Prof. Henry Becker on the critical changes needed to avert the
national health crisis
Like most Western countries, and increasingly the rest of the world,
Canada faces a staggering, swelling burden of medical costs that challenge its
ability to maintain the quality, comprehensiveness and universality of health
care services. In April 1991, the federal government set up a Commission on the
Future of Health Care in Canada, headed by Roy J. Romanow. Its mandate was to
review medicare, engage Canadians in a national dialogue on its future, and
deliver recommendations for enhancing the systems quality and
sustainability. The Final Report of the Commission, Building on Values: The
Future of Health Care in Canada, was published in November 2002 (http://www.hc-sc.gc.ca/english/care/romanow/).
Unfortunately this otherwise laudable, public-spirited and thorough study falls
far short of its stated goals.
Not one title among the 40 discussion papers commissioned from scholars,
policy analysts and experts across Canada and internationally mentions
Although Romanow acknowledges in his preface to the report that, "it is
common sense for our health care system to place a greater emphasis on
preventing disease and on promoting healthy lifestyles", only 7 out of 354
pages deal with prevention, and the greater part of that on the evils of
tobacco and on vaccinations.
The report presents 47 recommendations, of which only three relate to
preventionone on reducing tobacco use and obesity, another on promoting
physical activity, and the third on a national immunisation strategy. This
projects and encourages, in my view, a most unfortunate skewing of priorities
that is not in the public interest.
The Canadian situation has much broader relevance, as the diseases of
industrial civilisation have taken hold and health care systems are bending
under the load nearly everywhere. Significantly, a United Nations study in 1999
found the prevalence of overweight and obesitya strong predictor of
chronic ill health and shortened lifespanto be increasing alarmingly in
the developing countries as well as the developed, and particularly among
children. A worldwide epidemic of obesity has been recognized, spread by
globalisation and penetrating to the remotest corners of the world.
The nature of the beast
During the past century, the common afflictions in Western societies
have dramatically shifted from infectious to degenerative diseases. Infectious
diseases were subdued largely by public health measures: improvement in
housing, provision of clean water and air, sanitary waste disposal, quarantine
of the infected, etc. Rise in living standards and education also helped.
Medical interventions such as vaccinations and increasingly potent drugs came
relatively late, but in todays public imagination, they get the major
credit for ridding us of infectious diseases.
Infectious diseases typically strike in unpredictable waves, or
epidemics. Degenerative diseases, however, have typically risen from small
beginnings and grown nearly exponentially to a level where much of the
population is chronically afflicted. Today these diseases are the major burden
on our health care system, and their proliferation the main cause of spiralling
We are what we eat
While some degenerative diseases have occurred in various societies
throughout history, those which most vex us now, such as cardiovascular
disease, inflammatory bowel disease, type II diabetes, asthma and many cancers,
were rare or virtually unknown a mere 80 years ago. Cases of myocardial
infarction (heart attack), for instance, began to appear in the 1920s and grew
decade by decade to epidemic proportions. Most degenerative diseases are not
caused by disease vectors such as micro-organisms or viruses. They are
primarily due to lifestyle factors of both the individual and
various layers of society and, as such, are highly preventable. These factors
include faulty food, dietary immoderation, abuse of harmful substances,
physical inactivity, disturbed biorhythms, environmental deterioration, social
breakdown and poverty.
The most important determinant of health is food. Just as good nutrition
is vital for a healthy immune system, faulty food is implicated in the
infectious diseases. In his book The Wheel of Life, first published in
1938, G. T. Wrench observed, "The inescapable conclusion is that in a very
large number of diseases faulty food is the primary cause. The suspicion is
that faulty food is the primary cause of such an overwhelming mass of disease
that it may prove to be simply the primary cause of disease [in
Hippocrates taught, "Let thy food be thy medicine". The corollary we
must learn is, "Let not thy food be thy sickener!"
