Is healthcare upside down? What does that mean exactly, and what can the scientific breakthroughs of COVID-19 vaccines mean for further wellness innovation? Hear from Oscar Franco, MD, as he shares his own journey to wellness, providing insights about barriers to optimal global health, and what it is going to take to create positive health trajectories for consumers and communities. This episode will inspire consumer healthcare companies to continue to support people’s decisions to lead healthier, happier lives through holistic, responsible self-care. A must listen!
- Episode Transcript
Welcome to CHPA Chat, conversations in the consumer healthcare industry.
John Troup: Welcome everybody, and thanks again for joining us in a continuous series of topics important to the dietary supplement category. Today, we're going to talk about public health and the impact that nutrition and dietary supplements can have in public health, especially given the changes in the past 12 months in the pandemic. I'm really excited to talk to our next thought leader, Dr. Oscar Franco, who's professor of Epidemiology and Public Health and the director of the Institute of Social and Preventive Medicine at the University of Bern in Bern, Switzerland.
Oscar is also adjunct professor at the Harvard T.H. Chan School of Public Health and Erasmus Medical College in Rotterdam, a scientific advisor for the French television channel, France24, I wish I could say that in French, sorry, Oscar. Then Oscar has been one of the most proliferative authors in the scientific world, and particularly, a thought leader in public health with over 700 publications in high-impact journals. Oscar, my friend, it's great talking to you and thanks very much for joining us today.
Oscar Franco: John, thanks to you for the invitation. For me it's always a pleasure to talk about public health and to talk with friends like yourself. So thank you for the invitation of this opportunity.
John Troup: So Oscar I've had the great opportunity and the fantastic experience of knowing you for something close to approaching 15 years. One of the things I've always enjoyed, is capturing your insight, and better understanding the impact and the role that epidemiology can have in establishing health policy and helping us define the trajectory of what the world, in fact, or Americans, should be talking about, about how to improve health practices. Give us, if you would, a little bit of insight of some of the top line and most important insights from the epidemiological world on what's happening today, especially through and post pandemic, and the impact on health practices that you're beginning to see take hold around the world?
Oscar Franco: Thanks John. I think the pandemic is going to leave us with a lot of lessons, with a lot of positive things, a lot of negative things. We all have experienced the pandemic in a different way. It has affected our mental health, our capacity of living, but in terms of its epidemiology, if anything, the pandemic leaves us a number of lessons that we should have learned earlier.
The first one is that patients are not patients, and patients are not clients. Patients are persons and they live in families and communities. If we really want to make the change, we are going to have to interact more closely with communities and improve the circumstances that communities are living. I think that's the number one. Epidemiology looks at large populations, it doesn't focus on individuals, it focuses on populations. And that's what we have learned in the pandemic. We are all in this together, the pandemic is problem of everyone, and in everyone is the solution, that's the first thing.
Second thing that it has shown us, the pandemic, is that epidemiology can help a lot in sharing something that is very important for the population. I think that it has shown us that health information and education are very important resources that should be benefited, and accessible to a majority of the population, and not to just a few. Epidemiology can help in understanding how these populations, how the knowledge, can be delivered to the populations, and how science can be translated for implementation. I think these are two of the largest contributions that epidemiology can leave for healthcare and for the future after the pandemic.
John Troup: Yeah, that's great. In my own observation, Oscar, I've seen that, probably now more than ever, the consumer is more motivated than ever before to find information, to understand better what they can do and control themselves. It usually starts with lifestyle and diet and nutrition practices and habits, but can you tease that out for us, on lifestyles? What are important in lifestyles? And then, you might also [speak] on what are the most important things, if you're going to improve your dietary practices, what should that include?
Oscar Franco: John, I think if I mentioned to you lifestyle, I'm preaching to a convert. What we have seen in the pandemic, is despite that the most important risk factors is being male, old, hypertensive, obese, and diabetic. If these are the most important factors for Coronavirus and to have a worse Coronavirus, or to die from it, none of these diseases appear from one day to another. But they are the result of a number of lifestyle factors, a number of bad diet, not doing exercise, sleeping badly, having a lot of stress, that have occurred day after day for years. Despite that, when we look at all the measures that are being taken to improve the health of the population or to prevent COVID-19, the majority of the measures are not talking about lifestyle. That hasn't helped the consumer to be able to know what to do to prevent Coronavirus.
