How fruit juice went from health food to junk food

This week, it looked as if fruit juice might finally lose its claim to healthiness and be put into the same category as fizzy drinks. It emerged that a headteacher, Elizabeth Chaplin, who runs Valence primary school in Dagenham, wrote to parents about a new rule to confiscate juice cartons from children's lunch boxes. Instead, pupils would only be allowed to drink water.

Days earlier, Susan Jebb, a government advisor and head of the diet and obesity research group at the Medical Research Council's Human Nutrition Research unit at Cambridge University, told the Sunday Times that the government's official advice that a glass counts towards your recommended minimum five-a-day servings of fruit and vegetables should be changed.

"Fruit juice isn't the same as intact fruit and it has as much sugar as many classical sugar drinks," said Jebb, who has stopped drinking juice. "It is also absorbed very fast, so by the time it gets to your stomach your body doesn't know whether it's Coca-Cola or orange juice, frankly. I have to say it is a relatively easy thing to give up. Swap it and have a piece of real fruit. If you are going to drink it, you should dilute it."

This comes on top of a year or so of stories about the high sugar content of fruit juice. The same US scientists who warned about the use of high-fructose corn syrup in fizzy drinks have now turned their attention to juice. "Fruit juice and smoothies are the new danger," Barry Popkin, professor of nutrition at the University of North Carolina, told the Guardian in September. Work by Dr Robert Lustig – whose book Fat Chance: the Bitter Truth about Sugar received much attention last year – and studies such as one published in the British Medical Journal in the summer, which found fruit juice is associated with an increased risk of type 2 diabetes, are starting to make people realise that fruit juice may not be as wholesome as they once believed.

So why is fruit juice still being pushed as a healthy option? "You can't trust government health advice," says Joanna Blythman, author of What to Eat. "They have the same advice that they've been recycling for 50 years and rarely change it. It's embarrassing to admit they've made a mistake."

Does she drink juice? "I don't, really – not in any great quantity," she says. At one point, she says, in the late 1980s and early 90s, she was "a very enthusiastic orange juicer. I remember coming back from the States, where everyone juices like mad, and I got a juicer. Then over the last couple of years there has been more and more evidence that sweet juices are basically just fructose, and have a similar effect on the body to fizzy and soft drinks in terms of sugar."

The juice industry has long enjoyed a healthy image. Anything to do with fruit, says Blythman, "has always been used to put a halo of health around dubious products that don't merit it. That's business as usual for the food industry."

For all their reliance on phrases such as "100% pure" and "pure squeezed", many of the big commercial orange juice manufacturers make a processed product, as detailed by Alissa Hamilton in her 2009 bookSqueezed: What You Don't Know about Orange Juice.

In the early 20th century, juice was mainly sold in cans. During the second world war, the US government commissioned scientists to develop a product that would supply vitamin C to soldiers overseas. "That's when research into developing a frozen concentrate that people would actually like started," says Hamilton. Until then, it had been fairly tasteless – the concentrating process removed the water, but also the natural chemicals that gave orange juice its taste. "They started adding fresh juice to the concentrate and that made it taste good. The discovery was too late for the war, but after the war that's when orange juice started to become really popular."

One primary school in Dagenham is to start confiscating fruit juices from children's lunch boxes. Photograph: Kidstock/Getty Images/Blend Images

However, as the market grew, it was becoming too expensive to use fresh juice to add flavour back to concentrate. "They developed the technology around the 1960s to capture and break down the essences and oils that were lost when the juice was concentrated, and came up with these things called flavour packs."

Producers of pasteurised orange juice began storing their juice in vast tanks. In order to keep it "fresh", the product had to be stripped of oxygen. Once this had been done, the juice could be stored for up to a year. The only problem was that this process also removed much of the taste. "You need flavour packs to make it taste like anything we know as orange juice," says Hamilton.

So, does she still drink juice? "I actually never did," she says. "I try to eat the whole thing. If I have an orange, I don't even stop at the fruit – I eat the pith, the peel. Juicing anything would not be my choice."

For most of us it is, though, and it is not obvious that any of the sugar scare stories are affecting the fruit juice market yet. In its latest report, the research company Mintel found that 83% of people drink fruit juice, a juice drink or smoothie at least once a week. It also estimates that the market will grow by 13% by 2018. It found 34% of consumers were concerned about the amount of sugar, but "a striking 76%" believed juice and smoothies to be healthy.

