You may or may not know that I was his private doctor, and I had several opportunities to discuss many issues on life, that were relevant to his life and that of the life of our community.
What became clear very early on was that he was mourning the diminution of our liberating communal spirituality by an enslaving materialistic religiosity, that had captured our political and economic systems of good governance and had created histories and legacies of mental enslavement of our people, still yet unseen.
In this light, I am going to take a deep history and deep heritage approach, to show from whence we came and to whither bound, to show how we can make the Great Turn to transform all of the rules of our social engagements so that they can uplift us to the highest heights and not lead us downtrodden to the lowest-lows.
Sir Probyn had pride of place of Brimstone Hill in his heart, for it manifested the unbreakable spirit in the hearts and minds and backs and hands and feet of the slaves who built it, as manifested in their superb craftsmanship.
For him this was proof of principle that no matter how diabolic the times were, THAT spirit could never have been extinguished and can NOW be tapped into as a source of transformation that guides our thoughts, feelings and actions, individually and collectively, in comprehensively inclusive and imaginatively creative life-enabling ways.
The global nutrition transition, which embraces major changes in how food is produced, distributed and consumed, is associated with rapid increases in the prevalence of obesity, but the implications for diabetes differ between populations. A simple conceptual model treats diabetes risk as the function of two interacting traits: ‘metabolic capacity,’ which promotes glucose homeostasis, and ‘metabolic load’, which challenges glucose homoeostasis. Population variability in diabetes prevalence is consistent with this conceptual model, indicating that the effect of obesity varies by ethnicity. Evolutionary life history theory can help explain why variability in metabolic capacity and metabolic load emerges. At the species level (hominin evolution), across human populations and within individual life courses, phenotypic variability emerges under selective pressure to maximise reproductive fitness rather than metabolic health. Those exposed to adverse environments may express or develop several metabolic traits that are individually beneficial for reproductive fitness, but which cumulatively increase diabetes risk. Public health interventions can help promote metabolic capacity, but there are limits to the benefits that can emerge within a single generation. This means that efforts to curb metabolic load (obesity, unhealthy lifestyles) must remain at the forefront of diabetes prevention. Such efforts should go beyond individuals and target the broader food system and socioeconomic factors, in order to maximise their efficacy.
Purpose of the review Environmental and social determinants of health often co-occur, particularly among socially disadvantaged populations, yet because they are usually studied separately, their joint effects on health are likely underestimated. Building on converging bodies of literature, we delineate a conceptual framework to address these issues.
Recent findings Previous models provided a foundation for study in this area, and generated research pointing to additional important issues. These include a stronger focus on biobehavioral pathways, both positive and adverse health outcomes, and intergenerational effects. To accommodate the expanded set of issues, we put forward the Integrated Socio-Environmental Model of Health and Well-Being (ISEM), which examines how social and environmental factors combine and potentially interact, via multi-factorial pathways, to affect health and well-being over the life span. We then provide applied examples including the study of how food environments affect dietary behavior.
Summary The ISEM provides a comprehensive, theoretically informed framework to guide future research on the joint contribution of social and environmental factors to health and well-being across the life span.
Keywords Total environment . Social determinants . Cumulative exposures . Life course . Health disparities
Obesity is still increasing in prevalence in almost all countries and is an important risk factor for poor health and mortality. The current approach to obesity prevention is failing despite many piecemeal efforts, recommendations, and calls to action. This Commission following on from two Lancet Series on obesity looks at obesity in a much wider context of common underlying societal and political drivers for malnutrition in all its forms and climate change. The Commission urges a radical rethink of business models, food systems, civil society involvement, and national and international governance to address The Global Syndemic of Obesity, Undernutrition, and Climate Change. A holistic effort to reorient human systems to achieve better human and planetary health is our most important and urgent challenge.