WPHNA World Public Health Nutrition Association

The pictures here are iconic. They are of the same woman, in her 20s and in her 60s, one knowing that she is already famous, the other looking like she is contemplating her death, which did come soon afterwards. One picture predicts the other, for pictures of the young Susan Sontag, whose writing I celebrate here, and who wrote of the meaning and power of photographs, often showed her smoking. Like dressing in black, this was part of her style. The one time we met, an event in my life, ended in London’s Sloane Square with her ‘borrowing’ money from me. She was that kind of a woman.

My first items this month are gossips from the Porto congress that took place late last month. Then there is a meditation on what ‘nourishment’ means, and on psychotropic substances, which includes some thoughts on smoking – thus Susan Sontag. The column ends with what may become a regular thought for the month.

Conference formats: Debates
Ways to confront controversy

Debates, were the most stimulating and innovative feature of the Porto congress. There were a grand total of ten. Topics ranged from ‘There are good reasons for phasing out the worldwide vitamin A capsule programme’ (motion carried 25:3, turned round dramatically from a ‘pre-vote’ of 10:15), to ‘The use of ready to eat foods should be scaled up rapidly’ (no vote take, which was rum), to ‘Ultra-processed foods are adverse to human health’ (motion carried 30:0). These sessions, parallel usually with half-a-dozen others, each were attended by 80-100 people. So as the numbers above indicate, most did not vote one way or the other. I guess because the debate format is an innovation.

The debate in which I participated, as proposer, was ‘It is best to be small’, with David Pelletier of Cornell University as opponent. Who won? Well, convenors Aryeh Stein and Juan Rivera required a pre-vote before the presentations, as a ‘baseline’. Perhaps bemused, only seven people put up their hands, all against my motion. Part of my task was to be reasonably precise about what was meant by ‘small’ – populations significantly shorter and lighter that now or as recommended. What I then did is mainly to rely on the environmental impact of being big. Measured in terms of cattle, a world population that, because of being small, turned over 10 per cent energy than now recommended, would save 150 million cows a year. Measured as hamburgers, the figure is 15,000 billion a year. Savings on oil, water and greenhouse gas emission are also awesome – or would be. I quoted John Waterlow, writing in 1998: ‘If everyone were to achieve the height now common in industrialised countries, the height explosion would be almost as disastrous as the population explosion, carrying with it the need not only for more food, but for more clothing, more space, more natural resources of all kinds’.

The case for being big – tall rather than fat – is in terms of the biological dimension, which is what David Pelletier relied on. Generally, it is firmly agreed that small babies, especially if so small as to be defined as ‘stunted’ or ‘wasted’, are vulnerable – more likely to die. Also, being tall evidently protects against heart disease, though the story with some cancers is that it is better to be short. One of my bottom lines was: ‘What matters most, heart attacks or human survival?’ The final vote was 14:15. So David Pelletier won by one vote (bah!), but in contrast with the baseline, I achieved a smash turn-round (hah!). Pity about the overall numbers, in all the debates, for this seems to show that most public health nutritionists prefer to sit on fences.

Conferences
Suddenly so many!

Public health nutrition conferences are now bustin’ out all over. As you’ll know from this month’s issue of our website, the Association, with the Brazilian national public health organisation Abrasco, is mounting the next congress in Rio de Janeiro at the end of April 2012. But Lluis Serra-Majem of SENC, the Spanish society for community nutrition, is persisting in putting on his third world congress after Barcelona 2006 and Porto 2010. This will be held in his own academic base in the Canary Islands. Lluis tells me that Las Palmas 2014 will have a connection with Dakar in Senegal, and one day on the programme will be held on a boat-trip from the Canaries to Africa.

Lluis and his SENC colleagues are happy to accept sponsorships and other material support from that sector of the food and drink industry whose profits depend on products that are harmful to public health, and also to plan conference sessions jointly with processed food and drink manufactures like Nestlé, whose advertisement was on the back cover of the Porto conference programme. By contrast, the Association and Abrasco, in planning Rio 2012, will not seek or accept support from conflicted industry. Is there space for international public health nutrition conferences every two years, bearing in mind also that the next International Conference on Nutrition will be held in Grenada, Spain , in 2013? This seems unlikely to me. (Also please see the editorials in this and last month’s issue of World Nutrition).