As part of its end-of-year "top products" survey, the retail trade journal the Grocer found a mixed picture for juice brands. The leading brand, Tropicana, experienced a downturn in sales of 5.4% throughout 2013, though sales of Innocent smoothies, owned by Coca-Cola, were up more than 7%. However, Innocent was one of the brands highlighted last yearas containing high levels of sugar: a 250ml serving of its pomegranate, blueberry and acai smoothie contains 34g of sugar, around the same as a 330ml can of Coke.

"I think the current coverage about fruit juice and sugar will have an influence on consumers," says Heidi Lanschützer, food and drink research analyst at Mintel. "The question is whether it's a short- or long-term impact." She says this will depend on how ongoing the coverage is, and whether more schools ban juice, though the biggest impact will be if the government takes Susan Jebb's advice and removes it from the five-a-day list. This, she says,"is one of the market's biggest selling points – if the market is not allowed to use that any more, that will definitely have an impact."

Not everybody is racing to demonise juice just yet. "It's about portion size. 150ml of fruit juice is perfectly acceptable as one of your five-a-day," says Azmina Govindji, dietitian and spokesperson for the British Dietetic Association. "But we would suggest you have it with a meal so it doesn't make your blood sugar go up too quickly. I think the difficulty comes when people think of fruit juice as being a really healthy drink and having half a pint, or having it throughout the day, or where children are being brought up on large amounts.

"The key message is that small amounts – a 150ml glass is quite small – as part of a healthy varied diet is fine. You get fluid and vitamin C but you need to be aware that it does contain sugar. If you can, always choose fresh fruit and veg [over juice]. You're going to get fibre, more nutrients and you're likely to have fewer calories."

Does she think the advice on juice being part of the five-a-day will change? "I think what needs to change is advice on portion size."

Blythman, meanwhile, understands that the mixed messages about juice are perplexing for consumers. "People are thoroughly confused," she says. "But I think [growing awareness of sugar levels] will have an effect. The simplest way to put it is: eat whole fruit, don't drink juice."

The rise and fall of our favourite foods – what's in:

Halloumi: Britons have become the biggest European consumers of the rubbery, squeaky white cheese outside of Cyprus. Tesco's halloumi sales rose by 35% during 2011 and 2012, while Waitrose reported a 104% increase. "I don't think it was one event that explains halloumi's popularity," says Louis Constantinou, director of the Cypressa food company, founded by his uncles in the 1960s, which now supplies halloumi to supermarkets. "It got exposure by celebrity chefs. It's a versatile product in the sense you can do lots with it – grill it, eat it as it is."

Hummus: Waitrose claims to be the first supermarket to have stocked hummus, around 20 years ago. Now, says Jonathan Moore, the supermarket's executive chef, they have around 19 varieties. "It has become a staple – people are using it on bread instead of butter." One recent survey found 41% of Britons had a pot of hummus in their fridge, and the British taste for the chickpea paste, which originates in the Middle East, is worth around £60m a year.

Sweeter apples: Theresa Huxley, apple technologist for Sainsbury's, says consumers are looking for sweeter apples. The supermarket is stocking a record 57 varieties of apple, including more British varieties than before. "Royal Gala remains our most popular variety, and that's a very sweet one, but there are lots of new varieties that are becoming more and more popular: Jazz, which has a peardroppy flavour, and Rubens which has tones of melon, and Zari, which is a sweet, juicy apple."

Bottled water: Environmentalists have long tried to wean us off our attachment to bottles of water, and for a while it looked like it might work – in 2009 sales fell by 9%. However, as a report for the Grocer put it last month, "all is forgotten". Last year we drank 8.7% more bottled water than in 2012.

Ceviche: The decreasing cost of international travel and the ability of a growing number of people to experience other cultures and cuisines, says Moore, have had a huge influence on our national palate. Middle Eastern influence has been strong, thanks to chefs such as Yotam Ottolenghi, but Moore is also looking at food inspired by South America, especiallyceviche – raw fish cured with citrus juices. "Ceviche is, for me, the sushi of 20 years ago. Twenty years ago, would anyone have said sushi was going to be this big in the UK?"