And I think the answer to this, and I said before, lifestyle is something that I don't need to convince you about, but I think we need to convince the population. That if we want to have good immune health, good cardiac health, and good metabolic health, lifestyle, not just nutrition, but not smoking, not drinking alcohol or drinking in small amounts, controlling the stress, sleeping well, and doing a lot of physical activity, and [inaudible] how this lifestyle is incorporated, is essential. Not just for individuals, for communities, and for the government, not only to tackle this pandemic but to tackle all future pandemics and the big, important crisis that we are really facing, which is planetary health and climate change.
John Troup: Chronic disease doesn't happen overnight. It's not like an acute situation, where I got a headache and it comes and goes fairly quickly. Chronic disease is something that happens over time, but can be addressed with better lifestyles and filling, in some cases, the nutrient gaps that exist from poor practices. Is that a fair and accurate statement from what you were describing?
Oscar Franco: Totally agree, John. An important aspect is not only that these challenges that we are adding to our organism by eating the wrong things, or behaving in a poor way, not doing physical activity, all those challenges are accumulating, they're building up. So it's never too early to stop those challenges. But another important message is that it's never too late to change your lifestyle. What we see, is that people even after they have disease, even after they have spent many years smoking or eating poorly, et cetera, as soon as they change lifestyle, they still accruing the benefits of an improved diet or of doing physical activity.
So the message that we need to deliver now, is that maybe there could be a new pandemic coming. Maybe we are living already in a pandemic of cardio-metabolic disorders. What are we doing to prepare to avoid the future pandemic, and to diminish the pandemic that we are living right now from COVID-19 and cardiovascular diseases? Why aren't we investing more in improving lifestyle? I think if we want to prepare in the future, we've got to start immediately, either forgetting Coronavirus in the coming months or years, or to prepare for the next pandemic. We need to improve our health by having a good, healthy lifestyle.
John Troup: Oscar, you talk about the investment, either an investment as being committed to better health practices, but also an investment in healthcare systems. I'm curious on what you think about this, is that at least in America, it's difficult to get full recognition by insurance providers to support the use of better nutrition or lifestyle changes, or even in the case where there are gaps in nutrition that could be solved in a transition way with dietary supplements to support that for some periods of time. What will it take to get the healthcare system to be more serious about understanding preventive care, and the use of appropriate tools and lifestyles, they can be used to facilitate and accelerate better health practices? I know that, for example, you've been an advisor to a large number of ministries of health around the world. And I can imagine you talk about this a lot with them, but what do they say? Do they support these kinds of general concepts, so that there could be greater investment in health systems within their own countries?
Oscar Franco: John, I think what we see worldwide, is that healthcare is upside down. We still think that health is dictated by experts and a specialist in a hospital. In hospitals, you can take care of disease, but you don't take care of health. If we want the healthcare system to really help the health of the population, and not just to treat diseases which is the model that we have right now, we need to turn the level of investment, research, and approaches to our population. And have a population approach in which we are going to work on improving the lifestyle and behavior of the population, in order to prevent that these people are going to be coming to hospitals to require very expensive medication, very expensive, intensive care unit treatments.
Right now, the system, the model is wrong. It's focused on diseases, and this is healthcare. We are not taking care of health, we are taking care of diseases, and this needs to change. What it takes to change, if it is not a catastrophe, if it is not a pandemic like the one we are living, I don't know what we need. I don't know how many more catastrophes do we need to be able to understand this, which I think the pandemic makes it even clearer.
John Troup: Yeah. To that end, Oscar, I know that you've been a contributor to the World Health Organization, the WHO's report on noncommunicable diseases, which is part of what we're talking about here. But as you prepare those reports and provide those insights, are there one or two, three, or four major insights that you've learned from epidemiological studies related to nutrition practices that are really important? I guess maybe the way I should have asked this question, is what's the best diet in the world? Is it the Mediterranean diet. You worked with so many cohorts that are well-known to our listeners and had a chance to dive deep. What are you learning from the epidemiological and the cohorts, that you have applied to the WHO report, and in your discussions to ministers of health?
Oscar Franco: John, one of the things we have learned, and first, there is no magical diet that is going to solve it for all of us. But there is one magical word that is going to help us all, which is, "Moderation." Everything we do, everything we eat, everything we take, most of it is okay, if we do it in low amounts or with moderation. It's very important to adapt those to your local facilities. I cannot advise someone in Africa to follow a Mediterranean diet. Or I cannot advise people in the United States to not to drink local, excellent wines, like the ones you produce.
