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WONCA and World Nutrition: A Positive Approach.

THE 11TH WONCA1 Conference has come and gone. Through a week of grey skies and less-thanbalmy breezes, 2,000 delegates representing primary health care physicians round the globe met in London's labyrinthine Barbican Centre to focus on the theme "Towards 2000". The theme represented WONCA'S commitment to the Resolution of the 30th World Health Assembly of May 1977 that "The main social target of governments and WHO in the coming decades should be the attainment by all the citizens of the world by the year 2000 of a level of health which will permit them to lead a socially and economically productive life".'2 To help meet this goal, the WONCA Executive determined that the 1986 Conferetce should "review achievements of family medicine and general practice and . . . examine what developments are necessary in the closing years of the 20th century in the light of these targets."3 Speakers at the plenary sessions focused on four areas of health care: maternal and child health; health education; nutrition; and community participation in the health care process. Dr. Philip Sive of the Primary Care Unit, Ben Gurion University Medical School, Beersheba, Israel, presented a paper, intriguingly titled "So They Did Eat, and Were Filled and Became Fat' , which touched on all the areas of focus of the WONCA 1986 theme. His paper also pointed to ways in which family physicians could participate in bringing the goal of health for all closer to fulfilment. Since modern Israel was established in 1948, it has experienced problems typical both of a developing and of a developed country. At first, problems of undernutrition were common. During a span of 33 years, however, total per capita calorie consumption has risen by 17.6%, animal fat consumption by 82%, and meat consumption by over 200%. Obesity now occurs fairly frequently, and mortality statistics are following Western patterns, with coronary heart disease and cancer figuring as the chief causes of death. Both types of problems are related to the urgent need for health education. Concerted action must be taken to find a permanent solution for such problems, not only on a national, but also on a global, level. Recognizing the seriousness of all these varieties of nutrition/health-related problems, what can family practitioners do to promote solutions? Some physicians have devoted themselves entirely or for a specific period to the care of starving communities. Canadian doctors, and those of other nations, have recently served, for instance, in famine-ravaged areas of Ethiopia. In a less visible but equally important way, Dr. Sive maintained, family physicians have both the duty and the power to change patients' eating habits for the better. It has been claimed that in developed countries poor nutrition is the second most remediable factor, after smoking, in reducing death. Although some patients persist in smoking despite physicians' advice, ". . . brief mention of this harmful habit at successive consultations can have a desirable effect. Why not use the same strategy with nutrition habits?", Dr. Sive urged. While handling patients' nutritional state as an integral part of their health care, family physicians might even use a questionnaire to determine "whether the patient is eating more vegetables, fruit and whole grain foods, and less calories, fat, sugar, and salt." Nutrition-conscious family practitioners should encourage mothers to breastfeed, "at least [ where] it has been shown to be of vital importance to infant health," and should be alert to identify patient families where, for psychosocial reasons, poor growth might reflect social hardship. Conversely, family physicians should "adopt an aggressive approach to weight reduction and a healthy diet when obesity is evident in infants and young people, within the constraints of normal psychological development." By extension, they should also be alert to adolescents' eating disorders when teenagers present "'with odd complaints which may be related to a distorted body image." The nutritional habits of the elderly, too, often need supervision, since this group's diet may be affected by decreasing income or energy, or even indifference, and their eating habits may often be concealed from the doctor. On a broader scale, "family physicians have an important role to play in influencing policy decisions of governments and others in authority in the best interest of healthy nutrition. This involves the prevention of famine. . as much as determining priorities regarding food resources and availability, distribution and advertising, or campaigns against harmful food prejudices." Though much has been accomplished to improve nutritional standards, much remains to be done. The family physician can help!