And what's out:

Meat: According to one survey published in November, a quarter of Britons are eating less meat, with a further 34% saying they would consider eating less. Just 2% reported eating more than they had previously. The survey was conducted for Eating Better, an alliance of groups including Friends of the Earth, launched in summer 2013 to encourage people to eat less meat. It attributed the results to the fallout from the horsemeat scandal, and growing awareness of the environmental impact of rearing animals for meat. Others blamed falling sales on rising costs – according to the Financial Times last month[http://www.ft.com/cms/s/0/b41bd746-61a3-11e3-916e-00144feabdc0.html#axzz2nnzEoiNl], British beef prices are at record highs, and sales of the most expensive cuts, such as roasting joints, are down by a quarter on the previous year.

Builders' tea: "The mainstream tea category has lost its sparkle," Neil Manders, Twinings' commercial director, told the Grocer recently. In September, the trade journal published a report on the hot drinks market. It found that people are moving away from traditional tea and – if they are not drinking coffee instead – towards fruit and herbal varieties, and green tea (sales are up 15% and 19% respectively). In a more recent report, the Grocer found volume sales of tea were down 6.1% in 2013, a bigger decline on the previous year.

Whole lettuces: The 1980s were the glory years for the iceberg lettuce, but over the last few years sales of whole lettuces have been falling[http://www.telegraph.co.uk/finance/personalfinance/8347648/Era-of-iceberg-lettuce-is-over.html] as consumers developed a taste for more unusual leaves and the popularity of ready-washed bagged salads took off. In a final indignity, last year the Office for National Statistics removed the round lettuce from its "typical" shopping basket to illustrate retail prices, though the iceberg lettuce remains. For now.

4th Ebola Patient to be cured....Round of applause for Emory!

Accompanied by beaming family members and amidst hugs and applause from the health care workers who treated her, nurse Amber Vinson departed a press conference at Emory University Hospital on Tuesday as the fourth patient successfully treated for Ebola virus infection here.

"As a nurse, and now as someone who has experienced what it's like to be cared for through a life-threatening illness, I am so appreciative and grateful for your exceptional skill, warmth and care," Vinson told the more than two dozen Emory University Hospital employees gathered behind her on the stage during the press conference.

Prior to Vinson's remarks, Dr. Bruce Ribner, medical director for Emory University Hospital's Serious Communicable Disease Unit, discussed her discharge, Emory's commitment to caring for such patients, and how the hospital seeks to share its knowledge to help others battling Ebola virus disease around the world.

"After a rigorous course of treatment and thorough testing, we have determined that Ms. Vinson has recovered from her infection with Ebola virus, and that she can return to her family, to the community and to her life, without any concerns about transmitting this virus to any other individuals," Riber said.

Vinson was the second of two health care workers infected while caring for a patient with Ebola virus disease at Texas Health Presbyterian Hospital in Dallas. She was transferred to Emory University Hospital via air ambulance on Oct. 15 by request of the Centers for Disease Control and Prevention and Texas Health Resources.

"As fellow members of the health care community, we deeply admire Ms. Vinson's courage and dedication in caring for patients with serious communicable diseases," Ribner said. "Nurses are on the front lines 24 hours a day in treating our patients, and it is their skill, their knowledge, and their passion for healing that makes one of the critical differences in caring for our patients."

The patient Vinson cared for became infected with Ebola in Liberia, then traveled to Dallas where he became ill, was diagnosed and treated at Texas Health Presbyterian Hospital, and died Oct. 8.

Vinson and another nurse who cared for the patient in Dallas, Nina Pham, were the first people to become infected with the Ebola virus in the United States. Pham was transferred to the National Institutes of Health in Bethesda, Maryland, the day after Vinson's transfer to Emory; she was discharged from NIH, free of the virus, Oct. 24.

"Now that Ebola virus transmission has occurred in the United States, we all recognize that there is a lot of anxiety in the community, and that is understandable. But the American health care system has been able to successfully treat patients with Ebola virus disease. We have the resources, we have the expertise and we have the knowledge," Ribner said.

"We must not let fear get in the way of our primary mission, which is caring for patients with serious diseases such as Ebola virus infection."