Why would you be drinking the ones in France, which are also good? But you have very good, local products. I think we have, in every community and every society and every geographical location in the world, there are good elements of diet that are hanging out there, that could be utilized. Following a model from a distant world, I don't think is realistic. I say moderation and application to a local circumstances and the local needs, are essential to be able to provide that advice. There is no magical pill. There is no magical advice, there's one magical word, and that is, "Moderation," within a healthy lifestyle. With lots of physical activity, trying to sleep well, not smoking, keeping an eye on what you drink and how much you drink, and trying to control your stress.
John Troup: Yeah, in the United States, the USDA, the US Department Of Agriculture, released their 2020-2025 dietary guidelines. They identify, for the first time, across various specific population segments, the issue of nutrient gaps, where a good 40 to even as high as 60 percent of Americans have nutrient gaps. What's the cause of those gaps, and how can we fill them?
Oscar Franco: We've seen an excess consumption of certain products that do not deliver the nutritional needs of the population. We've been maybe drinking too much carbonated drinks, or maybe we have been eating too many big burgers, and we haven't been having balance and moderation into our diet. So it's very important to go back to those local products that are really healthy. And go back to how people used to eat in the past, fresh, local, and balanced. I mean, we have wonderful fruits, wonderful vegetables. America is full of fertile lands, that produces amazing products. Why do we need to go for processed foods?
Why can't we eat fresh and natural? And I think that is a very important message. So far, we have been complicating our own lives, eating things that we don't need, eating things that do not solve our needs. Now we're having gaps of nutrition, where we are obese at the same time, because we've been eating a lot, but a lot of things that do not deliver what we require. Now what we need to do is basically look at what are the type of behaviors we have created that are unnecessary? And can we actually challenge them? Can we actually change them? And can we fill in some of those gaps that we have created ourselves?
John Troup: Yeah, great. One of the things that as you know, in most of the conferences and seminars that we go to, especially when we're together and some of our colleagues in public health, we talk about this issue of the nutrient gap. There can be no doubt, that the best way to fill that, is with better dietary practices and habits, and better food choices, and knowing what to shop for when you go to the farmer's market, or to the grocery store. But more and more science is beginning to show that while vitamins and minerals may be important, they're not necessarily going to provide the final solution, but it needs to be used also with a complete, almost like a whole-food approach into using active phytonutrients, and vitamins and minerals and other components that provide a better nutrient profile.
I know there's a lot of research, and you've done some research too, in looking at phytonutrients and especially with the interest in [inaudible], and there must be some interest and work that you've done in your cardiovascular work on cocoa polyphenols. In some of these what I call phytonutrients that play an important role. Which also was part of the discussion when people do talk about Mediterranean diet. But how do you feel about all these nutrients and ingredients that the population is essentially bombarded with? And should they be considering about that when they think about moderation and the foods they do pick to consume?
Oscar Franco: Yes John, the population has been bombarded with commercial products that not necessarily are accompanied by adequate science. I think science plays a very important role, and it does in [inaudible], nutritional epidemiology, nutritional sciences. I want to play a very important role in clarifying what is good for people, and what is not. We have seen during this year, we'd have witnessed a miracle of science, which is to have a pandemic and to have nine vaccines that we have right now, that seem to work, within a year.
We have never seen that before. Science is growing like never before. I said before, there is no magical solutions for nutrition, but perhaps if we invest a little bit more on science and understanding how the gaps are, how can they be fulfilled, how can we deliver them? I think we could have in the coming years magical solutions, or some solutions that are produced by science like these vaccines that we have for the pandemic that sounds like magic. Within a year, nine vaccines that work, I wouldn't believe that six months ago. So I think we can do a lot if we put the money where we should, which is science and development. If we invest in science, we are going to be able to understand better, John, the question, how can we deliver better products to a population that are going to be able to give them a better health?
John Troup: That's really interesting, Oscar. I'm curious on what you see around the world, in the United States for the first time, there are actually active discussions in the government now, talking about, how do you integrate all the interests in the agricultural departments and in the departments of health and human services? Because right now we spend something over a trillion dollars, much more in health policies and food policies that aren't connected. Yet they're directly connected in terms of health outcomes. So now there's talk about a food czar that would come in the government and help pull together all these departments and agencies and spend, in a way they could provide better focus of spend to do some of the things you just talked about. Better research funding to try to get at the answer and better preventive healthcare practices. But are there other countries in the world that you've seen that, that are already doing a coordinated effort within their countries?
