Hi, class I hope you're doing well today.
It is my great pleasure to have my colleague and friend Dr.
Gary Bennett in my office today Gary, thank you for coming.
>> My pleasure.
>> Dr Bennett is a unique individual to say the least.
>> Hm. >> Unique because his worked falls at
the intersection of so many areas.
Doctor Bennet is a Professor of Psychology, Neuroscience, and
Global Health.
>> Mm-hm.
>> And he works at the intersection of three areas that
we have talked about a lot in our class non-communicable diseases,.
>> Yep. >> In particular.
>> Behavioral change.
>> Mm-hm. >> Always a tough thing.
>> Exact, exactly. >> And also the way that we.
Can use appropriately new technology right and
new types of intervention to achieve, our public health goals.
>> Yeah. >> Through the US and
abroad that a pretty good summary?
>> That is a wonderful summary.
>> Fantastic. >> Better than the one I do.
[LAUGH].
>> So what I thought that we would do today is.
We're going to talk to Dr. Bill about each of these issues to get his perspective on
them, their importance and also to have him talk about some of
the work that he's doing in these different areas.
So let's rock n roll.
>> All right.
>> Yeah.
>> So I tell the students in class and
we're talking about non-communicative diseases we have some public enemies.
>> Mm-hm. >> Public enemy number one, smoking.
>> Yep.
>> Public enemy number two, saying broader, it's going to
pull together a constellation of things, metabolic syndrome.
In particular, diabetes and as we know one of the underlying issues is obesity and
now I'm adding actually air pollution.
>> Oh, that's good.
>> I didn't add that a while ago.
>> Yeah. Hm-hm.
>> Now, but now I do.
And we've talked a lot about, about obesity, and about diabetes in class but
as someone who really works and
does research in this area, I wanted to get your perspective.
On the challenge that say obesity in particular is creating in global health.
>> Yeah.
So, I think so it's a huge challenge There are several billion overweight and
obese people in the United States.
>> Mm-hm.
There, I mean in the world, there just proportionately in the United States but
increasingly in places like Asia, South Africa, the Middle East.
And so obesity's a really big problem no, no pun intended.
>> [LAUGH] If it was that would've been horrible right?
>> Yeah, yeah.
But I, you know, I think the challenge with the, the challenge with obesity is,
is sort of very, it's very widespread.
So, obesity's a really potent driver of cardiovascular disease,
increasingly of cancers, particularly of cancers in populations where smoking is on
the decline certainly, as you mentioned, of diabetes but the problem is that
the relation between obesity and those NCD's is not uniform in each population.
So for example obesity as a predictor, as a risk factor for diabetes, is
a much bigger problem for folks in South east Asia than it is in the United States.
People experienced diabetes at much lower rates of
obesity there than they do here in the US.
People in South Africa, as one example, are protected against the impact of
obesity and diabetes, but they have very high rates of hyper tension and
cardiovascular disease and stroke there.
And so obesity's a big problem, but for lots of different reasons and
it causes lots of different health concerns all, all over the world.
But socially the problem I would say with obesity is that
people don't generally recognize it as a health problem.
>> We are now sort of an artifact of the last five or ten years of.
A lot of activity marketing and social marketing.
>> Mm-hm. >> And, and public and
global health activity about the ills of obesity have raised awareness but you know
in a lot of societies obesity, obesity for a long time was correlated with wealth.
You know you could if you could afford to eat well and
you could afford to gain well that mean that you were doing pretty well.
>> Oh yeah. >> People weren't exactly excited to
be skinny because it was generally viewed as an indicator.
>> Yeah right.
>> Of your socioeconomic level.
and, so, we're in,
we're still experiencing that in lots of parts of the world.
In China, as one example, you know, there are long-standing cultural traditions that
have sort of prized a little bit of heavier body weight.
>> Sure. >> And, now, with,
with one child policy, lots of families are really showering their kids with all
kinds of wonderful things, including food.
And, so, we have the Chinese, Chinese, childhood obesity epidemic in
China that is, is not recognized necessarily as a health problem.
>> Uh-huh. >> Today.
So so obesity's a big challenge but as you mentioned, the reason I love it
is because you have to think about things like health outcomes and social issues and
political issues.
>> Right. >> And cultural issues to
really appreciate its its burden and the challenge of, of, of ending.
>> And I would say something, just along those lines we
talked a lot in class about how we were discussing any global health issue or
any public health issue [COUGH] you must also be able to disaggregate data.
>> Yeah. >> Down to the appropriate level which
you're working so you just made this great point that not only do
you find differences around the world but
within populations within different regions you find differences.
>> Yes. Absolutely.
>> So in the US for example is there any correlation of obesity
with socioeconomic status, education, race, ethnicity.
>> Yeah.
>> Rural, urban what's, what's going on here?
>> So that's what, I'm really glad you mentioned this kind of,
this aggregation thing because it's a really, there's a really good example in,
obesity in the US presents a really good example of this.
>> Mm-hm. >> So we've had an obesity epidemic in
the US over the last 25, 30 years.
>> Mm-hm.
But that obesity epidemic really started in black women after World War two
>> After world war two.
and, at that point we started seeing rising rates of obesity among white women,
and that was trailed by-
I mean black women, I'm sorry, and
that was trailed by rising rates in white women.
And men were somewhat protected against these rates until probably
the last thirty years.
>> Uh-huh. >> And
then you started to see a bit of a divergence blacks, and
black women, in particular, having the highest rates.
