Monday, March 10, 2008

Replacing the Fatropolis with Fit Towns

New `healthy towns' that encourage people to walk more, eat the right kind of food and stay forever fit take repression to a new level. Comment from Britain

`Salt `could fuel childhood obesity"' whispered one headline this week; `World is in obesity crisis' roared another. It seems barely a day passes without some report or policy announcement reminding us that the deep-fried fruits of modernity are dragging us to our gluttonous, sedentry doom. Change your ways, they exhort. However, if recent plans to redesign our towns as `fit towns' are anything to go by, instruction and guilt-tripping are giving way to something far more repressive.

The possibility of replanning and redesigning our towns in order to encourage healthy lifestyles was originally raised last November by UK health secretary, Alan Johnson. Citing `international evidence and research' that shows we `need a large-scale approach across the whole community to help tackle obesity' he suggested proposed eco-towns should also be made `healthy towns. through their layout, facilities and construction'. He concluded that our `built environment [must] do more to help people make physical activity a normal part of everyday life' (1).

In Boston last Sunday, the conference of the American Association for the Advancement of Science saw a similarly depressing nod to lifestyle management. Professor Philip James of the London School of Hygiene and Tropical Medicine and, more importantly, chairman of the Brave-New-World-sounding International Obesity Taskforce, declared: `The environment in which we live is the overwhelming factor amplifying the obesity epidemic'. He continued, arguing that it was na‹ve to place `the onus on individuals making "healthier choices" while the environment in which we live is the overwhelming factor amplifying the epidemic' (2). Rena Wing of Brown University echoed the pessimistic view of individuals' capacity to make what the holier-than-thou alliance of policy makers and experts deem the right choices: `We live in an obesogenic environment that relies heavily on fast food, automobiles and remote controls - all of which can be labelled as "toxic" to maintaining a healthy weight.' (3)

The overarching aim of remaking our fatropolises as fit-towns is all too clear: as we can't be trusted to make the correct decisions, we, the public, shall be forcibly diverted from the dual-carriage way of temptation on to the fully pedestrianised area of righteousness.

Admittedly, some of the measures suggested seem innocuous enough. Stairwells, for instance, should be made to look less like badly lit fire escapes and made a bit more glamorous, spiral perhaps. And parks should be better maintained, with better lighting. Other proposals, however, are all too restrictive. For instance, some of the proposed towns should give priority to pedestrians and cyclists over the car, perhaps providing office premises with bike-only parking. And the bane of the obesity warrior's crusade, the fast food outlet, must never be erected near parks or schools. (4)

Of course there is nothing especially novel about urban planning, nor its political underpinnings. Take Baron Haussmann's reconstruction of Paris between 1852 and 1870. With memories of the revolutionary commune of 1848 still fresh, Haussmann, under Napoleon III's instructions, demolished vast swathes of the city and built long, sweeping boulevards in their place. In doing so he both inhibited the erection of barricades and made it easy for the army to gain access. In other words the attempt to maintain social order was embodied in Parisians' lived environment.

Indeed, on a more general scale, our environment has long reflected the ruling needs of the moment. Richard Sennet in his 1997 book, The Fall of Public Man, saw in the bustling thoroughfares and concourses of the modern city the predominance of the private individual of bourgeois myth. Public space was made a mere function of private motion, of getting from a to b as quickly as possible. Strolling, meandering, and leisurely interacting with our fellows were incompatible with the manic industriousness demanded of the bourgeois individual.

Accepting that urban planning - the regulation of public space - or indeed, its absence, has always provided a mirror of society, then what does the notion of the fit town reflect? Whilst it is not concerned, as Napoleon III was, with the threat posed by social disorder, it is still dealing with a threat. This time however, the threat is not embodied in, say, the communards - it is not external at all. It is, rather, internal to each and every one of us. Fit towns combat our tendency to consume and to seek convenience - we are our own worst enemies. While fast food, remote controls or electric tooth brushes save labour, they're killing us.

Fit towns embody more than the war on obesity. They wage war on our consuming passions per se, be it a desire to light-up, to booze, or to go large on a Big Mac and fries. Above all they fight our tendency to err.

To borrow, then, from the increasingly martial lexicon of government policy, fit towns are located on the frontier of the war on error. The result, from the jarring positivity of phrases like the International Obesity Taskforce, or, indeed, the `fit town' itself is an environment every bit as deeply repressive as that evoked in their different ways by George Orwell or Aldous Huxley.


