Episode 70 - Modifiable Behaviors Drive Most Chronic Disease and Premature Death (Prevention is Possible!) - with Dr. David Katz

Speaker A: M Improving health literacy. The ability to understand and act on health information is key to improving health outcomes and lowering costs. Welcome to The Health Literacy 2.0 podcast, the podcast series from Edlogix where we talk with business, HR, health and community leaders and explore unique data driven and effective behavior changing solutions that can help improve people's health literacy and increase their engagement with health and wellness programs. For show notes and bonus resources, visit www.edlogix.com podcast. Okay, let's get started.

Speaker B: Hello everyone and welcome to today's podcast on workforce health Literacy. I'm Seth Serksner, Chief Health Officer at edlogix and I'm very pleased and proud to have today as my guest Dr. David Katz. He is formerly a professor at Yale. Professor, uh, of medicine is a focus on preventive medicine, food, nutrition, many other things. And I'm going to stop right now because I really want to get into it, but I did not do justice to your significant career and background. So maybe you can just give a little bit more context and then we'll jump into it.

Speaker C: All right, set. Well, first of all, thanks for having me. It's great to be with you. You know, honestly, you did fine. Unless my mother's listening in and she wants the full Monty. Yeah, I mean, in brief, I did sequential after medical school, sequential residencies in internal medicine and then prevent medicine, public health, which landed me at Yale, went on to have faculty positions in both medicine and public health, and then founded the Prevention Research Center. So most of my career, 30 years, give or take, was the academic physicians triathlon of teaching, research and patient care. So I took care of patients for about 30 years, ran the Prevention Research center where we did clinical research focused on the prevention of chronic and in particular cardiometabolic diseases, obesity, type 2 diabetes, heart disease, and so forth. And the kind of work we did was translational research, so responsive to the can you make it play in Peoria question. Really trying to help real people in the real world. That was one of the defining elements of my career. So I finished my second residency in 1993. I'm now board certified in internal medicine and preventive medicine and still trying to figure out what I want to be when I grow up, assuming that never happens. And within a matter of weeks of my graduation and getting my mph, there was a paper published in JAMA entitled Actual Causes of Death in the United States. And I had been thinking, as most of us who are drawn to research and academic medicine, to do what most researchers do, boldly go where no one's gone before ask the unasked question, Probe the unknown. Push back the frontier of human knowledge and understanding. That's what I thought I was going to do. And then this paper came out and rocked me back on my heels. Because for those who know this paper, actual causes of death in the United States, basically, what it posits is that what we list as cause of death on death certificates is entirely unhelpful. So, for instance, somebody dies of cardiogenic shock, and that would be secondary to multiple myocardial functions and congestive heart failure, which in turn would be secondary to atherosclerotic disease of the coronary arteries. But it stops there, never goes further than that. So maybe you get a few steps. But it all ends with the pathology that led to the immediate cause of death. And completely unaddressed there is what caused the atherosclerosis of the coronary arteries in the first place. Why did all of this happen?

Speaker B: Yeah, exactly.

Speaker C: Yeah. So in actual causes of death in The United States, McGinnis and Feige say, what we really care about is the root causes that set all the pathology in motion. The root distal causes of death, not the proximal causes of death. So, famously, in this paper, they enumerated A list of 10 explanatory variables, root causes of premature death, that collectively explain just about all of the premature deaths that happen in the United States and, by extension, the developed world every year. And what grabbed a hold of, uh, my imagination as a newly minted preventive medicine specialist was that the first three things on their list of 10 explained 80% of premature death all by themselves. And they were tobacco, poor diet, lack of physical activity, or bad use of feet, forks, and fingers. 80% of premature death in the United States. So it changed my career. If knowledge were power, if we used what we already know, if we could eliminate 80% or more of all premature death and chronic disease, then that's got to be the focus of a career. Figuring out how to make it work. Not what don't we know, but how do we use what we do know to do actual good in the real world? So the Prevention Research center was all about that. It was translational research. How do we make it work at schools? How do we make it work at work sites? How do we make it work in communities and churches and supermarkets? And that's really been the focus of my career. I guess I would characterize myself as a public health pragmatist. How do we make it work?

