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AMERICAN JOURNAL OF PUBLIC HEALTH EDITORâS CHOICE Some 30 years ago, I remember watching patients outside an urban clinic in Zimbabwe as they queued to be seen by the health worker. Often Iâd see a mother offering a sip of soda to a toddler. The sweet beverage was accepted with delight. Sometimes, to my chagrin, soda was offered to an infant. Soda cost pennies then, making it a cheaper commodity than the bananas stacked in front of the vendorsâand much cheaper than an apple that could be found only in a store. A choice that didnât make nutritional sense actually made plenty of economic senseâat least from the motherâs perspective. And soda was a treat for a long wait without readily available drinking water. I tried to withhold my critical judgment of the sodasand-buns breakfast. After all, at the time the main nutritional concern in developing countries was undernutrition, not overweight and obesity. Things have changed. Today, the problem of overweight and obesity is overtaking all countries around the globe. A cost-conscious mother in urban America faces much of the same calculus as that of an African mother. On a cost-per-calorie basis, the âbest buyâ too often is calorie dense and nutrient poor. The food industry will continue to argue that a key problem is lack of physical exercise. Yes, many individuals do need more physical exercise, but if someone were to land on our planet from elsewhere, what this person would observe is lot of highcalorie food that is simply not nourishing. Among 194 of the worldâs countries reporting data on adult overweight and obesity, nearly 90 countries have data to suggest that one half or more of its adults are overweight. These are not all rich countriesâsome are quite poor. Even in Africa, where undernutrition is a main concern, overweight and obesity affect a growing number of adults, and prevalence is rising fast. It is currently estimated that 20% to 50% of urban populations in Africa are classiï¬ed as either overweight or obese and that, by 2025, three quarters of the obese population worldwide will be located in developing countries. This new form of malnutritionâoverweight and obesityâdoes in fact constitute a global challenge, and not just a challenge to rich countries. Faced with these data, it is heartening to see governments step up to level the playing ï¬eld in which people are making their nutritional choices. People make the choices available to themânot those theoretically available to them, but the real-life choices. And cost and access affect these choices, not just knowledge. The same is true for tobacco. Around the world, strategies that increase pack price, limit places where smokers can light up, and present people with hard-hitting information about tobacco risks will lead to lower rates of tobacco use. How do we ensure that when people select food items, they are not buffeted solely by market forces that drive an âeat moreâ strategy? This is where government comes in. Government possesses the tools that we as individuals lack: it can regulate, legislate, and tax. It can set standards. It can use its role as a (large) purchaser to enforce procurement policies. Individuals on their own can do none of this. Thatâs one of the reasons we have governments in the ï¬rst place: to take the collective actions that individuals cannot. New York City under Mayor Michael Bloomberg, with his health commissioners, and their staff, deserves credit for taking the lead in forging how government can protect the public by leveling the playing ï¬eld for healthy nutritional choices. As with tobacco control, New York City has signaled its intent to use taxation, rulemaking, and education to help improve population health, in this case by limiting the intake of unhealthy food that is too salty, too sugary, and just too much. j Mary T. Bassett, MD, MPH AJPH Associate Editor doi:10.2105/AJPH.2012.300952 Mary E. Northridge, PhD, MPH Farzana Kapadia, PhD Gabriel N. Stover, MPA Aleisha Kropf Mary T. Bassett, MD, MPH ´ Felipe Gonzalez Castro, PhD, MSW Michael R. Greenberg, PhD Soï¬a Gruskin, JD, MIA Said Ibrahim, MD, MPH Robert J. Kim-Farley, MD, MPH Stewart J. Landers, JD, MCP Stella M. Yu, ScD, MPH ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION Roger Vaughan, DrPH, MS INTERNATIONAL ASSOCIATE EDITORS Kenneth Rochel de Camargo Jr, MD, PhD (Rio de Janeiro, Brazil) Daniel Tarantola, MD (Sydney, Australia) DEPARTMENT EDITORS Leslie Beitsch, MD, JD Government, Law, and Public Health Practice Public Health Policy Briefs Elizabeth Fee, PhD, and Theodore M. Brown, PhD Images of Health Public Health Then and Now Voices From the Past Mark A. Rothstein, JD Public Health Ethics Kenneth R. McLeroy, PhD, and Deborah Holtzman, PhD, MSW Framing Health Matters EDITORIAL BOARD Jeffrey R. Wilson, PhD, MS (2012), Chair Jermane Bond, PhD (2013) Linda Chan, PhD (2013) Roy Grant, MA (2013) Thomas Greenï¬eld, PhD (2012) Jeffrey Hallam, PhD (2014) Alice M. Horowitz, PhD, MA (2012) Cassandra L. Joubert, ScD (2012) Dio Kavalieratos, BPhil (2012), Student Louise-Anne McNutt, PhD (2013) Joan Reede, MD, MPH (2014) Brian Saylor, PhD, MPH (2013) Helena Temkin-Greener, PhD, MPH (2014) David H. Wegman, MD, MSc (2014) Lynne S. Wilcox, MD, MPH (2012) STAFF Georges C. Benjamin, MD Executive Director/Publisher Nina Tristani, Publications Director Brian Selzer, Publications Editor Ashell Alston, Director of Advertising Michael Henry, Associate Production Editor (Sr) Maya Ribault, Associate Production Editor (Jr) Mazin Abdelgader, Graphic Designer Vivian Tinsley, Subscriptions Coordinator FREELANCE STAFF Gretchen Becker, Kelly Burch, Greg Edmondson, John Lane, Gary Norton, Michelle Quirk, Alisa Riccardi, Trish Weisman, Eileen Wolfberg, Copyeditors Nestor Ashbery, Alex Cook, Marci McGrath, Chris Smith, Proofreaders Vanessa Sifford, Graphic Designer EDITOR-IN-CHIEF DEPUTY EDITOR FEATURE EDITOR IMAGE EDITOR ASSOCIATE EDITORS Published online ahead of print July 19, 2012 | American Journal of Public Health Editor's Choice | e1
American Journal of Public Health – American Public Health Association
Published: Sep 1, 2012
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