We are on the verge of a major change in the health system both here in New Zealand and in the wider world. We face to sad paradox – while an estimated 870 million people are under nourished, over 1.4 billion are over weight. Both phenomena create consequent health problems, causing human misery and depleting our resources. Fortunately an increasing number of us are gaining more nuanced appreciation of this problem. It is clear that the problem of excessive weight is as much about the quality of food eaten, as its quantity.
The industrialisation of the globe has generated huge benefits for us and supported the development of modern health services. But consequent changes in our diet and lifestyle are eroding and even negating these benefits. We eat too much energy dense and nutrient poor, over-processed food.
A paradigm shift
It is helpful to understand the forces at work through the concept of the paradigm shift. Thomas Kuhn coined the term in his book The Structure of Scientific Revolutions in 1962. He argued that rather than evolving steadily, science progresses through periods of revolution and orthodoxy. After the revolution, a new scientific orthodoxy is established, but over time becomes resistant to change and new influences. The next revolution will only happen when the sheer quantity of new information and thinking displaces the old.
The dynamics of a paradigm change
We are approaching this point now. Industrialisation has provided us with convenience foods that are highly processed and nutrient poor – much of the nutrition in food simply doesn’t survive through processing and distribution systems. The health system has largely accommodated this situation and accepted it as “normal”. In Western economies, the majority of health resources go into dealing with the consequences of poor nutrition (this is still contentious, but it is not the focus of this article to argue this point). And incidentally, many health professionals and health service and supply industries benefit financially while the situation persists. Another force that supports this paradigm is the food industry that produces this “fake food”. Based on ineffectual public policy, it also appears that the majority of policy makers are embedded in this paradigm.
The new paradigm is based on the understanding that eating nutrient rich food that is minimally processed supports our health. One of the main forces supporting this change is the Internet. The exchange of scientific and clinical information about nutrition is intensifying exponentially and is available to an ever-increasing group of health literate users. These people can find supportive health professionals in their communities and online. Some cafés and restaurants are following the trend and providing nutritious and tasty food.
The broader sustainability movement supports this new paradigm. Approximately 26% of the New Zealand population fits the Lifestyles of Health and Sustainability (LOHAS) market demographic. The Living LOHAS report describes the demographic:
LOHAS aligned consumers look behind products and services to an Hippocratic oath assessing whether they should buy a given product or service. They probe for alignment of organisational intent. Authenticity of the offer is mandatory and the company is mandatory. LOHAS consumers want to know “where does it come?”, “how is it made?”, “what is it packaged in?” and “what will happen when I dispose of it?”.
Imagine the health we will enjoy when we embed this new thinking in health systems adding to the known benefits of industrial age healthcare – hygiene, infection control, appropriate surgery and physical trauma treatments for example.
The ethical challenge
The story of the two stonecutters illustrates the ethical paradox many health professionals face.
A man once encountered two stonecutters and asked the first “What are you doing?” He replied, “cutting a stone”. When the second stonecutter was asked, he replied “I’m building a cathedral”.
We have plenty of very competent and dedicated health professionals who are skilfully and diligently cutting their own stones. Its not so easy to find those who can find cognitive space for both their specialist skills and an overview of the system’s effectiveness. While practising ethically in their own professional space, they participate in a system that inflicts damage on society and an increasing burden on taxpayers. Where are the cathedral builders?
Engaging to change
For those of us who wish to promote a health revolution, engagement is a key to change. In the discursive battle that accompanies any significant paradigm change, it is easy for the antagonists to dichotomise, but this often leads to entrenched and reactionary views. Niki Harré’s excellent book Psychology for a Better World, suggests that people need to be engaged emotionally to further any worthwhile cause. She also emphasises the need for the need for positive example – leading by example.
I changed my diet for the better on being diagnosed as pre-diabetic. These changes helped me to lose 13 kgs in four months. The health benefits for me have been so dramatic that I need little motivation to stay on this path. In my journey I have found good friends with good advice, a rich resource on the Internet and supportive health professionals.
My work provides opportunities to work with health professionals and community health activists creating a rich matrix of people wanting change. We need to seek out those health professionals who can see the bigger picture and work together for change. Thus two avenues of change are created, a grass roots led change and , sooner or later, policy change.
What do you think?
Here are some of the materials that I have found useful. Gareth Morgan is a New Zealand economist who puts his massive intellect to work on various social issues. His book Appetite for Destruction elaborates on the dangers of “fake food”. He also provides an economist’s perspective on how a government might profit from a radical overhaul of health funding, including taxing “fake food”.
Several competent physicians provide mountains of information on health and nutrition:
The Green Med Info website includes a huge resource of research papers on health and nutrition.