Speaker B: It's funny. The, uh, CDC, 1980 did the research to publish the top ten causes of death in the United States, they broke down by age. But for me, that was the big realization. I was at School of Public Health at the time and it was all about these lifestyle related. And at the time they included things like suicide and motor vehicle accidents. But the ones that you talked about were right up there with heart disease and cancer. And they were all lifestyle, they were all modifiable behaviors for the most part. And that's what was a big realization, I think in the public health world. Kind of kicked off the wellness initiatives and we all thought, oh, if we can change these risk factors, you know, that you're talking about, well, let's do that.

Speaker C: We could change the world. We could change the world of public health, certainly. Yeah. So that was the legacy that led to McGinnis and Keegi's favor. They cite that work. It was the healthy people objectives, basically.

Speaker B: Yes, exactly. We refined it so nicely.

Speaker C: They did, they did. So they distilled it down. And there was a long history before that of healthy people objectives. What would we need to do to add years to lives and life to years? And then they enumerated this list of 10 modifiable factors. And as you say, some of the things on their list were environmental exposures, toxins in the environment, motor vehicle use. And so some of the remedies call on the body politic. Some of the best ways to defend the human body reside with the individual, but many of them require collective action. Fixing environmental contaminants and pollutants obviously is a collective decision. So sometimes it's the body politic. And they invoked both. But the critical commonality was, as you say, these are modifiable causes of human suffering and premature death. We know what to do to fix them. It's just a question of will we. And here it is over 30 years later from the 1993 paper and a lot longer from 1980. And by and large we haven't fixed any of them.

Speaker B: But you've gone pretty deep, particularly in the, in the fork area. Uh, talk a little bit about how you're translating science and providing information on that nutrition and the relationship to health and well being and frankly, sustainability.

Speaker C: I developed an interest in nutrition very young. It was my personal nutrition. I was an athlete and I wanted a high performance body and came to the realization that that required high performance fuel. So I, I got into that and then went to medical school and carried that interest with me. And that too was an epiphany, I'd say. My career was a two step revelation. The second was the McInnes and Foege paper that we could prevent so much of this premature death and chronic disease. The first was doing my internal medicine residency. So, you know, during your residency years, you're in the hospital for 110 hours a week and you're taking care of people sick enough to be in the hospital all the time. So, you know, a big part of your job is to try not let people die. But you're also taking stock of why the people are in the hospital. And most of us just focus on getting through the day and learning a lot about how to care for all the different diseases we're seeing. The heart disease, the cancer, the strokes and so on. Metabolic diseases. I'm naturally drawn to the big picture. That's not necessarily an attribute in academia. A lot of highly successful academics are very focused on some small piece of something and become the world's leading expert on that. I always see the elephant in the room. I'm a forest guy rather than a tree guy. So when I was doing my internal medicine training, I couldn't help but realize easily 8 out of 10 people that I'm taking care of all the time, Wave after wave after wave of hospital admissions have stuff they never needed to get. And so I was sort of anticipating where I was going to land with McGinnis and Foe's paper. This stuff doesn't have to happen. We already know that. And so what I really want to do, I do want to take care of them. It's a great privilege to be at the bedside of someone in their hour of most acute need. But I don't want their children to land in the same place some number of years. I don't want this to just keep happening. You know, we know about Humpty Dumpty. We basically say, well, we're not going to give Humpty balance training. We're not going to put a seatbelt on the wall, we're not going to put cushions at the base of the wall. We're just going to line up the ambulances and wait to fall and fall and fall, and then we're never going to be able to unscramble the egg. People need balance training and people need cushions at the base of the wall and a seatbelt at the top and people can stop falling off the wall and we can preserve their vitality. That was really a big part of the inspiration. And then the focus on nutrition was somewhat circumstantial. My own personal interest. But then it reverberated through all of those things. And it stands to reason. Nutrition is two things for the human body and for that matter, the body of all animals. It is fuel. And so every dynamic function in this incredible machine is fueled by what we eat. You could stop right there and say, what could be more important? But you can go further and say it's something else too. It's actually the source of all the construction material. In particular, it's vivid when you talk about growing children. So, you know, you watch a child go from this height to this height and ask, you know, what's that differential made from? You know, matter doesn't come from nowhere. It had to be sourced. And the construction material is what they eat. So it's fuel and construction material. What a powerful, intimate, compelling relationship that is. So I focused on nutrition. And then it turned out to be extremely opportune, because when McGinnis and Foege wrote that paper in 1993, actual causes of death. Tobacco was number one. Bad use of forks and feet were two and three. You fast forward to now, and here's another reference. Our food is killing Too many of us was a New York Times op ed on August 26, 2019. This was written in the New York Times by Darius Mozaffarian, who I'm sure you know, former Dean of Nutrition at Tufts, and Dan Glickman, former Secretary of Agriculture of the United States. Our Food is Killing Too many of us. That's the title, so anybody can Google that. You'll find it. Uh, these guys cite the Global Burden of Disease Study. They basically tell us in the United states, more than 500,000 people die prematurely every year from bad quality diet. Not hunger, not lack of food, but junk where food ought to be. The timing was fascinating. So this was August of 2019. I think everybody remembers what happened in December of 2019 and early 2020. We were overrun by SARS, COV2 and the COVID pandemic. And it was sort of a fascinating juxtaposition because that op ed called out to me because my career has long been devoted to nutrition. But during the pandemic, when we crossed the threshold where we had had 500,000 casualties at the time, President B led a national moment of silence in shared grief and reflection. And I thought rightly so. And yet we cross this threshold every year because of bad food, and it hides in plain sight, and it's just business as usual. In other words, from the time of McGinnis and Foege's initial paper, when diet was number two or three, to now, diet has overtaken tobacco. Diet quality is the single leading predictor variable for premature death from all causes in the United States. So I think it was a good choice. I've been focused on fixing that problem. Not that there's a lot of success I can claim, but I've been trying for a very long time.