Sharing what Emory has learned

Vinson is the fourth patient to be successfully treated at Emory University Hospital for Ebola virus infection.

Dr. Kent Brantly and Nancy Writebol, the first Ebola patients to be treated in the United States, arrived at Emory University Hospital in early August after becoming infected with the Ebola virus while providing humanitarian aid in Liberia. Writebol was discharged Aug. 19; Brantly left the hospital Aug. 21. A third patient, who did not want to be identified publicly, was transported to Emory on Sept. 9 and was discharged Oct. 19.

All of the patients were treated in Emory University Hospital's Serious Communicable Disease Unit, which was set up 12 years ago in collaboration with the CDC to care for CDC scientists and others who have traveled abroad and become exposed to infectious diseases.

On Oct. 20, Emory Healthcare launched an external website to serve as a resource for health care organizations regarding best practices for safe and effective screening, diagnosis and treatment for patients with Ebola virus disease.

"As grateful as we are for Ms. Vinson's recovery, we do recognize that our role as the American health care system, and our nation's role, is far from over," Ribner noted. "Emory has taken a lead in posting our protocols online as well as participating in webinars, answering myriads of phone calls and emails, and trying to spread knowledge of the management of this disease around the world."

Vinson: "I am so grateful to be well"

As Amber Vinson departed Tuesday's press conference, she hugged each of the health care workers involved in her treatment. Photo by Jack Kearse.

During the Oct. 28 press conference, Vinson was joined on the stage by the Emory University Hospital employees who helped care for her, as well as her grandparents, aunt and uncle.

"I am so grateful to be well, and — first and foremost — I want to thank God. I sincerely believe that with God all things are possible," Vinson said. "While the skill and dedication of the doctors, nurses and others who have taken care of me have obviously led to my recovery, it has been God's love that has truly carried my family and me through this difficult time, and has played such an important role in giving me hope and the strength to fight."

Vinson thanked her family and all of those who contributed to her care at Emory Healthcare and at Texas Health Presbyterian Hospital. She also thanked Brantly and Writebol "for your donations of plasma for me and other patients, and thank you for your leadership in helping to educate the public about this difficult but treatable disease."

Vinson offered a plea for continued attention to the plight of Ebola victims around the world.

"While this is a day for celebration and gratitude, I ask that we not lose focus on the thousands of families who continue to labor under the burden of this disease in West Africa," she said.

Changing the algorithm for Ebola care

Vinson did not take questions after giving her statement, but remained on the stage with her family while Ribner answered questions from the media.

Several questions centered on what Emory has learned from successfully treating four patients with varying severities of illness from Ebola virus infection.

Since beginning caring for Ebola patients in August, Emory physicians have confirmed that they can be tremendously helped by the kind of aggressive supportive care available at Emory and other hospitals in developed countries, Ribner said.

"The other thing that we have really changed the mindset on is how aggressive we can be with Ebola virus disease," he said, noting that previously, the prevailing medical mindset was if Ebola patients were ill enough to need dialysis or ventilators,  "there was no purpose in doing those interventions because they would invariably die."

"I think we have shown, with our colleagues in the U.S. and elsewhere, that that is certainly not the case, and therefore I think we have changed the algorithm for how aggressive we are going to be willing to be in caring for our patients with Ebola virus disease," he said.

Doctors don't know definitively why Vinson and Pham recovered more quickly than some other patients with Ebola, Ribner said. One theory is that the two nurses are among the youngest patients treated for Ebola infection in developed countries, and evidence from Africa suggests younger people are more likely to recover. Ribner also noted that Vinson was wearing personal protective equipment when she cared for the Dallas patient "and therefore the amount of virus that she was exposed to was substantially less than what we see in patients who get infected in less developed countries."

In response to a question about quarantine, Ribner noted the need to reassure the American public and advocated for a global perspective.

"I think the thing we really have to keep in mind is that the only way that we are truly going to be able to make our citizens safe is if we control the outbreak in West Africa, which is having a devastating impact on those countries. And so as we put in place various measures to try and protect citizens of this country, we have to be very mindful of any unintended consequences which may make it more difficult to manage patients in the African continent," he said, while noting that Emory is represented on an Ebola task force created by Georgia Gov. Nathan Deal to offer guidance on such issues here.

