silent prevention

doi:10.1136/bmj.329.7456.43

BMJ 2004;329:43-44 (3 July), doi:10.1136/bmj.329.7456.43

Commentary

silent prevention

Nicholas J Wald, director¹

¹ Wolfson Institute of Preventive Medicine, Barts and the London, Queen Mary's School of Medicine and Dentistry, London EC1M 6BQ n.j.wald@qmul.ac.uk

The first 150 words of the full text of this article appear below.

Oakley and Johnston correctly criticise Britain's failure tofortify flour with folic acid. But the interventionist principlein nutrition and other areas of public health goes beyond folate.Contrary to current perception, the key to effective publichealth is not individual choice but collective action linkedto public trust in its value.

Most of the main determinants of health vary little among peoplein a community. The scope for individuals to choose healthyand safe foods, drinks, transport, or buildings is limited;the similarities in exposure are greater than the potentialdifferences. To differ significantly from the collective normwe would have to isolate ourselves from the mainstream of society.It is glib and disingenuous to say that we are all consumersexercising choices, when most of the options are essentiallysimilar. For example, most people in developed countries consumeabout 35% of their energy as fat, about 10 g/day . . . [Full text of this article]