Its important to realise there were once whole
populationsnot just individuals here and thereflourishing in states
of robust good health and virtual absence of disease. That is not a utopian
myth, but well-established fact. The evidence is compelling that our
hunter-gatherer paleolithic ancestors who subsisted mainly on animals
supplemented with such wild plant foods as were availabletender leaves
and stems, roots, fruits and nuts, but virtually no grainstypically had
fine physiques and enjoyed remarkable freedom from degenerative disorders. Sea
foods appeared to be particularly valuable, and there is a growing school that
argues these were pivotal in the special development of the human brain.
Since the Neolithic (agricultural) revolution 10 000 years ago, many
agricultural communities that maintained a sufficient animal component (fish,
meat, milk, cheese) in their diets also achieved excellent health. Examples of
healthy communities have extended into our own time, though in rapidly
diminishing numbers. They have been scientifically observed and documented,
most notably by Weston A. Price (Nutrition and Physical Degeneration,
first published in 1939), Sir Robert McCarrison (Studies in Deficiency
Diseases, 1921; Nutrition and national health, in J. Royal Soc. of
Arts, 1936), and Viljhalmur Stefansson (The Fat of the Land, 1956;
Food and food habits in Alaska and Northern Canada, in Human Nutrition,
Historic and Scientific, 1958)
These lessons of the past demonstrate whats possible for human
health, and what can be achieved again. The foods eaten by healthy peoples of
the past were perforce "organic", as no others existed before modern
industrialised agriculture. They were whole, fresh and completely natural. The
genius of industrial civilisation has been to introduce a vast array of highly
processed foodstuffs that are anything but whole, fresh or natural.
Attention is paid to packaging, appearance, presentation, palatability,
uniformity, convenience, transportability, shelf life andit must be
saidaddictiveness, while almost wholly ignoring the crucial issues of
nutritional value. A gigantic middlemanthe processed food industry
now stands between the consumer and the primary producer (the farmers,
ranchers, fishers, etc.) and profits richly from economic value added.
The consumer buys these products, which are typically heavily promoted, and
pays the predictable price of nutritional value subtracted, i.e.,
The growth of degenerative disease is an indubitable economic burden on
society as a whole, but enterprising parties have skilfully exploited that as
an opportunity for profit. This gave birth to the pharmaceutical industry,
another mega enterprise of our times. The main effect of the industrialisation
of medicine on degenerative diseases is palliative rather than curative,
usually with many adverse side effects. As with processed foods, the
manufacturers interest is overwhelmingly the pursuit of profit.
Finally, the "health care" system has come to rest on acceptance of
degenerative diseases as inevitable features of life and the medical treatment
of symptoms as the normal response to this grim reality. There is, to be sure,
an ongoing quest for "cures", e.g., the "war on cancer", but what it mostly
accomplishes is to produce ever more drugs that fall well short of the
ever-receding goal of cure but succeed at return on investment.
Physicians are indoctrinated in and co-opted into this defeatist
paradigm by their basic training, and reinforced by their continuing education
at the hands of the pharmaceutical companies. Thus, the people we should expect
to tackle the plague of degenerative disease at its sources, instead act like
firemen who have strategically decided not much can be done to stop fires from
happening, so its best to downplay prevention and concentrate on
Our lifestyle failings
So how did we get here? These are some in the long list of our
Excessive intake of carbohydrates, particularly those leading to high
blood sugar (sugars, flour, potatoes, white rice, etc.).
Excessive energy intake (too many calories), exacerbated by the trend
to super-sizing of portions of fast foods, snack foods, soft drinks, etc.
Consumption of partially hydrogenated fats and oils; consumption of
overheated and rancid fats and oils; excessive intake of omega-6 fatty acids (a
major component of many common vegetable oils, excepting flaxseed, olive and
some nut oils).