Asked what overall message he would give to help quell public fear over Ebola, Ribner offered a reminder that the Ebola virus is spread through blood and other bodily fluids, not through the air or casual contact.

"Again, as we look at measures in the United States to potentially control additional exposures that might occur, we need to keep the science in mind," he said.

http://www.cdc.gov/cdctv/Babybook/

http://www.cdc.gov/cdctv/Babybook/

Study shows global need to produce more fruits and vegetables...

The global supply of fruits and vegetables falls short of the needs of the population, according to a study by researchers at Emory's Rollins School of Public Health.
Low fruit and vegetable intake is a leading risk factor for death and disability globally and is attributed to approximately 1.7 million annual deaths worldwide. With current global dietary guidelines recommending a daily fruit and vegetable consumption of at least five servings, researchers analyzed whether the supply of fruits and vegetables is sufficient to meet current and growing population needs.
"There is a strong relationship between higher fruit and vegetable consumption and lower mortality," says Karen Siegel, MPH, in the Hubert Department of Global Health at Rollins School of Public Health. "This relationship extends to major chronic diseases such as cardiovascular disease, diabetes and certain cancers. Although much of the world's population does not consume the recommended servings, if health professionals are to encourage these recommendations, we must also consider the shortage of supply."
Using global population and agriculture databases, the team compared the global supply of fruits and vegetables  (supply)  with the recommended dietary intake (demand) for the year 2012. They also projected the supply and demand for 2025 and 2050. 
Findings suggest that the global supply of fruits and vegetables falls 22 percent short of  the global population's needs and approximately 95 percent short in lower income countries. An estimated fruit and vegetable supply gap of 34 percent and 43 percent was projected for years 2025 and 2050 respectively, if current production levels remain constant.
"Our research is significant because it shows that these gaps may only worsen with time, particularly for low-income countries," K.M. Venkat Narayan, MD, Ruth and O.C. Hubert Chair of Global Health at Rollins School of Public Health and study co-author. "This information sets the stage for further analyses and a deeper look into policy levels for increasing production and supply. Change is possible

Contact

Melva Robertson 
404-727-5692
melva.robertson@emory.edu

I'm a Failure (And That's OK)

This post by Greg Hodgin on LinkedIn,  i find very informative and inspiring. Please read it.

This is my first post on LinkedIn, so please: be brutal and merciless in your comments. First, thanks for even opening this. I am going to assume this is being read by maybe 5 people, so thanks, 5 people reading! This wasn’t written by anyone else; this is me typing at my computer at 12 on a Wednesday. A little about myself: I’m finishing up a Ph.D. in Political Science and I started a non-profit, Peacebuilding Solutions, in 2008. That’s not why I’m writing though. I’m writing because I’m a failure. Many times over. And I want to tell you why that’s all right, and why failure isn’t as bad as people think it is.

This is my third career. That’s right, third. I’m 36 now, and my first two careers went down in flames, I must admit. First it was medical school. I got my degree in Chemistry from a decent school, and I thought my future was set. 8 hours doing a rotation at the university hospital taught me otherwise: I must have lost 3 pounds throwing up. I had a pathological fear of blood and fluids so medical school definitely wasn’t for me. I tried to do industrial chemistry but that was just too boring for me. I ended up drifting from low paying job to low paying job, alcohol numbing the pain for a bit as I realized that my dream wasn’t going to happen. I’d never be a medical doctor. I’d never save lives, and there was nothing I could do about it.

That was career one. Mercifully, it was short. And it was the first big failure of my life. I took it very hard as you can easily see. But I did learn one thing: medicine wasn’t for me, and I was kidding myself if I thought otherwise. So. Back to the drawing board.

I started teaching high school. Career two. I lasted three years. The students loved me; I still have students from that part of my life telling me that they actually enjoyed chemistry when I taught it. Who knew that someone would actually enjoy chemistry? But teaching wasn’t for me either. By the third year, I was completely burnt out and it showed: sloppy lesson plans, lack of energy… lack of passion. It wasn’t for me. Even my students told me my heart wasn’t in it anymore. So I asked the principal to move me to another subject, possibly history as I always had a social studies interest. I was told there were no jobs there, so I quit. I went to grad school (which sad to say I’m still in but the end is in sight, I am happy to report).

