David Katz: I find that one of the more polarizing topics in all of medicine and public health practice is the choice between environmental determinism at one end of the spectrum, and personal responsibility at the other. So we’ve got environmental determinists and at the extreme, I find that new to be something of an “Oh woe is me” attitude. You know, until the world improves enough around me there’s nothing I can do to help myself. And then there are the personal responsiblists who feel that everybody should pick themselves up by their bootstraps, regardless of whether or not they’ve got boots.
My view is, in between environmental determinism and personal responsibility, we say, “where there’s a will there’s a way.” It’s not true. You really need both and they’re somewhat independent. We must both cultivate will and pave the way. If you inspire an impassioned people so that they have the will but there’s no way, all around them are walls with no doors or windows. It’s terribly frustrating. On the other hand, if you put a very nice way at their feet and they have no will to follow it, that doesn’t produce anything very good either. Will is not way. You need both. Knowledge is not power. We need both knowledge and the tools the resources, the policies, and the programs to empower people to use what we know.
In fact, I’m inclined to quote the Spiderman movies. I imagine everybody viewing this is highly cultured and has seen the Spiderman movies. 1 was quite good, 2 is excellent, 3 was a little too complicated. But in any event, in the Spiderman movies, Peter Parker’s Uncle Ben says, “Peter, with great power comes great responsibility.” I think public health requires a corollary to that. Before we ask people to take responsibility and ultimately we must, people have to own their own health. They must take responsibility but before we ask them to, we must make sure they are empowered. So my view of chronic disease prevention of fighting epidemic obesity and diabetes, of turning the tide, is that it is the job of professionals to pave the way and to cultivate the will; to stir people up so that they understand the stakes, so that they recognize that adult onset diabetes stalking children is a clear and omnipresent danger. The wolves are at the door. You must defend hearth and home. And here are the means to do it: we must provide programs, policies, tools and resources so that everybody can do the job.
Recorded on: July 06, 2009