chickenfeet: (death)
[personal profile] chickenfeet
I spend a lot of my time working on issues related to chronic disease and the first things one learns about chronic diseases is that they are incredibly common, have a massive impact on individuals, families and the broader society and that the probability of becoming chronically diseased is profoundly influenced by smoking, drinking, diet and exercise. I don’t much care for tabloid language like “obesity epidemic” but it’s pretty clear that, at a population level, more people are fatter than in the recent past and that this is a factor in the increased incidence of a broad range of diseases.

Now, one of the more immediate consequences of the current economic crisis is that the profits of fast food and confectionery companies are rising. This makes me wonder about what the long term impact of the recession will be but also causes me to observe that here is proof positive that lifestyle “choices” are not made in a social or economic vacuum. This is crucial because at the moment the principal public health intervention related to obesity is the generation of vast numbers of preachy messages.

This is really annoying and stupid because everyone concerned with public health and the determinants of health knows that preaching is spectacularly ineffective. Not only is it ineffective as a public health intervention it causes people to get very defensive which is understandable but not helpful. The classic case study on just how ineffective preaching is is smoking (or as we insiders call it, tobacco cessation strategy). Warning messages just give politicians the warm fuzzies. They have no impact at all on smoking behaviour. We have decades of evidence to prove this. We also know what does work; economic incentives (1) and changing environments.

Now it strikes me that “obesity strategy” today is very much where tobacco strategy was fifty years ago. Back then, everyone who cared to look at the science knew there was a problem but nothing was done about. Producer lobbies (tobacco farmers, cigarette companies, the hospitality industry) had government by the short hairs and by a combination of economic FUD and spurious civil rights arguments ensured that governments restricted themselves to utterly ineffective propaganda campaigns. Smoking began to decline sharply only when it became more difficult and expensive to smoke.

Fifty years on we are in the same boat with obesity. We know that it would be of societal benefit if people ate better and exercised more. We also know how to make that happen. It’s not rocket science. The diet piece is probably easier than the exercise one. Direct and indirect subsidies to agri-business need to be realigned to promote healthy eating. Right now they have exactly the opposite effect. In fact, where I live, virtually every component of a cheeseburger is massively subsidized(2). The exercise piece is more complex and, perhaps, more interesting. Recent research in Canada shows that people who live in the inner city exercise more and are lighter and healthier than people who live in the suburbs. Going down a level shows that this is largely a function of people walking or biking to do things that suburbanites use cars for (this is a good example that shows that lifestyle choices are very much not made in some sort of environmental vacuum). So we can see that a really effective public health intervention would be to make it easier for people to live in cities without a car.(3) Where does government stand on this? Governments at all levels in Canada continue to subsidize the suburban lifestyle by direct subsidies to the auto and lumber industries and by building roads and other infrastructure that, together, make the suburbs profitable to develop and artificially affordable to live in. Obviously there are other useful exercise related initiatives that governments could take and they don’t include pumping out pro exercise propaganda while closing school swimming pools. The whole situation is not helped by a political system that is systematically gerrymandered to reduce the influence of large cities.

Why then do governments pursue policies that cost the economy billions and curtail millions of lives? It’s essentially the same story as with tobacco fifty years ago. Again we have a producer coalition that desperately wants to rubbish the public health agenda. This time the producers are even more powerful. They include farmers (4), processed food companies, the auto industry and the property development industry. All of these groups are politically incredibly influential. Property developers pretty much own local government in Ontario for example.

What will it take to break the cycle? I don’t know. I’m not sure that the research has been done on what finally tipped the balance of forces against the tobacco lobby. I suspect that we could learn a lot from such a study.



(1) A very distinguished public health physician once pointed out to me that raising the price of a pack of smokes by $1 had more impact on mortality than all the advances in cancer treatment of the last 30 years.
(2) I remember a senior executive of McCain’s back when NAFTA was first signed complaining that his US pizza competitors who got export subsidized Canadian wheat flour, tomatoes and cheese would now be able to re-export them back to Canada, tariff free, as frozen pizza.
(3) This would probably be the most effective way of reducing carbon emissions too.
(4) Why are farmers so powerful? They are a small group of corporate welfare bums but the public loves them. I don’t get it.