>> Mm-hm.
>> Latinas having some, somewhat in the middle.
>> Mm-hm. >> White women having lowest rates and
then all men.
>> So in the last ten years, though, what you hear a lot about in public
discourse about obesity is that we've had a plateau in the rates of, of obesity.
>> Mm-hm. >> And in fact, we have but
only if you look at the general population.
>> If disaggregate by gender, what you see.
Is that men, in the last ten years,
have actually had increasing rates of obesity for the first time in history,.
>> Interesting.
Mm-hm. >> Men are really beginning to
catch up with women.
And that's led by higher rates of obesity among black men in the US.
>> Mm-hm. >> Black men have traditionally had
the lowest rates of obesity black women,
Latinas are twice as likely as white women-
>> Mm-hm. Yeah. >> To have, to be obese but
it really gets interesting when you think about poverty.
Obesity is not associated with poverty in Blacks at all.
>> Huh. >> In fact, the,
in women there's some studies that show that the rates are reverse.
So that higher educated,
higher income Black women, some have somewhat higher levels of obesity.
But, in-,income and poverty are associated with obesity among Whites.
>> And to some set, some extent among Latinos so,
you know, a lot of us belief that obesity to be a condition of poverty.
And at least for our most effected groups it's probably not.
>> Probably not.
>> It's the case that the entire population of those groups are effected.
And so poverty doesn't play as large of a role as it does for some other groups.
>> Fascinating.
So we can't make simple assumptions and simplify the whole notion.
Determinance.
>> No, by no means.
>> Because when you start disaggregating data and
looking at populations in individual groups, the,
what might be seen as general determinance really doesn't hold any water.
>> Absolutely. >> So
we've gotta mash our determinant analysis and our, indeterminant detectives with
a level of with the level at which we are researching at the moment.
>> Absolutely.
And this has real life consequences.
So, if you think about that, you know, we've put lots of policy attention and
lots of resources that have been tied to policies into the challenge of say, for
one example, changing food deserts.
>> Right.
>> In the United States.
>> Mm-hm.
Mm-hm. >> Right.
We all know what food deserts are.
We believe the food deserts are potent predictors of obesity and
a lot of us believe that obesity is correlated with poverty inversely and so,
we should put money into poor communities to try to eradicate food deserts.
To try to improve access-
>> Mm -hm. >> To healthful foods.
I'm for all of that.
>> Sure. >> But the data isn't really supportive of
that, necessarily.
>> Fascinating.
>> Right, so obesity is probably not a problem exclusively in poverty.
>> Mm -hm.
>> And there's not a lot of data that food deserts are associated with
obesity in a causal way and its got a lot of evidence that eradicating those food
deserts will lead to reductions in obesity in among individuals who are impoverished.
And, you know, these things sometimes sound very simple but the devil are in
the details and understanding the complexity of these kind of things is
very important when thinking about how to invest limited prevention resources.
For instance.
>> Absolutely. Instead of just assuming because you
observe it seems that your relationship is not necessarily the cause.
>> Absolutely.
>> You know, you get through, that through the heads of most public health and
global health surgeons around the world because you might have something better.
>> Couldn't agree more.
>> That, better lives.
You know, you were saying that I thought of
I thought of something sort of analogous without sort of applying solutions.
Are trying to create solutions that are basically gun shot what's it called?
Gun, ,.
>> Scatter shot?
>> Scatter shot, thank you, sir.
>> Is that right?
>> Scatter.
>> Shotgun.
>> Shotgun, baby.
Okay.
>> Shot.
>> Shot gun.
Okay.
>> Oh, we're shot.
[LAUGH] We.
We miss a lot of things.
>> Yeah.
>> And I was thinking about drugs.
I honestly, because of the way that drugs are designed, the ones that get the ones
that make it to market for the most part, because of the way they're tested.
I think we can honestly say that most pharmaceuticals are made for white men.
>> Oh yeah. >> With a lot of other people taking 'em.
>> Oh yeah. Yeah.
>> White adult men.
Exactly exactly.
With just this assumption that its going to work in everyone.
And now I even recently saw some work saying that, you know, differences between
men and women biologically, that basically every cell is gender.
Yeah, but you know.
>> Yeah. >> And it has huge impact.
>> This is why the NIH is now.
>> Yeah. >> Requiring investigators,
basic scientists to use female rats in bench science.
>> Uh-huh.
>> In bench lab work, because we recognize even at that level, a lot of
even very cellular, cellular mechanisms, basic biological mechanisms are gendered.
Or maybe in ways that we can't fully appreciate because we lost all of that in
the science aspects.
>> Oh, yeah. Oh, yeah, yeah.
And I think the food desserts was a, was a great example because something like
getting your food desserts is an attempt to.
It's an intervention that's,
that's intended to nudge people towards also behavioral changes as well.
>> Mm-hm. >> And
this is something that students ask me about a lot and
we talk learned that in global health interventions.
And that is, how do you go about, promoting good health and
changing behaviors among populations because none of us likes to change.
>> Yeah. Yeah.
Well, if I had a good answer to that,
I promise you I would be, on an island somewhere.
[LAUGH] [LAUGH] I'd have all of you over at my house in Hawaii.
>> Fly us over.
>> Totally.
Exactly.
Fly or beam you over.
[CROSSTALK] [LAUGH] But I guess I can maybe I
can start by saying what doesn't work.
>> Okay. >> So what doesn't work is education.