[Posted on 19 August, 2019 by David Eberhard]
I host a radio podcast called “Hälsa för ohälsosamma”, in other words “Health for the unhealthy”, where the aim is to engage experts and politicians in discussions about health issues. We’ve talked about nutrition and which kinds of food are healthy and which are not. We’ve discussed the effects of exercise with various experts. Alcohol and tobacco have naturally been addressed as well, as have a whole range of other topics.
One thing that quickly becomes apparent when talking to politicians about these issues is that ideology – not science – often dictates the decisions that all of us ultimately have to live by. Another thing I can’t help but realise is how hard it is to address various types of health problems associated with unhealthy lifestyles. And how little we actually know.
However, it certainly does seem that the large majority of people are leading increasingly healthy lives. Even so, regulations are becoming more and more rigorous. Restrictions on whatever unhealthy and destructive things we might do virtually always affect all of us, one way or the other. However, the effects of these regulations are complex and contradictory; it isn’t entirely clear that harsher restrictions actually lead to a decrease in consumption or associated negative effects. For example, Swedes are drinking less and less these days, even though alcohol is more easily accessible now than it was fifty years ago. And yet, alcohol-related injuries seem to steadily remain at the same rate. Their distribution is skewed and affect certain marginalised groups disproportionately.
We smoke less than any other country in the EU, although not because cigarettes are more expensive but rather because many people use snus instead. Even so, snus is heavily taxed and costs consumers just as much as cigarettes. A number of organisations supported through public means equivocate snus with cigarettes. This likely causes many people to not realise how much less dangerous snus actually is – at least judging by a recent poll where shockingly few knew the difference between the effects of the two products. Thus, many people wouldn’t dream of switching from cigarettes to snus, even though one is a hundred times more harmful than the other. But it gets even more complicated. We Swedes live just as long as people in Italy, France and Spain, and they all smoke much more than we do. Surely it must have something to do with that Mediterranean diet we’re always hearing about. Then again, that diet varies quite a bit from country to country, so it must obviously be something else they do as well to avoid dying prematurely. You know, even though the smokers in all of these countries tend to die younger than their non-smoking counterparts.
The people who keep smoking are often part of a group with many other problems. Compared to the population at large they exercise less and have unhealthy diets, as well as less education and more mental problems. Also, they tend to die much earlier. Unhealthy lifestyles have come to be closely associated with mental problems. It isn’t always so obvious which of the two gives rise to the other, nor is it necessarily clear what a healthy lifestyle actually entails. Many of the studies lauding the merits of exercise are based on pure epidemiology, and obviously exercising isn’t as easy to someone who is already sick. How healthy is exercise, anyway? And what would be the optimal level? Isn’t there some kind of upper limit? After all, quite a few people have died while running the marathon. Too much exercise is a source of stress for many, as is the nagging sense that one isn’t exercising enough. The effect of pushing others to exercise might just as easily be disheartening as emboldening – it’s very hard to know for sure.
The same might to a certain extent be said about alcohol. What is a safe, reasonable level? That is up for debate, but we do know that too much alcohol is definitely very harmful. We also know that people who drink too much very often tend to suffer from poor mental health. But does the alcohol function as a way of self-medicating a psychiatric diagnosis or does it in fact bring about psychiatric issues? Well, in this case the answer is most certainly both.
As for food, however, figuring out what is good or bad for you is actually much harder than most nutritional science books tend to let on. The truth is that what works for one person might not work for someone else. Tons of bold, prophetic proclamations on this topic – everything from the wonder of broccoli to the magic of turmeric – seem to have no basis whatsoever in scientific research. What does seem rather healthy is that famous Mediterranean diet I mentioned earlier. Healthy enough to statistically compensate for something as harmful as smoking, even. But this once again begs the question what a Mediterranean diet in fact is. The widely recommended Swedish version of it skips the red wine – we wouldn’t want to romanticise alcohol, right? Then again, how can we be sure that the wine isn’t the very thing that’s good for us? Or that it at least has an overall positive impact on our health? There are many studies suggesting that this is indeed the case. And would it really be wise to round out such a diet with a hearty breakfast? We know that people around the Mediterranean certainly don’t. Are we even sure that humans are built to eat three meals a day? I doubt most of us were doing that around the dawn of our species. Back then, humans usually got by on nothing for long periods of time before virtually gorging themselves on whatever they happened to find.
Knowing anything for sure about these issues seems next to impossible. The only recurring theme regardless of field is the increased mortality rate among people with mental illnesses and psychosocial problems. These groups are hard to reach, whether through legislation, taxes, public information or popular science literature. I suppose it’s natural that people who don’t feel too well tend to not care as much about their health. We need to find good methods of helping these groups towards healthier lifestyles, because all of our efforts thus far really haven’t been very successful.
The best way might be to create new ideals that would attract even those who have no desire to be like the middle class. If so, we need to be conscious of which ideals we’re promoting. A good starting point would be to do everything possible to make sure that smokers start using snus instead. If people would stop being so afraid of saturated fats and meat, they might turn their attention to what actually appears to be the true dietary danger, namely excessive carbohydrate intake. Judging from recent studies, saturated fats seem perfectly fine.
With all these recommendations on what to do or not do, there are many who stop listening entirely. If we were to instead focus on obvious and clearly demonstrable facts, we could perhaps reach more people. Here’s some simple advice for people who stuff themselves with unhealthy things to feel better:
Go ahead and eat hamburgers, but skip the soda and cut down on the French fries. There is at least a fair bit of scientific support behind that strategy, although the Swedish National Food Agency would probably take issue with it. Then again, their recommendations are built not so much on research but rather ideology and worn clichés like “eating more greens”, whatever that even means. Unfortunately, all this contradictory information about dos and dont's likely contributes to indifference among those who are at the very bottom, mentally and emotionally. A good strategy for helping our patients would be to focus entirely on damage control instead of tired clichés and tiresome lectures.