Heart disease: we need medicine not moralism

Fear of rising heart deaths is unfounded. And if we're serious about lowering the death rate even further, we need better treatment not lifestyle lectures

This week, a number of news headlines have highlighted the deadly threat of heart disease in Britain: `Bank crises "increase rate of heart attacks"`, warned the UK Guardian on Tuesday. The day before, The Times (London) cautioned that `Young adults' inactivity puts them at risk of heart attack'.

The Guardian report is based on research from the University of Cambridge. Data from the World Bank and World Health Organisation over a 40-year period was analysed at Cambridge, where the researchers concluded that between 1,280 and 5,130 Brits `could die from heart attacks if there was a widespread repeat of the Northern Rock banking crisis' (1). Lead researcher David Stuckler said: `To put this effect in perspective, this is more than 10 times the number of British troops who have died in Iraq.' The researchers found that `cardiac deaths surge briefly and regularly every time there is a systemic bank failure' and it is the elderly that are at greatest risk.

But those of us aged 35 to 54 had better not be too complacent, we're told, because our lives may be cut short by our `live-now' lifestyles. Simon Capewell, professor of clinical epidemiology at the University of Liverpool, said: `The flattening trends in mortality rates among young adults suggest that the cardiovascular disease epidemic is not being controlled.' He warned: `The party is over and complacency runs a high risk.'

Having recently lost both my mother and my uncle to heart disease, I am not about to advocate complacency. It is estimated that in the European Union, cardiovascular disease kills over two million people every year. Still, a little perspective would not go amiss. The fact is that despite the impression given by various newspaper headlines, heart disease is not on the rise. Instead, the concern voiced by some experts, and blown out of all proportion by others, is that the dramatic decrease in deaths from heart disease over the last few decades has started to flatten out.

In my view, the experts should be concerned. They should be continually trying to reduce deaths from heart disease. Clearly, a hell of lot more can be done to improve medical intervention: my mother died from a massive heart attack several months after being put on a waiting list for heart surgery. If she had been given the treatment she needed earlier she may still have been alive today. If the medical establishment could spend a little more time putting its own house in order and a little less time lecturing us about our `live-now' lifestyles, we may all be better off.

The warning that up to 5,000 people could lose their lives if we faced a massive banking crisis may be shocking. But these figures were arrived at using not-entirely-reliable computer models comparing associations between banking crises and cardiovascular disease deaths. Also, when we consider the Cambridge study's figures alongside the fact that there were 68,230 fewer deaths from heart disease in 2000 than there were in 1981 in England and Wales, the potential effect of a financial crisis no longer seems so shocking.

There was a 62 per cent reduction in deaths from heart disease among men and a 45 per cent reduction among women over two decades from 1981. Various factors have contributed to this dramatic decrease. A large-scale study in 2004 by Capewell indicates that 58 per cent of this decrease is due to a reduction in certain risk factors, such as smoking, and 42 per cent is due to the availability of more advanced medical and surgical treatments - although this study, too, was the product of a computer model (2). Today's heart scare is the result of scaremongers twisting what is actually a good news story: the dramatic decline in deaths from heart disease over the past 20 years. That this decline seems to be levelling off should be investigated, of course, but it should also be seen in the context of an overall successful war against death from heart disease.

We all know smoking is bad for us and don't need to be lectured any more about that. The effect of obesity and diet on our health and our hearts is much more uncertain and, to the extent that there is a problem, there is as yet no simple solution like there is with smoking - we can't exactly quit food. So, rather than telling us how to live, physicians should now concentrate on reducing mortality rates further by improving the availability and efficacy of medical intervention.



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

Even statistical correlations far stronger than anything found in medical research may disappear if more data is used. A remarkable example from Sociology:
"The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre's yield of cotton. He calculated the correlation coefficient between the two series at -0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic conditions and lynchings in Raper's data. Raper had the misfortune of stopping his analysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic conditions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added."
So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.

"What we should be doing is monitoring children from birth so we can detect any deviations from the norm at an early stage and action can be taken". Who said that? Joe Stalin? Adolf Hitler? Orwell's "Big Brother"? The Spanish Inquisition? Generalissimo Francisco Franco Bahamonde? None of those. It was Dr Colin Waine, chairman of Britain's National Obesity Forum. What a fine fellow!


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