Consumption of most processed foods. The main ingredients of many
include white flour and sugars, partially hydrogenated oils or fats, which are
further compromised by the absence, loss or damage of vital nutrients, impaired
digestibility, and incorporation of nutritionally questionable additives
(fillers, extenders, thickeners, stabilisers, preservatives, flavourings, dyes,
etc.). Most products offered by fast-food outlets rate in this category.
Inadequate intake of omega-3 fatty acids (major components of
flaxseed oil and of marine fats and oils).
Inadequate total intake of high quality fat. Contrary to recent
prevailing wisdom, this includes natural animal fats.
Inadequate intake of high quality protein. A high carbohydrate,
low-fat diet easily becomes a low-protein diet.
Inadequate intake of water.
Inadequate intakes of various minerals, vitamins and other
micronutrients. Many whole foods today are very deficient relative to earlier
examples, or compared to good organic products. Diets high in processed foods
are particularly likely to be inadequate.
Inadequate exposure to sunshine, leading, among other effects, to
widespread vitamin D deficiency.
Inadequate levels of physical activity.
Inadequate rest and disturbed circadian rhythms, due to shift work,
long work hours, too much noise, bad habits such as late-night TV, etc.
Pollution of soil, water, air and food with agro-chemicals,
industrial chemicals and various other noxious substances.
Immoderate intake of alcohol, use of recreational drugs, etc.
Hugely excessive use of pharmaceuticalsboth over-the-counter
Poverty, particularly when associated with highly uneven distribution
of income, which is rapidly growing almost everywhere.
Stress of unsatisfying work, or of unemployment.
Breakdown of family and community life.
What to do
I shall limit myself here to addressing nutrition, the single biggest
determinant of health.
A paradigm change is needed in medicine
"Orthodox" physicians have too long based their practice principally on
knowing drugs. To prevent or effectively treat the degenerative diseases,
they must know food and make it their primary instrument. These diseases
are largely caused by faulty food, and curesto the extent
possibledepend largely on the prescription of the right food. The
education of physicians has too long neglected nutrition. Physicians should, in
fact, be thoroughly acquainted with all the lifestyle factors that
promote health or precipitate disease. Although still a minority, a growing
number of physicians are already committed to prevention and cure by lifestyle
modification. Currently, their practice is commonly referred to as
"alternative", but it is time for them to become the main stream.
Major changes needed in the field of applied nutrition and
There are many things very wrong today in applied nutrition and the
nutritional goals set for citizens by authorities such as Health Canada.
Standards such as Canadas Food Rules and the USDA. Food Pyramid are badly
skewed and need drastic revision. The obsession with the alleged dangers of
dietary saturated fats and cholesterol is a proven but persistent and egregious
folly. Theres nothing wrong with sound natural fats. Nor is there
anything wrong with beef and lamb, with all their fat, if the animals are
healthily raised and not dosed with antibiotics and hormones. There are,
though, truly bad fats that indeed do contribute to degenerative diseases:
synthetic fats; partially hydrogenated fats; oxidised and rancid fats; and
excesses of omega-6 fatty acids. Carbohydrates have been hugely over-promoted;
the healthiest amount of sugar is none, and white flour products arent
much better. Processed foods should be revealed for what they are: mainly junk,
dangerous to health, and never a fit substitute for whole, natural foods.
Synthetic foods, such as soft drinks, are typically slow poison. I can hardly
begin to list all the reforms desirable in nutritional teaching and
consultation. It is essential to get the story right according the best
knowledge of the facts, and to stay open to correction by new findings. It is
also necessary to get the story out so the public is well informed,
without kow-towing to industrial interests (processed foods, agrobusiness).
Optimum nutrition must be our aim
Optimum nutrition is especially crucial for good outcomes during
conception, pregnancy, infancy and childhood, the whole process in which new
humans are moulded for better or worse. Canada should be vigorous in providing
parents with supportive information, programmes, resources and assistance.
