The President’s Report from David Katz

The Road Before Us

August 2016

If I’m not mistaken, this is my final ACLM newsletter column as President, and the last before our conference in Naples, Florida, in October.  These opportunities to address you, and the role overall, have been my great honor.

I’d like to encourage all who see this to join us in Naples if not already committed to doing so.  Those who have been before don’t need me to tell them that ACLM conferences are truly extraordinary.  The content, of course, is terrific.  But there is so much more.  The passion on continuous, vivid display, and the several days of swimming in a veritable sea of expertise, devotion, innovation, and professional solidarity is inspiring, and energizing beyond words.  Join us if you can; you will not be disappointed.

I can say that with confidence, in part because our conference is where the action is.  That, in turn, is because our field is where the action is.  And that, in turn, is why I’m here.

In medical school, I was at first uncertain about where to go next, as I trust many of us are.  I settled on Internal Medicine as much to keep my options open and broad as for any other reason.  While mired in the ardors of that residency, working over 100 hours a week in the hospital, and surrounded at all times by the desperately sick- I chose the road less traveled.  Predictably, it has made all the difference.

I went on to a second residency in Preventive Medicine, wanting to do more about those desperately sick people in hospital beds than delaying their death a bit.  I wanted those waiting in line behind them to choose a different medical destiny altogether.  I wanted them to use lifestyle to stay vital in the first place.  My various efforts and contributions, such as they are, in this area are largely a matter of public record, so no reason to belabor them here.

I will simply say that I chose my path because it’s where the action was.  I completed my Preventive Medicine training just as McGinnis and Foege told us that lifestyle practices were the “actual” causes of premature death in the United States.  I was caught up in the rising tsunami of an obesity pandemic, pulling a rising tide of global chronic disease in its wake- as it does to this day.  Lifestyle in medicine was the lifeboat that would enable individuals to ride this out.  Lifestyle as medicine in the form of culture change could turn this menacing tide altogether.  My choice was made.

I was very content with it for quite some time.  I felt validated when I heard Dr. Jim Marks, now at the Robert Wood Johnson Foundation, then Director of the National Center for Chronic Disease Prevention and Health Promotion at the CDC, tell an audience that any clinician not addressing the impact of lifestyle factors on health was at the margins of what truly matters.  I was quite sure I was in the right place.

But a lifelong friend, and now esteemed colleague and fellow member of the True Health Initiative Council of Directors, Dr. Steve Osofsky, recently with the Wildlife Conservation Society and now newly appointed to the faculty at Cornell University- gave me pause.  Steve and I are very close friends, so we tease one another as only close friends do, and we speak plain.  Steve was doing a bit of both as he challenged my career choice ever more frequently, and ever more emphatically.  His case?  Quite simply, I was doing all I could to extend the lives of the very creatures busily destroying the planet!

He had a point, obviously.  We Homo sapiens have been making quite a mess of things down here.  Steve’s particular field, wildlife conservation, was in some ways a direct casualty of any successes in mine.  Ever more people, living ever longer, consuming ever more resources, was all highly correlated with ever accelerating rates of extinction. 

This argument, to the extent it wasn’t tongue-in-cheek in the first place, took on ever greater validity as the evidence for climate change went from academic to all around us; as water access went from being “their” concern to being our concern, too; and as the sustainability of our food supply became a topic of almost daily concern. 

I was having doubts.  I was beginning to think I had actually missed rather than chosen the big issue of my time.

But these particular roads that diverged long ago in some wood –one leading to lifestyle medicine, the other to environmental conservation- take a highly fortuitous turn.  It need not have been so, but it is: they intersect, and run on together.

The diet, activity, and lifestyle pattern most conducive to the addition of years to human life, and life to human years, need not have been beneficial to the planet- but it is.  A diet of minimally processed, predominantly plant foods redounds to the benefit of everything from the land’s fresh water supplies, to the seas’ supplies of fish.  When we use lifestyle to take better care of ourselves, we are doing some of the most potent and immediately actionable things there are to be done- to take better care of this gem of a planet, too.

We are where the great action of our time is, after all.  Lifestyle is the focus for those devoted to healthy people on a healthy planet. Lifestyle is the focus for those looking for health to bequeath the generations that follow us.

Dr. Osofsky and I, and for that matter a whole roster of luminaries in conservation and related endeavors, including Dr. Samuel Myers of Harvard who will address us in Naples, now collaborate ever more routinely.  The One Health concept- the confluence of human and planet health promotion efforts- is evolving into the only valid approach.  The Council of Directors of the True Health Initiative is home to ever more experts in sustainability and environmental scientists, along with “health care” professionals of the traditional variety.

We are in this together, and we are where the action is.

Artful applications of lifestyle medicine have the potential to foster the health of people and planet alike.  Those of us here have long known the profound implications of our field for the well being of our own species.  It is time, just as we are doing in Naples at Lifestyle Medicine 2016, with the theme of Healthy People, Healthy Planet, to take in an even greater vista than that.  We are very much a part of where the world needs to be for there to be a viable and vital and biodiverse world to bequeath our children, and theirs, and theirs.

For the moment, we may say the action is in Naples- and I hope to see you there.  But we may also say with conviction that our field is where the great action and issues of our day reside.  We are where that action is.  I write to say exactly that, reassured that it is so.  I write to say that, in solidarity with you, proud to have chosen a road those years ago that does indeed lead to all the right and urgent differences.  It lies before us.



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