Oscar Franco: If we have seen anything, is in general, a lack of coordination throughout the last year, is what I have seen working in science, is a lack of coordination. Not only between countries, but even within countries, a lot of repetitive efforts, a lack of conversation and openness. I think this needs to be better articulated. We've seen that there can be articulated work, that we have seen with the vaccines that I was mentioning before. We have seen that we can actually do it, if we have the right investment, the right education, the right solidarity by individuals working on the scientific, the production, the marketing, et cetera, the policymakers. If we work all as a team, and we have the clear goals. And the goal in this case for health, should be keeping people healthy, allowing people to maintain health, to return to health. If we have that in mind, maybe we will be able to invest far more on prevention, and reap the benefits by having to pay less with cardiac surgery, or pay less with drugs that are really not necessarily if you follow a healthy lifestyle, and you take care of your health.
John Troup: Can we give our listeners hope? To say, "Look, even if you're on the worst diet, you can still change your health trajectory. You just got to do it soon enough and stay with it." I mean, what's that secret to get the right health trajectory for a great health span?
Oscar Franco: It reminds me of the yellow brick road, that you probably know. There is a yellow brick road for all of us. Sometimes we walk away from the yellow brick road, but it's really never too late to start searching back for it, and go back to that road that is going to lead us also to help in this case. I think what we have seen so far, and this is the study that we have done in populations like [inaudible] the scope of the study, which had large cohorts in America with American citizens, that were helped and that were followed for many years. What we have seen, is even people over age 50 or 60, that had followed a sedentary lifestyle, if they start doing physical activity, they can reap the benefits in later life. It's the same for dietary practices. If you avoid being obese in middle age, to avoid it in later life, there are still benefits.
Throughout your life, every day, we are taking a decision how we want to live our lives, and how are we going to die, and when we are going to die. We say that there is nobody that can predict when they're going to die. That is a matter of destiny, it's a matter of luck. But we have a big responsibility in the lifestyle that we are doing. Do we want to kill ourselves quickly? Then we need to follow an unhealthy lifestyle. Do we want to live as long as we choose, and as long as luck allows us, then we need to have more physical activity and eat better. It's up to us. Every day we take that decision. It cannot wait, but it's also never too late to make some changes.
John Troup: Yeah. Awesome. I've heard actually you and others talk about, I've always believed this, the human body has been estimated to be built to last 110 to 120 years. Yet, the average lifespan is, or the death rates are hovering right around the low to mid 80s, I think. So that gap between what the body is built for, and where the majority of people seem to be dying, is that going to be the result of the improvement in health span? Or what's the reason that the gap is, and how much of that do you think we can improve by changing our habit? Can we get ten more years out of that gap? Or what's it look like?
Oscar Franco: John, I think the body is not a programmed to live up 100, maybe up to longer. I don't know [inaudible] really existed. Maybe the [inaudible] could exist. Maybe we actually can live until 1,000. I don't know if I want to live more than 100 myself, but I don't think that the body is scheduled to die at one particular age. I have seen it in myself, that what we do, is going to determine our health. This year when the pandemic is started, I started working from 6:00 in the morning to 1:00 in the morning. Day and night, never ending, including the weekends. After a few months, I realized that I got dizzy, I started feeling bad. My blood pressure was up the roof. I wasn't taking care of myself. I saw it on a direct basis. I realized, and I got an urgent call, that if my body is scheduled to live for 80 or 100, my activity, my lifestyle, my poor diet, my lack of rest, et cetera, is going to kill me at age 50.
I'm 46, and I'm already almost dying. Do I want to kill myself? So I started changing my lifestyle in the way that we continue working in the pandemic, working very hard, but trying to take care of my diet, trying to eat fruits and vegetables, trying to do physical activity. So I try to incorporate, I go for a run five times per week. I also, one aspect that we tend to forget, is that body and mind are very strongly connected. Quite often we don't take enough time to take care of our mind, and sleeping well, and are allocating some time for reflection. In my case, I'm doing half an hour meditation every day. I do at least half an hour, that a fit between my work.
Now I feel that I can do the work that I was doing in March and April when the pandemic has started. But with my physical activity, with my good diet, with my meditation, I'm feeling that I'm doing a lot better work, and I am being able to cope with it. My blood pressure is back to normal. It's those decisions every day that is killing us. I don't think the organism, I don't think our bodies is scheduled to die on one particular age. We kill ourselves.