Date: 2009-02-25 07:15 pm (UTC)
From: [identity profile] valkyriekaren.livejournal.com
Not forgetting that the corrolation between being overweight and having a chronic illness may go the other way - being chronically ill makes it more difficult (often impossible) to exercise.

Date: 2009-02-25 07:17 pm (UTC)
From: [identity profile] chickenfeet2003.livejournal.com
Agreed. I tried not to imply a simple causal chain of the stupid/lazy = fat = sick kind which is really unhelpful in my view but I'm sure that I could have been even more nuanced.

Date: 2009-02-26 01:50 pm (UTC)
From: [identity profile] kittenexploring.livejournal.com
There's pretty convincing evidence that weight is not an issue at all but rather activity (which obviously then relates to weight). I really should find some references to point to for that since it comes up occasionally.

It's not hugely different as a public health issue, though, and a measure of size is much easier to use than trying to work out how active a person is. The new thing in Australia (http://www.measureup.gov.au/internet/abhi/publishing.nsf/Content/How+do+I+measure+myself-lp) is to use waist size rather than BMI. It's been talked about since 2005 but I haven't seen much about it elsewhere

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Date: 2009-02-25 07:26 pm (UTC)
From: [identity profile] aitchellsee.livejournal.com
I'm guessing (from south of the border, here) that "McCain's" must be some Canadian corporation, rather than our recent also-ran fella?

Date: 2009-02-25 07:29 pm (UTC)
From: [identity profile] valkyriekaren.livejournal.com
You don't have McCain? we have them in the UK - they're a frozen foods company that are particularly known for oven chips and pizza.

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Date: 2009-02-25 07:36 pm (UTC)
From: [identity profile] chickenfeet2003.livejournal.com
Yes. Big in French fries and pizza.

Date: 2009-02-25 07:27 pm (UTC)
From: [identity profile] nancylebov.livejournal.com
http://www.amptoons.com/blog/archives/2006/09/14/will-being-a-few-pounds-overweight-kill-you/

There's less evidence than you might think that ordinary levels of fatness are dangerous. If you go by the BMI and longevity numbers from the NIH, "overweight" people live a little longer than "healthy" weight people, and low-end obese people have intermediate lifespans.

Admittedly, BMI isn't the same thing as fatness, but it's probably got a loose correlation.

Date: 2009-02-25 07:31 pm (UTC)
From: [identity profile] valkyriekaren.livejournal.com
Thanks, I was looking for that article.

BMI is such bullshit. I'm a curvy girl but pretty healthy, yet my BMI says I'm obese. Which doesn't exactly motivate me to lose weight!

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Date: 2009-02-25 07:42 pm (UTC)
From: [identity profile] chickenfeet2003.livejournal.com
I deliberately kept away from any argument around this particular level of BMI is/isn't good. I think BMI as a diagnostic tool is pretty weak. As a measure of how population "fatness" is trending over time it's probably pretty decent and the direction of the trend is up. There are also a really large, and increasing, number of people in weight categories that are clearly bad for them. I'd really like to get away from arguments about where the BMI tipping point is and onto how do we help people lead healthier lives.

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Date: 2009-02-25 07:34 pm (UTC)
gramarye1971: a lone figure in silhouette against a blaze of white light (Default)
From: [personal profile] gramarye1971
A few thoughts:

1) Regarding food, I suppose one could make the argument that no one has to smoke, but we all need to put food/drink in our mouths at some point. And the food that's worst for you tends to be designed to appeal to the greatest number of tastebuds, whether through the salt, sugar, or fat content. Wasn't the original point of high-fructose corn syrup the fact that it's (a) cheaper to use and (b) exponentially sweeter than sugar, so the manufacturers got more intense taste for less price? It's hard to imagine someone loving the taste or smell of tobacco as a young child -- most smokers would probably admit that their first cigarette made them feel sick -- but what about the taste or smell of a cheap cheeseburger?

2) I've chatted with my mother about food trends, mostly about how tinned food and TV dinners were so trendy when she was a child because they were new and modern and available at any time. Nowadays, tinned green beans are just a convenience item, and many consider them not as good as 'fresh' beans simply because they're packaged. And there's a lot of hidden salt and sugar in those foods because it helps preserve them and conceal the tinned taste. And yet my mother still has more tinned food and frozen dinners than I think I ever will, because that's how she was raised and how she's most comfortable cooking. Do you think habits will change as the generations change?

