally, I find the argument that encouraging the public (including the poor) to substitute soda for healthier choices is a discriminatory burden, to be the most troubling. Richmond, Calif., City Councilor, Courtland Boozé, a vocal opponent of the soda tax, is quoted as saying, “We are primarily an economically suppressed community. It will be a huge hardship.” I wonder if he’s considered the health burden levied on the youth of the Richmond community.

According Dr. Wendel Brunner, the local director of public health, 52 percent of the region’s elementary school students are overweight or obese. That’s an individual and community hardship that no one can afford.

According to Margo Wootan, Director of Nutrition Policy at the Center for Science in the Public Interest, “… sugary soft drinks are the number one source of calories in our diets. We get more calories from sodas and sugary drinks than any other individual food – cake, cookies, pizza, anything.”

My rebuttal to all these arguments against promoting less sugary drinks is that it’s time for a bigger helping of health justice. We need to create an environment where living healthy is the default choice. If asked, “Would you and your family like to live in a community where it’s easy to find good food that’s good for you at a good price?” Most of us would say, “Of course!” We all deserve equal access to the ingredients that help us live a good long life.

The proposed policies in New York City and Richmond, Calif., won’t fix the obesity problem on their own. But, they are bold steps in the right directions. Now that we’re focused on the value and cost of health and health care, it’s time to serve up some real health justice.

Powering the Lights: Building Resilience

It was a dark and stormy night last fall on the campus where I work. Actually, there were several dark nights that were uniquely memorable. Now that this academic year’s over, I find myself reflecting on those turbulent times and taking stock of their hidden blessings.
In the fall of 2011, Tropical Storm Irene hit. The storm challenged our college community in ways that staff, faculty, and, especially students, will (knowingly or unknowingly) celebrate for years to come. Don’t get me wrong, Irene certainly caused unwelcome destruction and harm for many. Still, most of our campus family – including our newest members – weathered the storm relatively well. In fact, I suggest that despite our wide-spread electrical failures, there were surges of power and light among campus-locked students and their evacuated friends.
From what I and colleagues saw, the storm presented stress that inspired many to shine despite the dark. Absent their laptops, phones, and internet, students plugged into their new community and found new strength. Adversity and challenge, in the right environment, can make people grow and glow. In this instance, the many storm stories of “glow in the dark” students serve as testament to their resiliency potential. After the storm passed, the job of staff, faculty and parents was and is to host an environment that enables students to sustain the power to persevere and light their own way ahead. Students’ job is to embrace the lights (the lessons) in the dark and apply them in the tests of today and tomorrow.

Beyond the campus, this story’s familiar. Most of us have shelves of dark and stormy night stories we relive when new adversity comes. Being in the dark is scary; especially when in unfamiliar territory. Sometimes we feel the best we can hope for is to live to tell the tale. But if we focus, our history illuminates lessons that help us “bounce back” and move forward. Ultimately, our job in crises is to tap into supports and energies; power the lights within and find the way to thrive. Our job is to build resilience and bounce back.

Bouncing back is the definition of resilience, as described in the article, Road to Resilience by the American Psychological Association (APA). Resilience is “the process of adapting well in the face of adversity, trauma, tragedy [or] threats …” It involves believes and behaviors that can be learned and developed. According to the article’s authors, research shows resilience to be “ordinary, not extraordinary” with people commonly exhibiting actions indicative of resilience. Consider how individuals and communities rebuilt their lives after Hurricane Katrina and the September 11, 2001 terrorist attacks. So we can all develop and strengthen our resilience. Here’s a summary of the APA’s resilience building strategies (For more information check the APA link): 

  1. Make connections. Accepting help and support from those who care about you and will listen to you strengthens resilience. Assisting others in their time of need also can benefit the helper.
  2. Avoid seeing crises as insurmountable problems. You can’t change the fact that highly stressful events happen, but you can change how you interpret and respond to these events. 
  3. Accept that change is a part of living. Accepting circumstances that cannot be changed can help you focus on circumstances that you can alter.
  4. Move toward your goals. Develop some realistic goals. Do something regularly — even if it seems like a small accomplishment — that enables you to move toward your goals. 
  5. Take decisive actions. Take decisive actions, rather than detaching completely from problems and stresses and wishing they would just go away.
  6. Look for opportunities for self-discovery. People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss. 
  7. Nurture a positive view of yourself. Developing confidence in your ability to solve problems and trusting your instincts helps build resilience.
  8. Keep things in perspective. Even when facing very painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion.
  9. Maintain a hopeful outlook. An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear.
  10. Take care of yourself. Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing. Exercise regularly. Taking care of yourself helps to keep your mind and body primed to deal with situations that require resilience.


