by Marion Nestle
Jul 6 2012

A food politics thought for the weekend: treatment vs. prevention

I’ve been at meetings in London and Geneva on non-communicable (what we call chronic) diseases and how to prevent them. 

On the way to Europe, I did some catching up on reading past issues of The Lancet and ran across this letter from Sally Casswell of the School of Public Health at Massey University in Auckland. 

Professor Casswell was responding to an article arguing that a major priority in chronic disease prevention should be to strengthen the capacity of countries to deliver primary care services.

Yes, professor Casswell writes, primary care is important.  But it is even more important to focus prevention efforts on the environmental factors that influence the behavior of individuals and cause them to need primary care services in the first place.

Do we really want to continue to live in a world where the oversupply and marketing of tobacco, alcohol, unhealthy processed foods, and soft drinks is tolerated simply to allow continuing profits for the shareholders of the transnational corporations producing and distributing them, while the taxpayer funds the health services and pharmaceutical response to the ensuing disease and injury?

This is a refreshing way to look at this problem, and one well worth pondering.

  • Anthro

    That is certainly my view!

    So, I’m off to a healthy road trip–taking all my own food in my little trailer–across most of the country. I’m even taking a kale plant in a pot! You just can’t pick up good (lacinato–the “dinosaur” kind) any old place. I’d like to take a chicken as well, but…

  • FarmerJane

    Have fun, Anthro! With Walmart now handling some 25% of the US food retail, this seems like an almost impossible trap for us to get out of. Even the presidents of the most powerful dairy coops testified at hearings that Walmart has such massive power that they can even slap food giants like Dean Foods around, pushing for cheaper milk, who in turn exert downward pressure on the farmers prices. I imagine it is the same in other real foods and also the so-called “foods.” Does anybody have information on how Walmart is growing worldwide and where?

  • The issue comes with the government nutritional guidelines that are not only wrong, but devastatingly so!

    The last thing we need is MOAR government involved in our health! They are responsible for turning the U.S. into one big fat camp with their low fat diet recommendations!

  • Brandon

    -1 Graham. The issue is that there is no money in prevention.

  • I can see where pharmaceutical companies benefit from sick Americans, but what I’ve never understood: where are the health insurance companies? They are gambling on our health, they have a horse in this race. Why aren’t they taking on these issues?

  • brad

    Michele’s point is good: in fact there is money to be made in prevention, or at least money to be saved, and it’s in the insurance industry’s interest to beef up prevention. Years ago I was in an HMO health plan, and that’s exactly what they did: your first visit to your doctor lasted a full hour, and the doctor spent most of the time talking about diet, exercise, and general health tips. The HMO also sent out a periodic newsletter with tips and advice on healthy living. How many people paid attention to that advice? My guess is not many.

    And that’s the problem: education only gets us a small part of the way. You also have to approach it from the other end by making it harder for people to engage in unhealthy behaviors: make it harder for people to take up smoking or maintain the habit, make it harder (or more expensive) for them to buy soft drinks and junk food, etc.

  • I can agree with that, Brandon.

  • I am glad to read that someone is coming out and telling it exactly like it is. Another (simpler) way of putting it is: do we really want to live in a world where our health is damaged to make other people rich?

  • Margeretrc

    Interesting question. But what’s the solution? A George Orwellian world (or country) where everything that is “bad” for us is outlawed? I’d rather see the subsidies that make a lot of bad stuff cheap disappear and education based on actual science promoted. Then let consumers take it from there, just as they did after learning (even though it isn’t true) that fat is bad for us and started demanding low and no fat products, which subsequently flooded the market–leading to our current problems. End the war on fat and ramp up the (educational) war on sugar and processed junk.

  • Doug

    Gosh, this argument sounds like the same argument that the livestock industries uses to justify its use of subtherapeutic antibiotics….to prevent disease. See there is money to be made in prevention….

  • James

    Is there no room for enjoying a sugar-sweetened beverage around here? I agree that overconsumption is a problem, but let’s not throw the baby out with the bathwater. Limits on advertising seem prudent, particularly on ads focused on children, but the fact is that in addition to shareholders, many consumers derive considerable pleasure from consuming these beverages. Should we really ban them? Isn’t there a realistic middle ground?

  • Benboom

    Of course the is a realistic middle ground; it’s just that it needs to be a lot closer to the consumer than to the producer. And your comment can also be answered with a reductio ad absurdum argument that shows just what thin ground you are treading on: many addicts derive considerable pleasure from consuming heroin. Should we really ban it? Isn’t there a realistic middle ground?

  • Benboom

    Of course there is a realistic middle ground; it’s just that it needs to be a lot closer to the consumer than to the producer. And your comment can also be answered with a reductio ad absurdum argument that shows just what thin ground you are treading on: many addicts derive considerable pleasure from consuming heroin. Should we really ban it? Isn’t there a realistic middle ground?

  • James

    Not too impressed by your analogy, Benboom: is soda that analogous to heroin?

  • Tom

    Good question.

  • Education isn’t the answer, we all know that too much sugar and fat is bad for us, the problem is this food is readily available, cheap and pushed at us all the time through marketing. The cost of diabetes and CVD will be huge in the near future. Every day I see more and more people for prediabetes. The reason there is an obesity epidemic is because our food environment has changed. Changing our food environment is what will help turn this around. I wonder when governments will take action.

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  • I could not agree more. Recently, on NPR, I listened to a report about how soft drink and junk food companies are already contaminating the diets of the most remote areas in South America — places that don’t have great health care, including dentists. Children in these areas are now suffering from bad dental problems — something that was unseen even 10 years ago.

    Something needs to be done about all of this. It really needs to start with the individual. We need to learn more about how these products affect our bodies, our health and our world at large. The answer is not health care — the answer is better nutrition, education on nutrition, information on cheap modern food and its effects, etc., etc.

    So I completely agree with Professor Casswell. And thank you Marion for all your blog and all your work!! Felicidades!


    Irene from

  • Prevention of disease is good because the quality of a healthy life is better than the quality of an unhealthy life.
    Sometimes prevention may actually cost money. It’s no different than money spent on other improvements to quality of life. Prevention does not have to have a positive “return on investment” in order for it to be worthwhile. It has to provide value to the person in exchange for the money spent on it. Of course, when it does save money, so much the better.