About five months ago a large Brazilian publishing house put out a Portuguese translation of my book Hyping Health Risks: Environmental Hazards in Daily Life and the Science of Epidemiology (Riscos ambientais à saúde: mitos e verdades, Rio de Janeiro: Guanabara-Koogan, 2010). Soon afterward I heard from a professor at the State University of Rio de Janeiro inviting me to visit Brazil for ten days at the expense of the publisher to publicize the book.
Together with my host, Professor Renato Veras, I crisscrossed the country from south to north and from east to west, with talks and book-signing events hosted by four very special institutions with somewhat different audiences. In Porto Alegre in the state of Rio Grande do Sul in the far south, I spoke at the Escola Superiora da Magistratura to judges and lawyers, including, I was told, five justices of the supreme court of the state of Rio Grande do Sul. In São Paulo, the venue was an organization devoted to health promotion among the elderly called AGE PLUS. In Rio I spoke at a foundation called Casa do Saber, which hosts lectures, movies, and other cultural programs. Finally, in Manaus, the capital of the state of Amazonas, the Academy of Medicine of Amazonas State hosted my talk, which was introduced by the president of the academy, Dr. Claudio Chaves.
Each of the talks was followed by lively questions and discussion. Questions ranged from how public discourse about climate change is distorted to how one can counter the inflating of health risks, to what allows lung cancer to develop in people who never smoked, to the pervasive influence of the pharmaceutical industry in shaping messages about health.
Ever since receiving the invitation, I was curious to know how my book, which dealt with the inflation and distortion of health risks largely in the U.S. and Western Europe, came to be selected by a Brazilian publisher to be translated into Portuguese. But it was only after the last talk, that I understood what had motivated Professor Veras, to select my book and then to organize the tour to promote it.
After doing a residency in psychiatry in the late 1970s, Professor Veras had obtained a doctorate in London focusing on the epidemiology of aging in Brazil. Starting seventeen years ago, he developed an innovative, multifaceted program in the area of health promotion for the elderly at the State University of Rio de Janeiro. He believes that geriatrics needs to be informed by an understanding of public health and epidemiology, which reveal important trends about changes in the rates of disease over time and in different socioeconomic and population groups. In addition, he feels strongly that geriatrics must be understood in the context of Brazilian society. Because of his interests, my book, which attempts to explain how many supposed health hazards get exaggerated and distorted, distracting people from what are well-established factors that affect health, struck a chord with Professor Veras.
He felt that people needed to hear the message that not everything that gets featured in the media needs to be worried about and that people should focus on what is important. He appreciates the fact that science is constantly evolving and that things are rarely as simple as one-issue activists would like to make them appear. Distinguishing what are important and well-established findings in public health from what are minimal or non-existent risks assists us in applying this knowledge to improve health. And this is especially true for the elderly who, in Brazil, as in the developed world, are living longer, and, consequently, are in need of reliable information about what they can do to reduce their risk of developing the chronic diseases that are the major causes of death.
In our travels around Brazil I was struck by a number of sharp contrasts. First, Brazil is undergoing enormous growth and has become the powerhouse of South America, but there are huge disparities in income and health between the privileged and wealthy minority and the poor. Furthermore, economic development has been accompanied by dramatic, positive changes in health and longevity of the population as a whole. For example, death rates from cardiovascular disease have declined dramatically over the past twenty years. In addition, the number of elderly people in Brazil increased from three million in 1960 to 20 million in 2008. However, there are large differences in the pattern of disease in different socioeconomic strata and between rural and urban areas. In fact, overall trends – dramatic though they are — mask the fact that there are two different patterns of health and disease – one characteristic of under-developed countries and the other characteristic of developed countries. Brazil is frequently described as a country in transition from developing to developed nation. Finally, the booming pace of economic development poses difficult questions about how to protect the natural environment. Given these realities and challenges, in talking with gynecologists, gerontologists, lawyers, dentists, and others about what the important issues are concerning health and welfare, I realized that, compared to North America and Europe, Brazil can even less afford to devote its resources and energies to the pursuit of illusory and distorted health threats.
The many impressions and warm experiences from this trip and the many encounters with people from very diverse backgrounds brought home to me how little one can anticipate the consequences of one´s actions. You send a piece of work out into the world and have no way of knowing what responses it will evoke in a place and a culture you knew next to nothing about.
Geoffrey Kabat is in the Department of Epidemiology and Population Health at the Albert Einstein College of Medicine.