Public health nutritionists
Social responsibility of science

So far, nutrition conferences have built-in biases. One is caused by their penetration by conflicted industry. Another is that the great majority of those who participate in conferences are citizens of, or work in, high-income countries. During a Porto session on ‘malnutrition in all its forms’, I began my intervention by requesting of a room with about 80 people present, that everybody there who had been born and brought in a rural area in Africa and Asia, raise their hands. Four showed. One problem, I said, with interventions designed to address malnutrition, is that almost by definition, they are top-down, epitomised by the phrase used by ready to use therapeutic food (RUTF) champion Mark Manary – ‘we wanna fix the problem’.

Finally I said what many people at Porto and previous conferences have wanted to say. Why do these meetings take place apparently oblivious to what’s actually happening in Iraq, Afghanistan, and many sub-Saharan countries? Now is the time for the profession of public health nutrition to find its collective conscience, as did nuclear scientists after the first atom bombs were dropped on Hiroshima and Nagasaki. Population nutritional health and well-being will really be possible in many countries only after they are no longer invaded, arms sales are banned, and their external debt is cancelled. And? Well, I got a lot of applause from a number of people in the room.

Recreational drugs. Psychotropic substances
What is nourishment?

Gentle reader, you may be thinking – perhaps not for the first time – that my columns are in part a preposterous game in which I introduce a topic that cannot possibly have anything to do with public health nutrition, and then seek to persuade myself and hopefully also you of its relevance. Last month exotic singers and dancers from Paris and Rio de Janeiro, this month a literary diva from New York. What next, Santa Claus? What has Susan Sontag’s smoking got to do with nutrition? Patience! As a clue, it depends what is meant by ‘nutrition’ and ‘nourishment’.

Cigarette smoking is unusual, in being an addictive toxic habit whose pleasures are far, far outweighed by its risks. It is much too dangerous, plainly more so than any other recreational drug. Its reputation has been blackened, like so many tar-smeared lungs, by the outrageous hanky-panky of the Big Tobacco companies, as wicked in their ways as the US and UK governments’ policies concerning Iraq and Afghanistan.

In my 20s and 30s I flirted with and flitted from Sobranie to Gitanes to Marlboro (as I also did with and from Cointreau to Pastis to Jack Daniels) depending on where I was and with whom, and how I tried to define myself. Between the 1920s and the 1960s, convenient accessories were the name of the style game. In my smoking days I thought that cigarettes aided concentration; but now I think that for a smoker, it is lack of cigarettes that impedes concentration. As you see, at the time of writing I am still around, after flushing my last half-smoked pack down the pan in a mid-town New York City hotel nearly 30 years ago. Here’s continuing to hope that the carcinogenic properties of tobacco fade away.

My friend and fellow columnist Fabio Gomes puts sweetened cola and other soft drinks in the same category as tobacco. This is I think a bit strong. Soft drinkers don’t make other people fat by breathing on them, and cancer of the airways is worse than obesity. But I see what he means. Cola and such-like sweetened soft drinks are also products about which nothing good can be said. They are fun, say their manufacturers. Really? Without incessant glamorisation by advertising, would people consume Coke™ or Pepsi™? Surely far less. Indeed, without advertising, some of which is of the most insidious and indefensible types, would young children consume sugared breakfast ‘cereals’? Perhaps, for ‘free’ sugars do have addictive qualities. But a lot less, that’s for sure.

The place of booze

Alcohol seems different to me. Exclusion of alcohol from consideration of diet in societies where alcoholic drinks are sanctioned and also part of their history and culture, just seems silly to me. Yes, alcohol also has addictive qualities, and other down-sides. Alcoholism, with all its consequences, is indeed a major public health problem.