John Troup: Good insights, Oscar. So what you're talking about, I guess I would describe as happiness. I look at, more and more companies are hiring people and giving them the title of vice-president of happiness. Even your title is director of the Institute of Social And Preventive Medicine. So what a great job title, to be in charge of a social component. But define that a little bit? And can you give us a link of social to happiness, and then also social determinants of health? What's that key, you just alluded to it, let's not kill ourselves. Part of that is had social component. How can we better manage it? Just the way you just described it? Or are there other insights that you've picked up from different studies?
Oscar Franco: The social component is essential. Human beings are social animals by nature. We need contact, we need families, we need friends. We need to have a community. We need to be able to feel that we are respected, that we can contribute, that we can serve. We need to feel that we are approved. We seen an explosion in social networks, people in Instagram, posting pictures of what they eat and how beautiful they look like, and if they don't get enough likes, they get depressed. We have seen really a pandemic, if anything, besides of this information and of Coronavirus, we are seeing a pandemic of looking for instant gratification. I post things on Facebook, or I post things on Instagram or on Twitter, and if I don't get enough likes, I get depressed.
I think happiness, this is more of a philosophical discussion that we could have, John. I think for me, happiness is feeling myself useful in life. Therefore, I feel I can reach happiness by serving, because as a social person, as a social member of a community, I feel I have a responsibility towards the rest. Not only to my family, but to the population in general. I think that is the key to finding happiness, is the moment that we as human beings, we start serving a purpose in our life. And finding that purpose is what is difficult to many.
But I think as social beings, we need to promote that. As elements of change, as elements of happiness, that are the societies, the communities, the families, et cetera. Keeping yourself healthy and keeping yourself alive is the way that you serve your family. If you die, you will be of no use to your daughters, but if you're still alive and healthy, you will be able to go for a run with them and enjoy your walk in the park. You have to choose, do you want to be useful? Or do you want to be a burden? Or do you want to die?
John Troup: Yeah, wow. Well, I have to admit to our listeners, Oscar, that I've learned a lot about happiness and social skillsets from you. Every time we were together, you introduced me to a great tasting wine or some great chocolate, or even a couple of times, when we were in the UK together, the best bangers and beans, if you can believe that, in all of England. So I have to say, thanks for teaching me about being happy. But tell us a little bit about your insight. I know you're a big American football fan. Does that keep you happy too? And I've shared probably six a NFL football games with you across America since the time we known each other? Is that your sports passion, which is odd for me, because I thought it would be European soccer?
Oscar Franco: So yeah, I grew up playing soccer and soccer used to be the passion of my life. But when I was 16, I went to live in Australia and I experienced rugby. I played rugby in Australia, which I really liked, until I came back to Columbia and I watch a game of...It was the Houston Oilers versus the Redskins, as far as I remember. This was 1991 and I was amazed by the quarterback, because in rugby you cannot pass the ball forward. It took me a long time to understand the rules of the game, but then I became a fan of American football, and I became a fan of the Dallas Cowboys. As you know, I'm a big fan of the Dallas Cowboys. I used to say it with pride in that time. Now it's a little bit more of a regret, because the last seasons had not been the best for the Cowboys.
But I found a lot of aspects of the game that I really enjoy in American football, which is the strategy and the effort, the team spirit, the interaction between the different sections of a team. How your attack is not enough if you don't have enough defense or a special teams that are well-prepared. It's that balance that really has shown me that this is, right now for me, I think the favorite sport that I follow. I enjoyed this season, despite that the Cowboys did not do well, but I forecasted that it's going to be a Kansas versus Tampa Bay. And I've been a big fan of Tampa Bay in the time that they won the Superbowl many years ago. But also to Kansas City, because I really like that quarterback.
But it was a fantastic season, I thought, despite Coronavirus and despite all the disruption. So I think those kinds of things like activities that you can do, not just watching the sports, but practicing sports, is a way to find happiness. I think happiness is not, again, not something impossible to achieve, but it's a collection of little habits, domestic issues, being with your family, enjoying your life, enjoying a good Thanksgiving, three games that you can watch in a Thanksgiving day in America. Or enjoying a good Sunday night, Sunday football night, or a Monday night football. Those are part of living a happy life, I think.
John Troup: Awesome, and on that note, some great advice for all of us, Oscar, as how to be happy, get a strategy to keep you happy and some hobbies and activities to keep that spark alive in our lives. Dr. Oscar Franco, always a great pleasure talking to you. Thanks very much for the insights and the difference that you're making in the study of public health, and especially during this time of helping the world achieve a healthier health trajectory. Oscar, thanks for joining us. Great talking to you.
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The views expressed in this podcast are solely those of the speaker and do not necessarily represent the opinions of the Consumer Healthcare Products Association.