Speaker B: Well, and I don't want to get political, but we do have a secretary of health right now who many, many confusing and inaccurate messages. But, uh, an overriding one is something about food and health and lifestyle is causing a lot of disease. The connections he makes may or may not.

Speaker C: The right wine's one of my columns on the dietary guidelines and talked about the baby in the bathwater. Yeah, there's a little bit of baby there. RFK gets it right, that diet is broken, and ultra processed foods are certainly a big part of the problem, but we should not be eating more beef. There's really no compelling argument for everybody having three servings of full fat dairy a day. And so a lot of things are wrong there. At least he's looking in the right general direction. This is broken. He's just not right about how to fix it necessarily.

Speaker B: Yeah, exactly. Well, tell me a little bit about some of the detailed work you're doing. How are you translating, Spreading the word, spreading best practices out there these days.

Speaker C: So, three particular areas. The one that has taken up most of my time for the past decade is a fundamentally new way to assess dietary intake. Diet quality, measured objectively, is the single leading predictor variable for premature death from all causes in the United States today. Full stop. There's no argument about it. It's the single leading predictor for all major chronic diseases, and yet we measure it in just about no one. So if we do a little experiment of the mind, Imagine a world where we know that hypertension causes strokes and heart attacks and kidney failure and blindness. And we know that if we were to intervene and fix hypertension, we could prevent a lot of that. But the blood pressure cuff hasn't been invented. And the only ways we can measure blood pressure are painful and objectionable. Intra arterial catheters, for example. I mean, you can do that when someone's unconscious. I put them in people, they don't like it if they're conscious. We knew the importance of blood pressure before the blood pressure cuff was invented. What was that world like? Basically, people with hypertension went undiagnosed until they had their first stroke or heart attack. And then inferentially, ah, uh, your blood pressure is probably part of the problem. But it was after the fact. That's terrible. That's a very high price to pay for ignorance. You have a heart attack, you have a stroke, and sometimes that's a fatal event. That's where we are now with diet. And that really vexed me. So all this focus on nutrition. My whole career watching nutrition go from a leading cause of death to the leading cause of death, but we never get upstream of it. We wait for obesity and type 2 diabetes and coronary artery disease and all the rest, and then your diet's probably part of the problem. Maybe we should talk about it. It's like dealing with blood pressure without a blood pressure cuff. I was sort of mired in that frustration as a clinician, taking care of patients, as a researcher, where change in diet quality was a measure we cared about and it was extremely difficult to measure. We could do it, but it's the dietary equivalent of the intra arterial catheter. It's a two hour semi quantitative food frequency questionnaire and it takes a massive amount of time and it's very expensive. If you do a seven day food journal and then submit that to a Dietitian for an N of 1 analysis, it took a week of your time. It takes a couple of hours of the dietitian's time and we're putting a price tag on that, discounting your time and discounting hers. Uh, a hundred dollars? 150. You know, imagine if it took a week and cost $150 every time we wanted to know somebody's blood pressure. Blood pressure would not be a vital sign. Diet quality should be a vital sign. It's that important. But we needed to make it easier to measure. So that was the grain of sand. I was the crusty old oyster and I just couldn't let go of this. And then one day in 2016, February of 2016 to be exact, I was working out. When I work out, I just let my mind go. It's a very productive time and it either is just for relaxation or it's to open up new doors. Everybody's talking about psychedelics these days. I guess for me the psychedelics are exercise. I've never tried to.