Lifelong good nutrition is the foundation of a healthy and happy old age. But
even when many years have been lived in poor nutrition, appropriate changes in
diet can still ameliorate much of the damage done and greatly diminish needs
for medical treatment. The nutritional quality and adequacy of food served in
homes for the aged should be a matter for public concern and government
Optimum nutrition is not uniquely defined, diversity and
individuality must be respected
Canada has citizens with ancestry in all regions of the world: central
African and south Asian, Mediterranean, North European, and from recent
hunter-gatherer to 10 000-year experience of agriculture. Thus there is a broad
range of food tolerances and intolerances that should be taken into account
rather than prescribing a one-size-fits-all. The case of Canadas first
nations is especially notable for suffering from the foods of industrial
civilisation in high rates of type II diabetes, cardiovascular disease, etc.
Generally, everyone is an individual with characteristics that may deviate
substantially from the average and merit special attention. One of the jobs of
the enlightened physician will be to discover those individual vulnerabilities
and needs and help the patient make due adjustments.
Public institutions must set an example
Publicly funded hospitals and institutions of education, and cafeterias
and restaurants in government buildings, should lead by behaving as models of
excellence in the foods offered on their premises. Currently, a minority of
schools, colleges and universities offer their students healthy food and drink.
Many, however, have admitted fast food outlets to their halls, with monetary
benefit to the institution but a great disbenefit for the health and food
habits of students and staff. Utterly scandalous are the deals with cola
Huge reforms needed in agriculture and animal husbandry
A return to wholly organic operation is needed to put an end to the
incidental poisoning of land, water, air, people and most other life forms.
Todays high-input "modern" agriculture is simply mining the land, sapping
future productivity for the sake of temporary monetary gain. Its not
sustainable. Further, the concentration of animal production on factory farms
should be stopped and production redispersed over the land. Animals should be
raised humanely and in such a way that they are naturally healthy. Grazing
animals should be raised largely by grazing; it is part of what gives their
meat and milk high quality. Much greater attention should be paid to raising
the nutritional quality of farm, ranch and market garden products.
Government must ensure quality in food supply
Government should not hesitate to use its powers of regulation,
inspection and stimulation to ensure high quality in the food supply. Programs
to recognise and promote quality, such as is happening with Canadian wines and
Québec cheeses, should be expanded to other products. Quality production
should be encouraged. The nutritional implications of any food processing
should be evaluated by competent agencies and adjustments required to ensure
acceptable nutritional outcomes.
National and provincial laboratories need to be reinvigorated
They should be given a new mandate and funding to effectively serve the
public interest with appropriate research in nutrition, testing of foods and
drugs, etc. Their primary concern should be protecting and informing the
public, rather than assisting industry and promoting business. The
government should also fund a number of university research Chairs and/or
Institutes specifically to work on questions of food and nutrition that are of
significant national or local importance.
In order to deliver health, we must deliver good food through
implementing sweeping changes in medical education and goals, food and
agriculture and government policies. We may still need as many physicians, if
they indeed become guardians of our health rather than managers of disease.
Economies will result primarily from vastly reduced demands for diagnostics,
hospital care and other patient services, and medical therapies (medications,
radiotherapy, etc.). Sales of pharmaceuticals may plummet, but the sacrifice of
this economic activity will be happily endured as part of the price of better
health. The same may be said of major sectors of the processed food
The many people who regard degenerative disease as an inevitable feature
of living are wrong. Weve seen these diseases proliferating and appearing
earlier and earlier in life, so young children are now succumbing to obesity,
Type II diabetes and even cardiovascular disease. However, if the needed
reforms are made, onset of such diseases can be retarded and relegated to
extreme old age, and indeed most of these diseases need not be commonly
experienced at all. The choice is ours.
The author is Professor Emeritus of Chemical Engineering,
Queens University, Kingston, Canada. This paper is based on his
submission to the Romanow Commission and a forthcoming book.