[bettercaust]

This "miasmist approach" to public health starts from a belief, not a basis of fact or empiricism. There are certainly circumstances in which malnutrition makes someone more susceptible to infectious disease, but what evidence is there that this is a significant contributor to infectious disease in countries like the US? What evidence is there that an otherwise healthy immune system could be "boosted" with proper nutrition and elimination of environmental toxins to the point that it would have a meaningful impact on infectious disease?

No one's against nutritional public health measures or elimination of environmental toxins to improve public health. The fact is lifestyle interventions are ALWAYS first-line recommendations by medical doctors for things like obesity, but Americans are stressed out, overworked, inactive, eating garbage food, and have clamored for easy solutions like taking a pill for a long time rather than making lifestyle changes. There's been no neglect of "living a healthy life", it's just that Americans don't want to do it because it requires lifting a finger. There are many positive public health impacts HHS and the Trump admin could have, but they are talking out of both sides of their mouth when they claim "MAHA" while cutting food access entitlements, rolling back environmental regulations for clean air and water, and of course "drill baby drill". RFK Jr. made a deal with the devil to be HHS secretary.

[somenameforme]

There's endless studies looking at the relationship between exercise and just about everything. It can do everything from substantially reduce your risk of cancer [1] to dramatically reducing your risk of getting a cold [2] and resulting in equally dramatically less severe symptoms if you do catch one.

And nobody really knows why this is, though there are plentiful hypotheses. And exercise is just one aspect of living healthy, though a very important one. You find similar strong associations between 'clean' eating and all other sorts of aspects of a living a healthy life.

Not only does it have effects but rather dramatic ones. I'd think most people would probably see this in their daily lives as healthfulness has dramatic effects on both physical and psychological wellbeing.

[1] - https://www.cancer.gov/about-cancer/causes-prevention/risk/o...

[2] - https://www.bbc.com/news/health-11664660

[somenameforme]

Also, excuse the double reply, but there are simple solutions to also help push society in the right direction. For instance requiring employers over 'x' employees (let's say 1000) to provide free access to a specified minimal set of exercise equipment and grant employees at least 'x' hours per week of paid exercise time which must be spent within this area exercising at a reasonable intensity (in other words not taking an hour break to go play on your phone in the gym).

Other things would be to offer a 100% tax credit for things like gym memberships. If this actually incentivized people, then it'd probably pay for itself through better health outcomes for society. It could also be paid for by adding a health tax, such as already exists on cigarettes, to e.g. highly processed foods, candy, and cola.

Similarly, the FDA should have some sort of an accreditation that restaurants and other food services can apply for that confirms some standard of minimal healthfulness of their food. This accreditation would be extremely critical since, in general, just dumping salt and sugar into food makes it more addictive, which increases margins, so when you go for health - you do so at profit loss. Such an accreditation could help combat this by giving people something to look for.

[bettercaust]

I'm going to reply here to both comments.

I didn't contest the relationship between regular exercise and health. The questions I raised were: what evidence is there that [malnutrition] is a significant contributor to infectious disease in countries like the US? What evidence is there that an otherwise healthy immune system could be "boosted" with proper nutrition and elimination of environmental toxins to the point that it would have a meaningful impact on infectious disease?

I agree with all of these solutions for encouraging regular exercise, and I'm open to the solutions for encouraging healthier nutrition.

[somenameforme]

The most clear example of this in the US is obesity. It correlates extremely negatively with basically every disease in existence, in every single way (susceptibility, severity, outcomes, recovery, etc) and is driven by malnutrition.

Solutions are not difficult to find for this specific manifestation of malnutrition. The primary issue is crap foods and cola which enable one to consume far more calories than you'd even be able to if eating a comparable amount of healthy food. For instance 2400 calories is 15 100g (cooked size) chicken breast servings. Or it's less than 2 McDonalds Big Breakfasts.

[bettercaust]

Not difficult to find? Maybe, maybe not. Effective public health solutions for obesity for which there is political will to implement them seem difficult to find to me. At the individual level, if you can manage to cut out ultra-processed food, exercise a few times a week, and get any comorbid medical conditions treated you're probably in the clear. All that is to say, it is relatively easy to identify at least some of the determinants of obesity for solutions.

