Pub: Sydney Morning Herald
Section: News and Features
Overfed, overgrazed and difficult to overcome
JOIN THE DEBATE
I would like to say I wrote this column while running, or at least walking in a staunch and punishing manner, but in truth I have not perfected the trick of typing fluently during exercise. Still, among the upper-middles the treadmill desk is the new botox, said to achieve miracles by aping (as it were) our inner savannah-dwelling primates.
I was moved to dust off this class terminology while staring fixedly at last week’s diabetes map. With its clear postcode-by-postcode matching of diabetes to socioeconomic status, the map shows the classless society to be as illusory as the paperless office. Class, like the poor, is always with us.
The Sydney diabetes map reveals a clear doughnut pattern with dark, congealed patches around the west and exurban fringes (Mt Druitt, Wollongong, Toongabbie) and pale bits in the old centre (north shore, city, Coogee). It’s the direct inverse of how a rickets or tuberculosis map would have looked a century ago.
It’s not just fat. Maps of obesity, heart disease, renal failure, smoking, TV-watching and hypertension – diabesity, if you’ll excuse the coinage – would show similar patterns.
It’s not even just that 61 per cent of us (and 66 per cent of Americans) are overweight or obese, nor that we’re now seeing heart disease in under-10s, nor that fat is lowering our life expectancy for the first time in centuries. What’s interesting is that this stuff is class-related. Diabesity is a poverty indicator.
But poverty isn’t what it was, for where rickets and TB were diseases of deprivation, diabetes is a disease of excess. Poverty now means excess. Not excess money or work, necessarily, but excess food, fat and leisure. Excess indulgence of appetite.
Contrast with sub-Saharan Africa, whose current crisis reminds us that, for real savannah-dwelling primates, poverty still means less, not more. For the real poor, want still means unmet need; malnutrition, starvation, death.
Yet there are similarities – specifically, that in both cases, while externalities play their part, lifestyle also figures, and this implies choice.
Take Africa. The immediate response to those appalling nightly images, timed for dinner, is to feel the world list like the Titanic, dangerously lopsided. If only we could post them some of our McCalories, we feel, this primitive evening-up – this communism – might be good for us all. Our next response is to head to the net, post-prandially, and throw a credit card at the famine.
But these kindnesses – however necessary just now – are part of the problem, sustaining situations and behaviours that must change for Africa to mature beyond its boom-bust cycle. Africa’s starvations are not simply the product of drought, and its droughts are not simply the product of weather patterns, though this one is said to be a La Nina underbelly, reinforced by climate change (ours), as well as wars, AIDS and policy failure.
Call those externalities. But there’s pilot error as well and in Africa, as in NSW, it’s lifestyle. A primary cause of Africa’s rhythmic famines – turning mere drought into catastrophe – is soil degradation. Africa has some of the world’s oldest and poorest soils, far worse even than ours, made poorer still by overgrazing, deforestation, salination and erosion.
Saharan dust storms, regularly filmed from space and often thousands of kilometres across, have been blamed for algal blooms in Florida and foot-and-mouth in Britain. NASA’s YouTube films even show the little green creatures clinging to the dust grains.
Worse than the West’s influx of foreign microbes, though, is Africa’s loss of precious soils. Thirty years ago the Sahel belt, long conceived of as sub-Saharan Africa’s defence against the desert, supported antelope, giraffe, addax, monkey, wolf, fox, lion, squirrel and elephant. Hunting supplemented grazing. But the animals were hunted out, the trees felled and the soils lost.
Yet, even as desertification accelerates, culture persists. Just as Barry O’Farrell can’t stop releasing land, Africans can’t stop grazing. Their family wealth is tied up in grazing stock, just as ours is tied up in our houses. It’s part of the savannah mindset. Grazing animals – camels, cattle, sheep or goats – are wealth.
In a food-scarcity situation, you can see why – just as you can see why people have more children. So, in good times their herds – like our houses – get bigger. These herds are Africa’s sprawl, their McMansions, their dangerous cultural addiction.
But like big houses, big herds bring false and passing comfort. It’s population dynamics 101. With 100 or more animals and eight or 10 children per family, the demands on the soil outgrow its capacity. Nothing is returned to the soil, since everything is eaten; the grass dies, the soil blows away and drought brings famine.
The key to breaking this cycle is reforestation, which would regenerate rainfall, return compost to the soil and make biological farming possible. But reforestation for Africa is like density for NSW: politically and economically difficult.
Why? Because, just as poor Africans still, wrongly, see their great herds as wealth not threat, so (relatively) poor Australians, despite decades of education campaigns, still see conspicuous consumption – of land, leisure, energy, alcohol, food – as a norm, not a mortal danger.
This is what no one will say: diabetes may be dreadful but it is, largely, a choice. It’s a matter of will. The coming question for us, equivalent in its way to the throwing of cash at African famines, is this: for how long are we happy to fund the expensive treatment of people whose diabesity reflects their refusal to stop overconsuming.
A patient with coronary artery disease leaves hospital fitted with maybe five drug-coated stents costing tens of thousands each. That’s more than $100,000 just for the hardware.
Admittedly, we’re unlikely to go the Japanese way and legislate acceptable waistlines. Admittedly, too, wealthy postcodes are full of people who overconsume, then consume more (carbon) to do penance on the treadmill desk.
But like it or not, the time is nigh when we’ll have to choose, not just who needs treatment, but who deserves it. Our health system will force behavioural change. You think the carbon tax is big. You ain’t seen nothing.
Drawing: By Edd Aragon