But alcohol is also mildly psychotropic – and I say ‘but’, because it seems to me, as to many others, that substances with the power to induce altered or enriched or heightened mental or emotional states are, for this reason, a kind of nourishment. Many ‘creative types’, such as novelists, poets, painters, and actors (and maybe nutrition scientists, who knows?) knock back a lot of booze. Is their work better as a result? That is to say, are they intellectually and emotionally nourished by alcohol? Often no, I reckon, and eventually, usually no. But sometimes – and I think this cannot seriously be denied – yes, they are. Indeed, sometimes the special quality that makes the difference between good art and great art is fuelled by ethanol, or else – and I am coming to these – other mind-altering substances.

Aha! Here, you see, is the connection. Cigarettes are not nourishment. But let’s allow the thought that whisky is, or let’s be rather more cautious and say it can be. (As may be wild, wild women, but only in a broader sense, for they are not inhaled; nor, in a usual sense, despite The Song of Solomon, do their lovers eat or drink them).

Blowing our minds

Why are mind-altering substances, of the types we ingest, usually not counted as nourishment? (1) Perhaps this is for three reasons. One is that as conventionally taught, nutrition is concerned only with physical impacts (2). Two is that nutrients are usually seen as substances that supply energy as well as having other qualities (3). Three, as suggested by Colin Tudge (4), is Puritanism: anything that makes us feel good must be bad, and therefore banned from the textbooks and curricula, or else classified as ‘drugs’ or ‘toxins’.

Alcohol is not the best choice of nourishment for the mind, heart and spirit. Better choices, as Colin Tudge also suggests, are hashish or mescal, used respectively as part of the culture of Islam and of various Native American nations (5). Both are illegal in most countries, of course.

What about danger? In our mission to preserve and improve public health, long length of life should not be our only aim (6). What is most precious is less easy to measure. Certainly, we need to maintain responsibility as family members, particularly if we are parents or providers. Nevertheless perhaps, as Aldous Huxley proposes (5), fulfilling our human potential requires the use of psychotropic substances. The mystics who inspired a number of religions, including Christianity, were frequently if not habitually ‘out of their skulls’. Indeed, we contain our very own endogenous mind-bending substances. Try fasting for forty days and forty nights, in or out of the wild, and you will see what I am saying.

References and footnotes

Although they are, in Alice in Wonderland. Remember the injunctions ‘Eat Me’ and ‘Drink Me’? Was Charles Lutwedge Dodgson On Something, when he drafted his masterpiece? Opium was commonly smoked, eaten or drunk at that time. You’ll remember that Karl Marx said that religion is the opium (not the booze) of the people. Much great art has been achieved under the influence of opium in its various forms, Samuel Taylor Coleridge’s Kubla Khan, frequently voted one of the top ten poems of all time, being just one well-known example.
But actually, it isn’t. Conventional nutrition scientists have been comfortable with the proposition that iron deficiency impedes children’s behaviour and performance at school, for quite a long time now. The implications of this admission are tremendous.
But this doesn’t work either, because in that case alcohol (ethanol) has to be defined as a nutrient, and vitamins and trace elements, which are always classed as nutrients, supply no energy.
Tudge C. Functional food, pharmacological impoverishment, and why ‘In biology nothing makes sense except in the light of evolution’. Given in 1999 at the Royal Society as a Caroline Walker lecture, now accessible on: www.colintudge.com. Colin has been brooding on the topic of ‘toxins’ and nutrients for a long time – see also Tudge C. You are what you eat. New Scientist, 3 April 1986. He is also interested in the effect of fermentation as enhancing the nourishment of foods and drinks. This item here is strongly influenced by Colin’s thinking, though he may not agree with all I suggest.
As see Huxley A. The Doors of Perception. New York: Harper, 1954. The rock’n’roll band The Doors named themselves after this book and its messages, and their singer Jim Morrison’s line ‘Break on through to the other side’ was a reference to Huxley, and to William Blake, from whom Huxley took the title of his book. Jim Morrison is a particularly bad advertisement for alcohol, which Huxley did not recommend: booze made him chaotic and bloated, and contributed to his death in Paris aged 27.
The ‘population explosion’ has three aspects. First, there are more and more people, and we know this is a bad thing. Second and third, people are getting bigger and living longer, and we usually think this is a good thing, obesity and dementia aside. Perhaps we should think again, and prefer and plan for a small human race that has a much better time during their life, and on average dies around the age of say 60. Just a thought…

