Globalization of Illness/Globalization of Health

A globalization of coronary heart disease, stroke, diabetes, and obesity is occurring throughout the world. While heart disease is declining in developed countries, it is rising dramatically in developing countries that are beginning to copy our diet and lifestyle.

In short, they are starting to live like us and die like us.

Because of this, there is a unique opportunity to practice preventive medicine on a global scale. If we can reach populations in developing countries and help them understand the value of their indigenous diet and lifestyles rather than copying ours, perhaps we can reverse the exponential rise in cardiovascular disease that is plaguing them.

Although HIV/AIDS is a terrible problem in Africa and other countries, I was surprised to learn that cardiovascular disease is killing more people each year than any other illness, in both women and men. Low and middle-income countries account for 80% of all cardiovascular disease deaths worldwide. It’s the #1 cause of death in South Africa. In the majority of African countries, cardiovascular disease deaths are roughly equal in number to HIV/AIDS deaths and rising exponentially. The average age of death from cardiovascular disease is at least 10 years younger in low-income settings than in developed countries, thus hitting adults in their most productive years. Few resources have been directed at the growing burden of cardiovascular disease in Africa.

Unlike treatments for infectious diseases such as AIDS, TB, and malaria, which require medications that may cost thousands of dollars per year per person or billions of dollars worldwide, all of the elements of lifestyle changes for preventing and reversing cardiovascular disease are less expensive than a diet and lifestyle that promotes heart disease, and few, if any drugs are needed. Walking, nutrition, meditation, smoking cessation, and a strong community require no special equipment, facilities, or drugs. Preventing cardiovascular disease can help free up critical resources for treating HIV/AIDS and other illnesses.

In our experience, when people make comprehensive lifestyle changes, they usually can reduce or discontinue medications such as cholesterol-lowering drugs, anti-hypertensives, beta-blockers, ACE inhibitors, nitrates, insulin, and so on. In our randomized controlled trials, we found that most patients could reverse the progression of even severe coronary heart disease by making comprehensive lifestyle changes. These studies were published in leading peer-reviewed journals.

We now have data on more than 2,000 patients who have completed our program in hospitals throughout the country in three demonstration projects, including one conducted by Medicare. In our studies, we found that most patients could avoid coronary bypass surgery and angioplasty by making comprehensive lifestyle changes instead. Highmark Blue Cross Blue Shield cut their costs in half in the first year, and Mutual of Omaha saved $30,000/patient in the first year.

Seven years ago, while giving a workshop at the World Economic Forum in Davos, I attended a small breakfast hosted by Bill Clinton. The man seated next to me introduced himself, “Hi, I’m Jack Greenberg, CEO of McDonald’s worldwide.” I thought, "What am I doing next to the CEO of McDonald's?" but it led to a discussion in which he asked me to begin consulting with them to develop healthier foods, which I’ve been doing since then.

During the past six years, I have also been consulting directly with the CEO’s of PepsiCo (which includes Pepsi, Frito-Lay, Quaker Oats, Gatorade, Aquafina, and Tropicana), ConAgra, Dole, and Safeway. There is an unusual opportunity to partner with large multinational food companies, as they are having a major influence in the diet and lifestyle of people both in this country and worldwide. I chair the health and wellness advisory board of PepsiCo.

Although I was initially skeptical, I began to realize that if these companies could use their food technology, celebrities, and resources to make it fun, sexy, hip, crunchy, and convenient to eat more healthfully, this could make a significant difference in the lives of millions of people each day by making it easier for them to eat healthier food, not only in this country but also worldwide. Having seen what a powerful difference changes in diet and lifestyle can make, this appealed to me. For example, McDonald's has 50 million customers every day, so even incremental change on that scale is important.

It's easy to be a critic, but I think it's ultimately more productive to help these companies to make healthier foods, which is really to everyone's advantage. It's a little like turning a battleship-- it takes a while, but it can go anywhere once it happens.

One of the early outcomes of consulting with them was McDonald's premium salads and their new fruit and walnut salad, which is just apple slices, grapes, walnuts, and low-fat yogurt. Last year, they introduced a go active meal for kids-- instead of a burger, fries, and milkshake, it has a premium salad, a bottle of low-fat milk or water, and apple slices with caramel sauce. (McDonald’s is now the largest purchaser of apples in the world.) This is especially important for those who are economically disadvantaged, where it often costs more to get produce at the grocery store than to eat fast food. I advised these companies to remove the trans fatty acids from their foods, and PepsiCo has already done so. I have been impressed by their CEO, Steve Reinemund.

There is a “perfect storm” of concern about litigation and legislation as well as an awareness that there is a growing market for more healthful foods. In addition to being the right thing to do, these companies are realizing it’s good business. This year, PepsiCo had the majority of their revenue growth in their healthier foods. McDonald’s profits are now higher than they have been in decades. When it's good business to make healthier food, then it becomes sustainable.

In 1979, while traveling through India and Sri Lanka, I found myself at the All India Institute in New Delhi (their leading Western-style medical school) in the curious position of lecturing to a skeptical and somewhat hostile group of Indian physicians about the benefits of yoga and meditation. Now, years later, they embrace it, in part because it first had to gain acceptance in the U.S. before they valued it themselves.

By analogy, large food companies in the U.S. can have a major influence on reducing cardiovascular disease, diabetes, and obesity worldwide by making healthful versions of foods that reflect each country’s local cuisines. In general, these foods are usually already good for you. By making it more convenient and cool to live and eat more healthfully and for people to value their own indigenous foods (predominantly fruits, vegetables, whole grains, legumes, and soy products), lifestyle, and community rather than adopting a Western diet of high-fat, high-sugar foods and a sedentary lifestyle that are major contributors to these illnesses. They can develop and market foods in countries that reflect local cuisines and tastes, which can reverse the trend towards a homogenization of the world’s diet.

In short, there is a rare opportunity to make a meaningful difference in the lives of millions of people in this country and even more worldwide. We can globalize health instead of illness.