Date: 2009-02-25 07:47 pm (UTC)
From: [identity profile] chickenfeet2003.livejournal.com
Food habits do change over time and sometimes for the better. Diets in North America and the British Isles now are probably healthier than they were a hundred years ago in many ways. Stomach cancer statistics certainly suggest that.

On e of the reasons HFCS is cheaper to use is because it's heavily subsidized! In the EU manufactureres tend to use sugar instead because that's heavily subsidized. Truly you get what you pay for even if you don't know you are paying for it.

Date: 2009-02-25 07:43 pm (UTC)
From: [identity profile] anthrokeight.livejournal.com
OH MY GOD. I LOVE YOU. Love. You.

See forthcoming post about commodification, food, power, and ethics. (Which I was just about to start but now I have office hours so I have to go.)

*love*

Date: 2009-02-25 07:58 pm (UTC)
From: [identity profile] chickenfeet2003.livejournal.com
You have no idea how much that means to me. I've been thinking about this post for a long time and being very hesitant about it because I knew that some people would take it personally. The last thing I want to do is point a finger at people and shout "Bad Fatty Bad" (which would be, if nothing else, ironic coming from a guy who desperately wants to lose 10kg) but I know some people will inevitably react as if that is what I intended. It's really quite disturbing how successfully the producer lobby, with medical accomplices, have framed this as being entirely about autonomous behavious choices.

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Date: 2009-02-25 08:31 pm (UTC)
From: [identity profile] metalana.livejournal.com
I could put you in touch with the Ontario tobacco control policy & research people, if you don't already know them. (I'm currently working for the smoke police.)

Date: 2009-02-25 08:38 pm (UTC)
From: [identity profile] chickenfeet2003.livejournal.com
Thanks. I've had enough dealings with people like Richard Schabas, Eric Holowaty and Jill Ross to have developed a pretty good grip on the issues around tobacco.

Date: 2009-02-25 08:44 pm (UTC)
ext_1059: (Default)
From: [identity profile] shezan.livejournal.com
This is extremely true. It is easier and cheaper to eat badly than well; and it is incomparably easier to have a healthy lifestyle at every level with a higher income and/or in a better area, not to mention the peer pressure depending on social class. (One figure I find amusing is that Victoria's Secret most sold bra size in the US is 36C, except in Manhattan where it's 34B.)

My old new job was in the immediate suburbs, and required my driving there (or facing three Métro changes.) New new job is within the Vélib catchment area (and a reasonable distance), and I can take buses or the métro when it rains. I no longer use my car and now bike or walk without even thinking of it distances I did not use to consider walkable. (The Vélibs put me back on a bike after close on 25 years. It's perfectly true, you don't forget.)

None if this is proper exercise, but it does make a difference, including the sheer feel-good factor induced by even a very modest rise in endorphin levels.

Date: 2009-02-25 08:51 pm (UTC)
From: [identity profile] helianthas.livejournal.com
It drives me nuts that farmer's markets don't accept food stamps. The one by me is WAY cheaper than the supermarket (like way way way way way way way way way) but it's hard to get to without a car. Government food programs like WIC ("Women Infants Children) and aid to veterans give huge blocks of "pasteurized processed cheese food" instead of anything fresh or healthy. What about giving a CSA farm share to people on WiC?

But also, we need to think about convenience. You're working 40+ hours a week, who wants to soak their dried beans and clean their greens etc etc etc. I spend 2-3 hours each weekend cooking my food for the next week, so I can just pull out a tupperware and snarf something down b/c I'm so busy. If I forget my lunch, I tend to just have a coke and 2 bags of Doritos.

Mmmmm.... Doritos...

(Speaking of which, we need to remember the chemicals in these foods-- those french fries smell good b/c of the chemicals! Doritos are so addicting because of the MSG! C'mon, chemicals!)

