A healthy population is better equipped to handle a pandemic

Obesity and corona are a bad combination. Are we to blame for the pandemic?

‘That is not how I see it. Being overweight is not a personal choice but a societal problem. As long as 80 per cent of the products available in the supermarket do not fall within the food guide pyramid, and three-quarters of the products on sale are unhealthy, changing one’s lifestyle will be difficult for most people.’

Does one’s vulnerability in a pandemic depend on lifestyle?

‘Yes. An unhealthy lifestyle increases the chance of chronic diseases, and that is what makes you vulnerable. People who are overweight, for example, suffer from diabetes and cardiovascular diseases more frequently. These are all risk-factors in an exacerbated response to a corona infection. This is something minister De Jonge repeatedly stressed last year: live healthily. If you are fit, your immune system works better, which makes you less vulnerable in a pandemic.’

Still, there are many who think: It won’t be that bad.

‘True. However, this is a far too casual attitude if you consider that there are ten million chronically ill people in the Netherlands. This includes diseases with mild symptoms such as hayfever and bronchitis, but over half -in excess of 5.4 million- have more than one chronic affliction and visited their general practitioner with symptoms (such as pain, mental afflictions, restricted daily functioning, ed.) in 2019.

So, the corona pandemic is a wakeup call?

‘Absolutely. It demonstrates how urgently we need to address the lifestyle issue. Not just from the perspective of sickness but also because it overburdens the healthcare system. Even without corona, lifestyle-related afflictions place a huge burden on the health care system, which is currently under extreme pressure because people with preconditions such as obesity or diabetes end up in the ICU. The fact that these vulnerable groups are the first to get vaccinated is just, but it does prompt reactions. As is if they themselves are to blame for having to be admitted to the ICU and occupying a bed there.’

A doctor who mentioned last year that a disproportionate number of people from non-western backgrounds occupy the ICUs was called out for it. Do you feel that we should state what people are in the ICUs?

‘Yes, but within the correct context. The causes are much more complicated than mere background, non-compliance with the corona measures or a lack of motivation to live a healthy lifestyle. The crux is that these people are more vulnerable due to their adverse position in society. Corona reveals the painful reality of socioeconomic inequalities and amplifies the differences. Many people with low-wage jobs are not able to work from home. Their smaller houses, which they often occupy with more people, are located in high-density neighbourhoods. Moreover, they experience more stress than usual about their income and fear of losing their job due to corona. Healthy eating is not a priority, and even less so if healthy products are more expensive than unhealthy alternatives. These people are relatively more often afflicted by health issues such as obesity and diabetes, which increase the risks of a corona infection. Thus, there are groups for whom it is much more difficult to escape the consequences of corona and a pandemic.’

How will you ensure we are fitter before the next pandemic emerges?

‘Our Consumption and Healthy Lifestyles group is in a unique position because we merge a large number of different disciplines. From health sciences to psychology, pedagogy, geography and anthropology. Understanding human behaviour and designing interventions call for a broad perspective.’

What interventions might that be?

‘Various ones: from food education in primary schools to adjustments in the food-environment (supermarkets, gas stations, catering, educational facilities, ed.) making it easier to make healthier choices. Moreover, there are digital tools in healthcare that help patients achieve behavioural changes. We collaborate with partners in governance and practice to study the effects of policy and interventions. A striking example is provided by the academic workplace public health (AGORA) in which we collaborate with the GGD (public health service) of North and East Gelderland and 22 municipalities to put scientific research to the test and create societal impact.’

Interventions are often aimed at small changes in behaviour, such as choosing an apple rather than a snack. Is that sufficient to protect us from the next virus outbreak?

‘For you, as an individual, it may not make much of a difference, but if the entire population eats two items of fruit, it does. If all of us exercise ten minutes a day, the population as a whole becomes more resilient against a future pandemic. Thus, we must not approach lifestyle as an individual responsibility but address the system that perpetuates an unhealthy lifestyle, for example, by introducing fat or sugar taxes. Many in The Hague have petitioned for such measures over the years, and corona is now increasing the urgency. I, for one, am happy that the importance of lifestyle and living environment is more often included in election programmes than four years ago, and that the government has recently earmarked two hundred million euros to improve the wellbeing and lifestyle of vulnerable groups.’