In sum, the weather of life can be unpredictably dark and troubling. Harnessing your life challenges and tapping into the resilience building strategies discussed here will build resilience. Resilience that will light your way forward and prepare you to weather the next storm with all the light and power you need. Be well. 
     

Move It or Lose It: The Tin Man Effect

If we lived in Oz we’d be screwed. Especially if we descended from any of the story characters native to the L.O.Z. (Land of Oz). For instance, assuming the Lion’s challenges were genetic, as distant cousins we could suffer from a spectrum of phobias and fortitude failures. As part of the Scarecrow’s tribe, I imagine we’d have all manner of orthopedic challenges, vulnerable to stuffing loss at the most inopportune times. And as Tin Men and Women, you and I would rust up, frozen in our tracks, whenever it rained or we stood still for too long. Thankfully, we live in the real world.

But, the Tin Man Effect is still in play. 
If we stay still too long, we’re screwed. I define the Tin Man Effect simply with the old expression “move it or lose it.” In this case, the less you move physically, the more you lose in health. When inactivity becomes habit, we rust up (in a sense), slow down and become less vital. Like Oz’s Tin Man, the effects of inactivity sneak up on us, slowly damaging our machinery and disabling our capacity. If you’re an older model human (like me), you know the T-Man’s pain; if you haven’t experienced it, you’ve surely witnessed it. The life pattern is common. As kids, we’re bundles of energy, playing from dawn to dusk. But as adulthood sets in, our circle of work and responsibility grows and our circle of active play withers. The less we move, the harder it is to get moving … and before you know it, … Bam! (or rather, creak, creak)! … The Tin Man Effect is in effect! But an oil can won’t fix the ills of our inertia. The negative consequences of inactivity include: high blood pressure, heart disease, obesity, diabetes, depression, fatigue, osteoporosis and respiratory conditions. Regular physical activity can help boost energy; control weight; reduce the risk of cardiac disease, diabetes and some cancers; improve mental health and mood, strengthen bones and muscles and ultimately, extend your life.

The Wizard told the moral of the Oz story and ours: “… you had it in you all along …” And that’s good news for most. You don’t need some magical instructions or a wizard’s blessing to tap into your birthright of lifelong locomotion. It’s really never too late to shake off the rust and return to your natural state of action. Here are ten simple guidelines for starting and continuing an active lifestyle:

10 Principles for Active Living:

  1. Make small activity-promises you can keep, then keep them (e.g., “I’ll walk around the block twice this week”).
  2. Find a safe and comfortable place where you can work your plan without worry or inhibition.
  3. Start with small doses of activity and increase the amount slowly over time, as it feels right.
  4. Some activity is always better than no activity.
  5. Team up with family, a friend, or co-worker to support each other and keep you moving forward.
  6. Keep it fun and fresh by mixing up activities and exploring new options.
  7. Invest in your new exercise habit by eating better.
  8. Balance exercise and other activities with sufficient rest.
  9. Be good to yourself and others by praising successes and forgiving challenges.
  10. Keep your gumption on and don’t give up – you’re worth it!

These are resources that will help you get moving:

So, thankfully there’s no need to sweat the perils of Oz. But here in today’s world you need the brains, courage and heart to protect your health. Remember, move it or lose it. Beware of the Tin Man Effect!

******************************************************************************

And finally, here’s some extra information that the public health nerd in me had to share:  
We’re not alone. According to the World Health Organization, globally about 31% of those 15 years and older were “insufficiently active” in 2008 (women 34% and men 28%). The greatest prevalence of inactivity was in the Americas and in the Eastern Mediterranean regions. In both these regions 50% of women were inactive, while the prevalence of male inactivity was 40% in the Americas and 36% in the Eastern Mediterranean. The Southeast Asian region has the lowest percentage of insufficiently active (women 19%, men 15%). In the U.S., a 2008 Centers for Disease Control and Prevention (CDC) survey found that about 25% of adults did no physical activity during their free time (e.g., walking for exercise, gardening, golfing or running). Residents living in parts of Appalachia and the South were the most inactive. Alaska, Vermont, Wisconsin and Wyoming were among the more active states. Worldwide, approximately 3.2 million deaths are attributed to insufficient physical activity each year.