*runs off to get Doritos*

Date: 2009-02-25 09:06 pm (UTC)
From: [identity profile] valkyriekaren.livejournal.com
See, I see dried beans/chickpeas as a convenience food - put them on to soak the night before, then whack them into the slow cooker or a low oven in the morning with some carrots, onions and a bit of pork, chicken or bacon. Hey presto, instant and healthy food when I get home - and enough to last several days. What could be easier or cheaper? Certainly not standing in line at the local takeaway or supermarket every night for a junk food fix.

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Date: 2009-02-25 09:04 pm (UTC)
ext_36143: (Default)
From: [identity profile] badasstronaut.livejournal.com
It's such a hard area to talk about, because people get so defensive. The reason they get defensive is because somehow fatness gets inappropriately moralised (which you allude to in the resistance to the telling off). Because of this there's this whole 'fat acceptance' discourse in response to the anti-fat thing. While I think addressing discrimination against fatties is important, I've always been uncomfortable with this whole fat acceptance thing that we're supposed to endorse in certain circles. It's kind of like 'high blood pressure acceptance' or something.

I'm kind of fat myself. I'm not averse to fatness in an aesthetic sense. But it's stupid not to be cognizant of the health risk. So we need to find a way of separating out the health issue from the moralising and from the aesthetic.

Date: 2009-02-25 09:08 pm (UTC)
From: [identity profile] valkyriekaren.livejournal.com
We also need to be clear on what the health risks are. It is quite possible to be a little overweight and yet be in extremely good physical health. Regular exercise, a varied diet and plenty of fresh air and sunshine are the most important things for health and happiness - not a number on a scale or a tape measure.

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Date: 2009-02-25 10:37 pm (UTC)
From: [identity profile] erotetica.livejournal.com
How are civil rights arguments about smoking 'spurious'? I find the restrictions on where and when I can smoke, as well as the absurd cost of tobacco, utterly ridiculous (especially when it's 'for my own good'); this ire is only heightened by the fact that I will cost the NHS far less money over my lifetime than a non-smoker.

Now, one of the more immediate consequences of the current economic crisis is that the profits of fast food and confectionery companies are rising. - I was discussing this with a friend the other day and I must confess I find this, if not strange, at least comment-worthy. It is, I would contend, relatively easy to eat a nutritionally balanced diet on little money, if you just know a few basics of cooking. So I suppose giving people access to fresh vegetables and teaching them to cook and stuff might also be useful, but that's as far as my suggestions went.

Date: 2009-02-25 10:51 pm (UTC)
From: [identity profile] chickenfeet2003.livejournal.com
I think the fast food profits thing is easy to explain. Where I work I have a fairly decent range of lunch choices within easy reach. They include McDonald's and a whole bunch of healthier options. A burger, fries and a coke would cost me about $5 if I ever did that. A salad and a V8 is double that. When times are hard people go for the cheaper option but they don't necessarily go the whole hog of making a healthy lunch at home and taking it to work.

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Date: 2009-02-25 10:37 pm (UTC)
lnr: Halloween 2023 (Default)
From: [personal profile] lnr
Of course in my case food has almost nothing to do with money, and everything to do with time and convenience and habit. I could save money by making healthy lunches to take to work, but it's easier to buy a sandwich and soup and maybe crisps or a piece of fruit from the canteen.

And despite recently upping my exercise (a 1 mile bike commute is now a 4.5 mile bike commute, and I still do it every day) I'm still not only putting on weight but getting fatter.

I do see the points you are making though. Interestingly we now live in a village rather than in the middle of town, but instead of taking up driving we get some food delivered and buy the rest in the village. Perhaps instead of encouraging people to move from the suburbs to the city you need to make sure that there are shopping and leisure opportunities in the suburbs. With such a small city I'm still pretty close to the town centre though, probably much the equivalent of many of your city dwellers!

I know I could lose weight if I was willing to diet, but I'm not currently willing to diet forever to keep it off. I wonder if I'll change my mind if I actually do start having high blood pressure or diabetes? But you're absolutely right that preaching doesn't work one bit. Not even when you're preaching to yourself.

Date: 2009-02-25 10:47 pm (UTC)
From: [identity profile] chickenfeet2003.livejournal.com
Perhaps instead of encouraging people to move from the suburbs to the city you need to make sure that there are shopping and leisure opportunities in the suburbs.