Speaker B: I'm a runner. I don't wear earbuds. I just did.

Speaker C: And I saw it. I saw this thing fully formed in three dimensions and thought, my God, that's beautiful. And then I thought, well, it can't be that simple. Somebody would have thought of this already. So I basically experienced reverse origami in my mind. I just started unfolding this thing from Its three dimensional beauty. Until I had a flat sheet in my head and saw all the facets, I thought, I think this works. And then immediately convened a club of close friends, Walter Willett and Frank Hugh at Harvard, Christopher Gardner at Stanford, and said, guys, tell me what's wrong with this? By the time we were done with that conversation, we all agreed it sounds like this could work. And I don't think anybody's come up with it. So what I did was I invented the first fundamentally new way to do dietary intake assessment, introduced in about 50 years, and reverse engineered dietary assessment. So the way we measure dietary intake now is we assemble a representation of your dietary pattern, one recorded or badly remembered food or eating occasion at a time. So, you know, with a food frequency questionnaire. How many times, Seth, in the past six months did you have pasta and what kind of pasta and how much pasta? Every time? And what sauce did you put over the pasta and what was in the sauce that you put over the pasta and how much of the sauce did you put? Can anybody answer?

Speaker B: That was impossible.

Speaker C: Exactly. We said, you know, at the end of all that, we don't really care, you know, whether we have an exact count of pasta noodles because we're never going to get there anyway. But we do care, you know, what proportion of your overall diet on average is made up of this, that and the other thing. And maybe we can get there by starting at the end. What if we show people representative images of dietary patterns that prevail in the real world and simply ask for pattern recognition? Which of these looks most like how you eat? This one or this one? You know, like the eye test, which is more in focus? 1 or 2? 1 or 2? 1 or two. You know, in 30 seconds they've got us in diopters. We invented that for diet. It's called diet quality photo navigation. We have multiple patents, we have multiple peer reviewed publications and We've done over 250,000 comprehensive dietary intake assessments in the last couple of years. But basically instead of relying on recall, it's entirely predicated on pattern recognition. We built a diet map. On the X axis we have diet type operationally defined. On the Y axis we have diet quality objectively measured using the healthy eating index. We stratified every kind of real world diet into 10 tiers of quality for every combination of coordinates. This type of diet, at this tier of quality, our, uh, dietitians developed a multi day meal plan. We then from that multi day meal plan created a library of high definition photographs of the foods and dishes and then we composited those in a standard way to represent three days of eating that type of diet at that tier of quality. And then we invented and patented something called dietary fingerprinting, which says we don't need a full three days of food because you can identify me with just this. If we can do that for a human and we don't need every food for three days to identify this unique dietary pattern combination of type and quality. Let's distill this down to the irreducible minimum so you can see two of these images side by side on a smartphone and say, which of these looks more like how I eat? A or B? Pick. And then we say, how about now? Pick again, pick again. Just like the eye test, we apified that and we developed a method to do dietary intake assessment comprehensively in about 60 seconds. It's effortless, it's infinitely scalable. It's fun. You're just picking between two images. You don't have to desperately try to remember how many pasta noodles or french fries or broccoli florets you had over the past six months. You don't have to write down everything you ate. And then we can use the same image based method to identify a personalized goal diet. And then instantaneously we can report to you the delta, the exact difference down to grams of this and milligrams of that between your goal and where you are now. And then we can coach to make up the distance. So the big thing that I've done over the past decade is to develop Dietid. And it became a company and was the reason I left academic medicine. And I'm an entrepreneur entirely by accident, never had that compulsion. But I invented this thing. And then the question is, how do we get this to daylight? And um, kind of looked around for somebody to just say, hey, I'll take it and run with it. And that didn't happen. So I had to build a company.