[somenameforme]

I don't agree there at all. Our society has become so screwed up with unhealthful practices that there's low hanging fruit all over the place. For instance don't offer soft drinks, junk food, "sports drinks", etc. at public schools or allow vending machines for such. Offer water, milk, naturally non-caffeinated teas, and so on. Vending snacks could include things like wasabi peas and other extremely low calorie + high flavor type items.

Another thing is to remove the ability to purchase junk foods and cola with government food assistance. There's an extreme inverse correlation between obesity and income (hah.. imagine people of a couple hundred years ago hearing that) and so steps like this could actually have a tremendously positive overall impact on overall social health and wellbeing. This is even more true when you consider that twinkies and cokes are being bought on strictly limited budgets which means that much less money (and now more) for healthy foods.

[econ]

You can force exercise by doing periodic checks the way we do with disease or addiction. If your score is below some point you require a different kind of healthcare with a different price tag. If stats don't improve there should be special hospitals

[econ]

You can force minimal exercise by doing periodic checks the way we do with disease or addiction. If your score is below some point you require a different kind of healthcare with a different price tag. If stats don't improve there should be special hospitals (with public funding)

Rather than have the stores and restaurants pay for changes they can be required and tax funded. Do it gradually.

The economy will thank you later.

[alejohausner]

I know I'm coming to the discussion late, but actually there is good evidence that improvements in nutrition, working conditions, and sanitation are a big factor in improving resistance to infectious diseases.

Look at "The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century", by Mckinlay and McKinley (1977). I know it's an old paper, but it has some fascinating and, to me, very persuasive time series. Those plots show mortality from various infectious diseases over the 20th century.

Example: death rates (per 1000) from scarlet fever dropped from 0.1 in 1900 to effectively 0 in 1940. There is NO VACCINE for scarlet fever.

Example: death rates from measles (lately very much in the news) dropped from 0.12 in 1900 to 0 in 1960 (a vaccine for measles was introduced in 1960).

A similar trend exists for many other infectious diseases: huge drops in mortality PRECEDE the introduction of vaccines or antibiotics for the disease. Surely we can't credit vaccines with such a drop in death rates. I don't see how anybody could come to such a conclusion.

[bettercaust]

No one is contesting the role of nutrition, working conditions, and sanitation in infectious diseases generally. What I asked was: what evidence is there that this is a significant contributor to infectious disease in countries like the US? (I should clarify that I'm referring to present-day US, because we're discussing in context of MAHA which is present-day US)

Yes, measles death rates had dropped precipitously (fortunately), however incidence (new cases) had only dropped a little. It wasn't until the vaccine was introduced that incidence dropped to nearly zero[1]. Yours is a common anti-vaxx talking point, and one that seems to neglect that death is not the only negative outcome from measles. It's understandable to take the talking point at face value when it appears to be scientifically-supported, though this is a good example of how a talking point uses a cherry-picked fact and reframes the issue for a presupposed conclusion (that vaccines are unsafe or ineffective), because the origin of that talking point had no interest in comprehensively informing people but converting them to believers.

[1] https://ourworldindata.org/grapher/measles-cases-and-death-r...

[alejohausner]

Yes, the measles vaccine is effective. It reduces cases of measles. But the paper in question says that deaths were reduced to almost zero before the vaccine was introduced. The graph that you linked to shows the same thing.

For me the paper shows not just that good sanitation and nutrition help reduce deaths from many infections diseases, but that they are the primary agent in that reduction. I thought it was a very cool paper, although you don’t seem moved in the same way as me.

When I was a child, my parents weren’t upset when I got measles (I was, because it meant missing a trip to the seashore). It meant that you were going to be miserable for a week, but would be immune afterwards. So I became one more case, but not one more death.

[bettercaust]

I mean, that good sanitation reduced infectious disease incidence and mortality was something I was already aware of so I've already been "moved" so to speak. As for nutrition, the paper cites one researcher who concludes nutrition was a major factor, and it probably was a factor, though the magnitude of its impact is not firmly established by that one researcher.