I realise that the city/suburb thing as I framed it in this article is a very North American perspective. The nature of north American suburbs is such that it really isn't viable to provide walking distance shopping and leisure opportunities. The population density is too low. People move to the suburbs because they want a big house on a large lot. The price of that is low density. Also, the developers aren't interested in that kind of livability. They want the shopping concentrated in large box stores which are more profitable for them and their tenants.

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Date: 2009-02-25 11:00 pm (UTC)
From: [identity profile] a-d-medievalist.livejournal.com
Speaking as one of the overweight (about 10lbs heavier than the pics on facebook) I'm glad to hear you say this. I've actually run into trouble over this, because I truly believe that what people mean by 'slightly overweight' is not what they thing. Yes, BMI is a bad indicator for some people. And some of us do store more fat than others in disproportionate ways -- I will always have a rather large bum in proportion to the rest of me, and that's where most of my body fat is. I know women with very large breasts. They will always be large. And they will always be largely fatty tissue.

And if you are a woman my age, the range for healthy is about 23%-35%. That's a big range. For a woman 20-40, you can still be considered healthy with 33% body fat.

So I'm sorry. If you are carrying more than a third of your weight in body fat, I don't care how much exercise you get. It's just not healthy. And it's not something to write off by saying that fat is a feminist issue. Yes, a fat person who exercises is likely to be healthier than a thin person who drinks and smokes a lot, but that's not actually the point, is it?

Sorry. This hits a real button for me.



Date: 2009-02-25 11:11 pm (UTC)
From: [identity profile] pyroclasticgrub.livejournal.com
Recent research in Canada shows that people who live in the inner city exercise more and are lighter and healthier than people who live in the suburbs.

Interesting, except that in Winnipeg, the trend seems to be reversed, not because inner city dwellers don't walk or take the bus, but because there are substantial food deserts within the inner city. There are few grocers or markets to begin with, and even the supermarkets like Safeway don't stock enough fresh and healthy food. So inner city dwellers end up buying crap which is also conveniently cheaper.

And also um...

Why are farmers so powerful?

Whoa, slow down there, Big City Dweller. I don't know which farmers you're talking to, but the farmers around here that I know and buy food from are not corporate welfare bums. Is this a comment on the Wheat Board? I;m not sure where this ire is coming from, so please elaborate.

Date: 2009-02-25 11:24 pm (UTC)
From: [identity profile] chickenfeet2003.livejournal.com
The results were clearer for the largest cities. Winnipeg may be something of an exception too. I'm not an expert on Winnipeg but in most large Canadian cities down town is a highly sought after place to live and is, mostly, relatively high income. I get the impression that that's not true in Winnipeg.

The farm sector in Canada, like most industrialised countries is highly subsidised. It also accounts for about 2% of employment so its small. I'm sure there are farmers who don't rake in huge subsidies but many do. Milk quota wouldn't be a valuable traded commodity if it weren't for supply management, which is a form of subsidy. Find me another economic sector where 2% of the workforce gets its own cabinet minister.

Date: 2009-02-26 12:35 am (UTC)
From: [identity profile] melted-snowball.livejournal.com
So, I know a ton about food, and nothing about exercise, really. And I find learning anything about exercise enormously uncomfortable: gyms are a space I don't feel safe in (between being gay and being not a jock). I haven't done any weight training at my gym (my workouts consist of, "run on treadmill" or "use elliptical trainer") because I can do those without asking anyone for help, and that's scary. Essentially, "gym" makes me think of having dodgeballs thrown at me in PE, or of not knowing how to hold a baseball bat, or of the lie that I was being taught "lifelong skills" when that would have been yoga, or the like.

I kind of feel like many other people have wound up in the opposite camp: they never learned anything about food: they don't know how to cook, no one ever taught them how, they watch those ridiculous shows on the Food Network (maybe), which mostly tell them that it's hopeless anyhow, and then they open a can or a frozen something. (As an aside, I watched the US Food Network last weekend with my mom, and boy are the ads for total shit food!)

And yes yes yes to fixing food subsidies to actually produce food, not chemicals. I remember when I learned that Iowa had once had the tastiest peaches in the US, until subsidies and refrigeration killed that. If we subsidized fruits and vegetables, not corn and soy, I do wonder how much better everyone's health would be. (I also kind of would like it if the patty on that cheeseburger cost more than the cheese.)