Speaker B: It is quite brilliant. I really, really appreciate that idea. As somebody who's tried to food journal or count all those things just out of general interest in scientific curiosity, I'm a big behavior change guy. And ultimately people talk about how they eat as much as what they eat, right? And who they eat with. And the challenge is to now, okay, great, you got my fingerprint, my food print. But it's tough to change. Where's that piece come in for you?

Speaker C: Totally agree with you. And frankly, it's always going to be tough to change when you live in a country that runs on Dunkin and where Coca Cola is the national hydration beverage, or, you know, some sports drink or whatever. We do not make it easy. Right? Everything in our culture conspires against healthy eating. And frankly, it conspires against all of the domains of lifestyle medicine. I'm a, uh, past president of the American College of Lifestyle Medicine. We have six domains. Feet, forks, fingers, sleep, stress, and love. So physical activity, dietary pattern, tobacco and other toxic exposures, sleep, making sure you get enough stress, making sure you don't have too much, and social connections or love. Those six domains, they're all broken in America, and our culture conspires to break them every day. And it certainly makes healthy eating nearly impossible. You can do it, but you need an incredibly refined skill set. So that's not fair. So my general argument would be we should fix the food environment. And I've been preaching that gospel for decades. But in the meantime, I tell people this is like the water being rough or the currents being rough. But if you're going to be in the water, if you have no choice, you got to know how to swim. Now, it would be better if the seas were easier, but if the currents are in the wrong direction, it just is what it is. You still want to be able to take care of yourself and your family. So I've sort of preached the parallel gospel of skill power. If you have enough skill, you can overcome this. So you're exactly right about behavior change. So embedded in diet ID is all of that. So we've worked closely over the years with a number of luminaries in behavior change, including Jim Prochaska, BJ Fogg, and, uh, we basically create these micro challenges, and they're related not just to eat more vegetables, drink less soda, but also who are you eating with? What's the environment you're eating in? What are the social cues that help you do a better job or that conspire against you? And how do you modify all of those? So all that behavior change science is folded into the digitized coaching we offer. So the full app does four things. It's basically the same four things that GPS does. GPS knows where you are now. You tell it where you want to go. It knows the route from here to there, and it tracks your progress and helps you get there with a turn list. Dietid does the same for diet. Where am I now? That's my baseline. What would be the ideal personal goal diet for me? What's the sequence of changes I need to make to add up to getting from here to there? And what's My progress along the way.

Speaker B: The other thing, it doesn't drive the car for you yet it's not self driving.

Speaker C: Exactly. That's right.

Speaker B: It doesn't make the road safer. So all your analogies are quite fitting.