“Come On Out Fat Albert!”

Fat Albert & the Cosby Kids was the first black animated cartoon (1972-1985)

I was a fat kid. Big boneded, my mother used to say. For the most part, being fat at 12 wasn’t really a big deal for me. Don’t get me wrong, I knew I was big and was reminded of it often. Going to the “Husky” section of Sear with my Nana to buy corduroys was mortifying. Even worse, was hearing my friend say, “Hey! Hey! Hey! Here comes Craig!” when they heard the “weeeka, weeeka, weeeka” sound of my corduroyed thighs coming toward them. Still, I was a happy kid living in the ‘hood with good friends and a loving family. And, I secretly loved the Fat Albert comparison.

Fat Albert was my favorite cartoon. For those of you born after the era of four TV channels and Saturday morning cartoons, Fat Albert and the Cosby Kids was a popular cartoon in the early 70′s and 80′s. The show was sparked by a classic Bill Cosby comedy bit about a neighborhood game called, Buck Buck (something like Red Rover) that featured a giant neighbor kid – Fat Albert – who was so big he could literally squash any apposing Buck Buck team. Fat Albert always announced himself with a hearty, “Hey! Hey! Hey!” He made fat cool. He was the rare big boy who could do it all – play sports, sing, make you laugh, and he always saved the day. If cartoon characters could be heros, Fat Albert was mine. Probably because I saw him in my mirror. I couldn’t touch my other favorites: Batman, The Flash, Spiderman, The Green Hornet. But, Fat Albert was a hero nearer to my world. He didn’t have much, but he was popular and happy; everybody’s go-to-guy, AND he was larger than most lives (i.e. real fat!).

Those were the good ol’ days. Back then in Fat Albert’s world (and mine) fat was not a concern. The word “fat” didn’t have the social weight it carries today. I don’t remember Fat Albert’s fatness ever being mentioned on the show – his health was never an issue. If he suffered from the friction rash that plagued my thighs, he didn’t complain. And he certainly showed no signs of asthma, diabetes, or heart disease. The dude didn’t even sweat (Is that a superpower?)!  In the 70′s and 80′s weight was not the public health issue it is now. Husky departments were pretty small and hard to find. In truth, I was never as big as Fat Albert and as a kid I never saw a person his size. The word “obese” was rarely known or used.

But the world changed and so did I. The teasing “Hey! Hey! Hey’s!” were no longer funny and I was less comfortable in the skin I was in. So, to make a long story short, I began walking and then I began running and eating better and I lost so much weight between the ninth and tenth grades that many didn’t recognize me. My discovery of exercise lead to an interest in nutrition and a growing need to understand how my body works and how I could help it work better. My hunger for health knowledge launched my academic and professional careers and my commitment to health care and health promotion.

In 1985 Fat Albert was canceled, I became a nurse and things looked different. In retrospect, there were warning signs of things to come. I saw a growing number of patients with a constellation of preventable conditions including hypertension, heart disease, respiratory issues and diabetes. What’s more, patients were also growing in size. The overweight became the obese and then the morbidly obese. Obesity begot diabetes, limb amputations, strokes and sleep apnea, and on and on. Patients we saw once, we saw again and again. The once obscure word “obesity” was slowing becaming an epidemic. Fast forward to now, typing this post through a public health lens, I can’t help but wish I and others knew then what we know now. That the rising incidence of adult (and later childhood) diseases would be so connected to our societal, environmental and personal choices; and that it all would be so preventable, so persistent and so costly. I’m not sure the overweight kid I was in the 60′s and 70′s could have the same unobstructed health success in today’s environment. At the same time, even though Fat Albert and the simpler world of my childhood are gone, I am hopeful. That’s because many, my age and younger, from diverse backgrounds and disciplines, see these health challenges clearer than ever before. We’re bringing unprecedented levels of creativity and passion to the root causes and outcomes of obesity … and we’re making a difference. Interestingly enough, we need Fat Albert’s judgeless optimistic spirit now more than ever. I like to think he’s with me and the growing gangs of health promoters aimed at the challenges ahead. Maybe he’s still here. Can you see him? Can you hear him? … “Buck buck number six come in!” … “Come on out Fat Albert!” … “Hey! Hey! Hey!”

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