Gym-phobia

Date: 2009-02-26 01:54 am (UTC)
From: [identity profile] valkyriekaren.livejournal.com
I can identify with this - I was bullied severely in school and my (perceived) lack of ability at sports was a major part of it. So team sports have very negative associations for me. Also, what sort of pervert came up with the sports uniform for schoolgirls? Take adolescent girls who are already feeling very vulnerable and exposed about all the changes going on in their bodies, and force them to wear little kicky netball skirts with matching 'gym knickers' to do sports? No wonder a lot of girls get turned off exercise in their teens.

My boyfriend doesn't know how to cook at all, despite coming from a very well-off family. He was never allowed in the kitchen as a kid so just didn't pick up the basic skills of how to handle meat, chop vegetables, saute an onion etc. So he lives off processed cheese and biscuits, salty snacks and microwaveable meals - and yes, I do worry about his health! I think it's irresponsible parenting not to teach your children about food - where it comes from, how to tell if it's fresh, what's in season, and how to cook and prepare it. A few basics go a very long way.

Date: 2009-02-26 03:18 am (UTC)
ironed_orchid: watercolour and pen style sketch of a brown tabby cat curl up with her head looking up at the viewer and her front paw stretched out on the left (Default)
From: [personal profile] ironed_orchid
Great post.

Perhaps we should have a sugar tax? Or rather, on processed foods (actually, I think our GST targets processed "ready to eat" foods, but not basic ingredients, or fruit, meat, and veges). It always seems wrong to me when, for example, frozen chips are cheaper than plain potatoes.

The subsidizing of agriculture in first world countries is ridiculous. I believe that in North America, many sweet things are made with corn syrup, which is made because corn farmers are subsidized and they need to use up all that maize somehow.

Subsidized agriculture in the first world directly corresponds to poverty in the developing world, and is one of the key issues that the Fair Trade movement seeks to address (some bullet points on teh matter here).

Date: 2009-02-26 04:09 am (UTC)
From: [identity profile] albionwood.livejournal.com
You're singing my song! (Well, Michael Pollan's song, I just love hearing it.)

North Americans have a thing about farmers. Hardly anoybody farms anymore, or even knows anyone who does, so we have subsituted a nice myth about the rugged individualist working 16 hour days and barely getting by so he can live free in the open air and produce pure healthy food for the hedonistic rich living in cities. We don't seem to have realized that farming has now become agribusiness; the work is done by slaves and the profits are collected by people who little, if any, real work on their land. One line from Pollan's last book stays in my head: "Goerge Naylor [corn farmer] works his fields fifty-seven days a year."

Since there are so few people in the agribusiness industry, and there is so much money in it, those people wield inordinate amounts of power. There are 300 million eaters in this country and a few thousand agribusinessmen - guess which group has a Cabinet office. Guess which group writes bigger checks.

Date: 2009-02-26 01:40 pm (UTC)
From: [identity profile] kittenexploring.livejournal.com
Where do the farmers come into this? Wouldn't they benefit from healthy eating as much as unhealthy eating regardless of how subsidised they are?

In Australia of those four we only have the property developers at a local level and the farmers on a state or national level. The farmers don't have the same level of subsidies or protection, either. The property developer leads to places without public transport in this state, although that's helped a fair amount by the government being appallingly bad at managing public transport. The benefit of public transport over cars in this case is that there's more temptation to walk. On the other hand the developers want to build denser suburbs closer to the centre of the city.

So perhaps we're well positioned in Australia for the sort of policy you're thinking of. It wouldn't be unprecedented policy here but there's plenty of room for something more coherent and comprehensive.

Date: 2009-02-26 01:49 pm (UTC)
From: [identity profile] chickenfeet2003.livejournal.com
I think some aspects of public policy in Australia (or at least Melbourne which amounts to pretty much my whole experience) are better than here though I'm unconvinced by the vast sprawling suburbs that Australians seem to love. One thing I did notice about Melbourne was how much provision there was for healthy outdoor recreation. Climate's a factor too of course.

The problem with the farmers is that the way subsidies tend to be structured they are incented to produce unhealthy food. Since the farmers are locked in a symbiotic relationship with government around subsidy policy I see them as part of the problem.

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