Health in a shrinking world

Dr. Kathleen Blumer, a pediatrician at Henry Ford Medical Center-Fairlane in Dearborn, Michigan, says that the rising incidence of obesity among American children goes beyond eating too much. Factors like the kinds of food and drinks consumed and how free time is spent weigh in. Okay, that’s nothing new.

She also says that today’s lifestyle where parents have come to rely a lot on processed foods—often laden with fat—contributes a lot to the problem. Again, nothing new. That’s what drove British chef Jamie Oliver to launch a campaign to obligate public schools to feed children better. Never mind the sensational way he did it. The food items in public school cafeterias shown on TV were shocking enough. That the government was feeding them to young children was even worse. But what really caught my attention was the part when the school children wouldn’t eat “real food” because they did not even look familiar. And that’s something the public school system couldn’t be blamed for. The kids’ parents were feeding them the same crap that they were getting in school.

The curious thing is that rising cost of food and related economic hardships that force families to keep a tight rein on their budgets, including how much is spent on food, does not seem to keep the obesity epidemic at bay. Food might be more expensive, families may be spending less and less on food and people might even be eating less, and yet many face the threat of becoming overweight. As people cut down on their food budget, they consume more processed foods, cheaper in Western countries, that are packed with fat.

Not too long ago, there was an interesting discussion in a comment thread in my Web log about why such a phenomenon has not happened in the Philippines. Despite our exposure to Western media and junk food culture, because we import most of the junk food that Westerners buy cheaply in their countries, these junk foods aren’t exactly an affordable option for the poor. Where the budget-conscious Western housewife will likely buy canned meat or hotdogs, her Filipino counterpart is more likely to choose daing (dried fish) and kangkong (swamp spinach). In a twisted sense, it would seem that poverty makes Westerners even more prone to obesity because what is more affordable is what is worse for their health.

But beyond junk food and fat consumption, I haven’t come across any study on the effect of our shrinking physical world on our health. This is especially true in urban areas where the rise in the number of households also means the less physical space available for each. What do I mean? Okay, let me illustrate by citing a true-to-life situation.

When I was growing up in Caloocan, the average residential lot in our area was about a thousand square meters. By the time I was in high school, our next-door neighbor had subdivided his lot into four to provide separate houses for his four married children. By the time I was a mother to two toddlers, there were twelve separate houses next door occupying the same space.

Consider the natural physical activity of someone who lives in a large house and that of someone who lives in a house that is one-tenth of that in size. This so-called fitness craze is directly related to this. Where our natural daily activities afforded us to move and burn calories simply by walking from one point of the house to another, in an age where the size of affordable houses is such that it takes ten steps from the front door to the rear door, you can do the math. If you consider the affordability of two-storey houses, it becomes more picturesque. People today buy exercise equipment called “steppers” and “stair climbers” to simulate physical activities that one used to do naturally in one’s home.

Now extend the scenario to the neighborhood. When I was a kid, walking on the street to go to the sari-sari store or to the church was something safe for young children. But where streets were once free from jeepneys and tricycles that use entire lanes for their terminals, where sidewalks were once free from vendors and weren’t used as private parking spaces by small business owners and their customers, what is the case today? Who would be encouraged to walk? Add to that the heat generated by the congestion and the scare we are given everyday about the dangers of exposure to sunlight… no wonder people opt to go to air-conditioned gyms to walk on treadmills while watching TV or listening to their iPods.

The thing is, while those who can afford it still have that option of engaging in healthy physical activity in gyms, tennis courts and golf courses, the poor simply do not have that luxury. They are constrained in their small houses and recreation is often limited to watching TV, playing tong-its or drinking with the neighbors. It’s not like they can afford the extra transportation cost to and from the gym much less the cost of paying for the gym services and facilities. That’s the scenario created by rapid and uncontrolled population growth, urbanization without proper planning and the so-called low-cost housing projects for the masses.

So what, let the poor just suffer? They can’t afford gyms, that’s their problem, right? You know, if local governments were a little more sensitive and sensible, they’d know that building parks, gyms and other recreational areas is something that will benefit a lot of people. Build them and maintain them—not for show, not as a token but as an answer to the deteriorating lifestyle especially in urban areas. It isn’t something just for the youth (haven’t we heard enough slogans saying basketball courts keep the youth away from drugs?) but for everyone, from the toddlers to the grandparents.

The sad reality is that many government officials, especially during a campaign, indiscriminately donate basketball goals, rings and balls to just about anyone who asks for it without care as to where the courts would actually be erected. That’s why we have makeshift basketball courts on the streets with the names of their donors prominently painted on the boards behind the rings. And that’s about the limit of their vision.

In a country where the threat of poverty and starvation can be answered by a resolve to plant kangkong in empty biscuit cans rather than turning to SPAM and chicken nuggets, it becomes less likely that we would experience the obesity epidemic that is scaring the Western world today. But health is beyond what we eat; it is also about what we do. If our shrinking physical environment would prevent us from doing free healthy cardio-vascular activities, well, the painful saying that health is a luxury reserved for the rich just took on a new dimension.