Philanthropy
The nature of charity

Perhaps the most overrated virtue in our list of shoddy virtues is that of
giving. Giving builds up the ego of the giver; makes him superior and
higher and larger than the receiver. Nearly always, giving is selfish pleasure, and in many cases is a downright destructive and evil thing. One has only to remember some of the wolfish financiers who spend two thirds of their lives clawing a fortune out of the guts of society and the latter third pushing it back.

It is not enough to suppose that their philanthropy is a kind of frightened restitution, or that their nature changes when they have enough. Such a nature never has enough and natures do not change that readily. I think that the impulse is the same in both cases. For giving can bring the same sense of superiority as getting does, and philanthropy may be another kind of spiritual avarice.

John Steinbeck

In August this year, 40 US billionaires pledged to give at least half of their wealth to charity(1). ‘By giving, we inspire others to give of themselves’ said Michael Bloomberg, who is also New York City mayor. The international media coverage encouraged viewers and readers to feel pleased and grateful. How nice that rich people are kind!

Hm. Half a $US billion (or in the case of Mayor Bloomberg according to Forbes in 2009 $US 17 billion) is still a fair screw, for any entourage and family. Most ‘ordinary’ people have little to spare – and these days, rather less than before ‘market’ deregulation enabled and created a new generation of robber barons, most notably in Russia, where public, social and family services have been raped.

Might well-publicised acts of massive individual benevolence be a factor in the decisions of governments to lower taxes, or to reduce the supply of public money to public institutions? Might very rich people achieve positions of elected political power? Might unelected others also use their ‘benevolence’ as a means of meddling in public affairs? Might such phenomena muddle public policies and confuse public servants?(2). Well, nothing is perfect, and variety is a spice, and worse things happen, but as my late son Ben (who once worked for Goldman Sachs) used to say in response to rhetorical questions of this type, do bears shit in the woods?

To sound even more ungrateful, shouldn’t we be asking questions about the laws and regulations (or lack of these) that enable the most ruthless, aggressive and lucky of what are usually the initially most privileged members of the human species to become filthy rich?

Many thanks to David McCoy of University College, London, for the above quote, from the Nobel Prizewinning author of The Grapes of Wrath, Cannery Row, and East of Eden, who also wrote the script for Viva Zapata! John Steinbeck is saying that we should not idolise rich people who give away some of their money, motivated or not in part by tax breaks. He also is doubting the virtue of charity itself, as a creator of dependency and a perpetuator and perpetrator of inequity. Knowing that there are people who are worse off than us makes us feel good, and giving them money or materials (or ‘of ourselves’) may make us feel better, but what they are in most need of, is justice. That’s the charge.

Reference

Clark A. 40 US billionaires pledge to give away half their fortunes to charity. The Guardian, 4 August 2010.
Edwards M. Small Change. Why Business Won’t Save the World. New York: McGraw Hill, 2010. See also at www.demos.org

Request and acknowledgement

You are invited please to respond, comment, disagree, as you wish. Please use the response facility below. You are free to make use of the material in this column, provided you acknowledge the Association, and me please, and cite the Association’s website.

Please cite as: Cannon G. Ways to confront controversy, and other items. [Column] Website of the World Public Health Nutrition Association, October 2010. Obtainable at www.wphna.org.

The opinions expressed in all contributions to the website of the World Public Health Nutrition Association (the Association) including its journal World Nutrition, are those of their authors. They should not be taken to be the view or policy of the Association, or of any of its affiliated or associated bodies, unless this is explicitly stated.

This column is reviewed by Barrie Margetts and Fabio Gomes. My thanks also and always to Google, Wikipedia, and the astonishing Guardian On-Line.

geoffreycannon@aol.com