That was career two, and it was a failure too. I only lasted three years and I was terrible at it. By this point I was in my late 20s and had two failed careers behind me. 0 for 2. As any sports fan will tell you, those aren’t the best numbers.

So grad school it was. At first I wanted to just get a master’s in education; maybe make some more money at the career I wasn’t good at. I lasted a semester. I wasn’t cut out for that, either.

Massive failure number three. Second one in a year. It was looking grim. I started taking classes in the political science department at Georgia State University as they had graciously allowed me to transfer over.

Then, I fell in love. I soaked up this discipline with gusto and fervor. And I was good at it. I knocked out the Master’s program and stuck around for the Ph.D. While in school, I founded Peacebuilding Solutions. You’re welcome to look it up if you’d like; I won’t bore you with the details here but suffice it to say I found something that when I wake up in the morning and I look in the mirror I get to think:

My job is great. I’m helping people by letting them help themselves.

I went to Haiti earlier this year to finish up some field work and I talked with the community we’re going to help. When I told them what we were going to do with them, they started clapping.

Money can’t buy that.

Am I a failure? Yes. Absolutely. Many times over. Will I fail again? Oh God yes. More times than I can imagine. But failure is one of life’s great lessons. Unfortunately, a lot of people don’t want to learn.

I hope I fail again. Many times. Failing my first 30 years of life gave me more lessons than any book or any school ever could. And I am grateful I had the opportunity to fail so often.

Just remember: failure is a crucible that forges us. You’re welcome to stay the lump of iron you are, or you can use it to forge yourself (with some good carbon, of course) into a strong steel plowshare or sword (feel free to choose the metaphor that fits you best).

Thanks for reading. Feel free to contact me.

I’m going to go fail again. I invite you to do the same.

Happy Day of the Girl Child!

Also praying for the return of the Chibok girls.

The Medicalization of Human Conditions and Health Care: A Public Health Perspective By Daryl A. Mangosing

"Public Health" focuses on the upstream causes of poor health, particularly those related to social and environmental factors that impact health status. However, biomedical advances in the last century have shifted the public's health to another aspect of care: individual causes and manifestations of illness and disease. This transition has led to what we call medicalization or “the process by which previously nonmedical problems become defined and treated as medical problems.” The medicalization of human conditions releases a ripple of effects, one being whether a consumer of health care recognizes a health problem that needs to be medically addressed. These problems are generally the result of failures in biology, hygiene, and behaviors, and they are resolved through biomedical treatments delivered by providers.

If such is the case, two significant questions surrounding health care arise: what is the relationship between medicalization and health care spending and health policy, and is the medicalization of human conditions generally justified at the public health level? The answers to these questions, as we shall see, warrant implicative actions that shift the direction of public health interventions to a more social, community-based effort in attacking the heart of poor health. Put simply, we have to translate the knowledge gained and lessons learned from medicalization of human conditions into preventive measures that go beyond what we may think is beneficial for health not just at the individual-level but ultimately at the population-level.

Individual problems of ill health have attracted the attention of money and manpower, lending to increasing concerns of medicalization driving up health care costs in the U.S. It is essential then that we take a further look into these estimations. For example, a study that estimated medical spending in the U.S. of identified medicalized conditions generated the following sum: $77.1 billion or 3.9% of total domestic expenditures on health care costs. Although it is a relatively minor portion of national health care expenditures, such an amount implies a substantial cost to private and public sectors as well as consumers. Whether this spending is inappropriate depends on the economic, social, and political dimensions of health care. Conversely, one can look to managed care, a major type of health insurance, as another major driver of U.S. health care. Conditions that are covered by health insurance fuel medicalization whereas the lack of coverage may slow it down; for example, Medicare and other medical insurance plans decided to consider obesity a reimbursable illness while some insurance plans do not cover certain conditions such as infertility. Furthermore, the only way to get human services paid for/reimbursed is to define a condition as a medical problem, thereby creating an incentive to medicalize more problems. The medicalization of human conditions therefore influences health care spending indefinitely, with increasing costs yielding unknown results. 

Policymakers have focused on increasing financial and geographic access to personal health services because of the assumption that health status problems are fixed by medical care. As the health problems of vulnerable populations became more medicalized, public policy started expanding access to individualized medical care. This approach may broadly help to achieve some public health goals, but key social and economic causes of health vulnerability and disparities lose attention. For instance, Medicaid provides a funding umbrella through which states finance expanded services and social supports that extend beyond medical treatment but services only become available or accessible after an individual is diagnosed with the health problem. On top of health care spending, the political drivers behind it have relied on medicalization to address health vulnerabilities by increasing access, but again, policy may lose sight of the root of the problem.   

When looking at patterns of health, patient/doctor ratios, the availability of tools for the job, and numbers of hospital beds may bear little relation to improvements in public health, and even disease and disability continues to directly result from medical intervention. Medicalization can also negatively affect how populations manage health problems in the following ways: the creation of ill-informed demand, enforcement of the belief that one has to spend more on medical services to secure a healthier population, and dependence on a system for medical help from womb to grave. Disease prevention then looks like a reliance on authoritative systems that give insufficient consideration for empowering people themselves to take responsibility for their health, giving people no choice but to support the system.  

The medicalization of human conditions have spurred the “individualization of social problems,” making social or environmental interventions either ignored or secondary and reinforces technical fixes for complex problems. One complex problem in which medicalization may be at odds with public health is alcoholism: is it truly a disease or is it just deviant social behavior? Not a single cause of alcoholism has been established or likely will be as patterns of alcohol abuse vary individually and are influenced by social structure and external events. Another surprising proposition is that prevention itself has become a key driver of over-medicalization. Certain diseases and conditions have a long lead-time, leading people to opt for treatment that possibly lengthens their “disease survival” without lengthening their lifespan. If screening was not enough to halt disease progression, physicians may intervene earlier or screen for “pre-disease” (e.g. pre-hypertension) that may or may not pay dividends in the end. In all truthfulness nonetheless, the medicalization of certain conditions and behaviors may surely benefit certain individuals more so than others. These others then unfortunately miss the intended benefits.

In summary, several conclusions can be inferred from what we know regarding medicalization and its effect on health care: medicalization influences health care spending indefinitely, policy has focused on increasing health access, prevention may have promoted reliance on authoritative systems, and medicalization may benefit some more than others. What remains common among these assumptions is the neutral yield of both benefits and losses, thereby calling for further research and analysis of such data. However, the implication raised here is to return to the public health view of upstream causes of health. This means policy action in income security, education, housing, nutrition/food security, and the environment to improve health among all populations, especially among socially disadvantaged groups. Accompanying this step is the transition from medicalization to “healthization” – lifestyle and behavioral causes and interventions – turning health into the moral rather than the moral into health. Doing so creates efficacious communities and stronger families, which serve as mediating institutions that can screen out the individual and social effects of disease. Put simply, the key could be a form of strong community self-help. The medicalization of human conditions is not an inherently negative asset of health care, but rather, it is a way for us improve our understanding of disease processes so that we may delve into deeper solutions that attack the root of the problem. In this case, the starting point is the holistic, societal unit of the individual: the community. References

Bastian, H. (2014). The disease prevention illusion: A tragedy in five parts. Scientific American Global RSS. Retrieved from http://blogs.scientificamerican.com/absolutely-maybe/2014/03/23/the-disease-prevention-illusion-a-tragedy-in-five-parts/

Conrad, P. (2013). Medicalization: Changing contours, characteristics, and contexts. In W.C. Cockerham (Ed.), Medical sociology on the move (pp. 195-214). Dordrecht, Netherlands: Springer.

Conrad, P., Mackie, T., & Mehrotra, A. (2010). Estimating the costs of medicalization. Social Science and Medicine, 70(12), 1943-7. doi:10.1016/j.socscimed.2010.02.019

Lantz, P.M., Lichtenstein, R.L., & Pollack, H.A. (2007). Health policy approaches to population health: The limits of medicalization. Health Affairs, 26(5), 1253-1257. doi:10.1377/hlthaff.26.5.1253

Paton, A. (1974). Medical Nemesis – three views. “Medicalization” of health. British Medical Journal, 4, 573-577. doi:10.1136/bmj.4.5944.573

Walsh, D.C. (1991). Medicalization run amok? Health Affairs, 10(1), 205-207. doi:10.1377/hlthaff.10.1.205