Speaker C: Exactly. But you could argue that food is medicine does drive the car for you. Right. You could identify your goal diet and then deliver those meals to your home if someone's able to pay for that, either you or your employer or wellness program or the government through a Medicaid waiver kind of thing. And so that would be another thing I've been doing over the last several years. I've been very involved in the food is medicine space. And that would append that last step. Let's do this. Let's teach you to fish and give you the fish so you can enjoy eating the perfectly prepared fish while you're learning how to do this for yourself. And as someone who advocates for plant based, maybe it should be about lentils rather than fish, but you get the idea. So that's been another focus of mine over recent years is participating very actively in the food is medicine movement. And then one other thing I should mention, I developed many years ago a, ah, nonprofit, as you know, the True Health Initiative. And that was because there's so much pseudo confusion about diet, in particular healthy lifestyle. And that's a very big topic. There's a lot of misinformation in play. You know, just like I was frustrated at our inability to make diet quality a vital sign like blood pressure, because it can be and it should be with the right methodology, I was frustrated by our inability to elevate the signal of true information about healthy diet, healthy living above the endless noise. And so I found myself grappling with what could we do to shift the balance in favor of signal versus noise? And what came to mind in that instance was a colleague of ours, another doctor, Dr. Seuss and Horton's who's. And if you remember the story of the who's, they were all going to be boiled in a giant vat of beesel nut oil. And they saved themselves by pulling together and pooling their voices. And what they yelled was, we are here. And ultimately everybody heard them and the rest is history. And I thought, well, you know, in preventive medicine, lifestyle medicine, nutrition, nobody needs to know that we're here. They know that already. What they do need to know is that we agree that enough of us across an expanse of multidisciplinary careers agree about the fundamentals of health promoting, nutrition and lifestyle. Not everything is in question all the time. That we really do not need to tune in tomorrow to Good Morning America Today show to find out what's the right way to eat this week.

Speaker B: Yeah.

Speaker C: Uh, so I founded the True Health Initiative, dedicated to that specific enterprise. I started reaching out to colleagues I thought would have a hard time agreeing, my vegan colleagues and my paleo colleagues, and saying, but come on, I look at what you guys eat. It's more like one another than either plate is like the typical American diet, which mostly glows in the dark. You know, one of you fills your plate with greens and grains and then get your protein from beans or lentils, and the other fills your plate with greens and grains, or maybe not and get your protein from wild salmon. But it's real food, whole food, mostly. That's the borrower from Michael Pollan.

Speaker B: Yes.

Speaker C: Eat food, not too much, mostly plants. You're both doing that. Uh, so can we say we agree about that? Because that's enough. If that could be the North Star, that becomes a beacon people could follow. And we can then develop policy to address it. We can stop pretending like what we ought to eat changes radically and diametrically with every news cycle. So ultimately, the True Health Initiative had a council of 500 people from 50 countries, vegan, paleo, Mediterranean diet advocates and everything else under the sun saying, we agree about what's true. We agree about the good it can do and people ought to know. Which, by the way, ties directly into your great work with health literacy. The idea here was to take that expert knowledge and say, we want to impart this so that it's common knowledge, so that everybody can feel secure that they know this. And then ideally go from knowledge to the power of implementation.

Speaker B: It's a perfect fit. You have to know how to read the water. You need to have information, make it interesting. To your point of the way you've done the assessment, health information, medical information sometimes can be. Be very challenging. The way people learn today, it's okay. YouTube, quick reels, infographics, pictures, stories. Why aren't we using that? I think to your point, one of the things you solve for this kind of agreement and that there is some consensus on so many of these things. Let's stop going in circles and swirling on it. And yet people are bombarded with all of kinds, kinds of information. The health literacy piece, the food literacy, nutrition literacy, all of that so important as a way to help people, you know, find their truth.

Speaker C: Incredibly important. There's so much information flowing all the time now that it's Never been more important, nor has it ever been more challenging. I can even just think about the span of my clinical career. I started seeing patients before there was an Internet. Most patients back in those days came to the doctor and said, I don't know, uh, help me, tell me what to do. And you had to fill an empty cup. And, you know, people had opinions back then, but they didn't think they knew everything. After the Internet, and certainly after social media now with TikTok and everything and AI and Google searches, everybody knows absolutely everything. And most of it's wrong. And it's massively more difficult to disabuse people of misinformation than to simply be an expert source of honest, trustworthy information. You now have to do both of those jobs, and you have to do the second job first. Empty the cup so you can put something new in it. It's a huge job, and both of us face a massive challenge.

Speaker B: Everybody became an epidemiologist during COVID Oh, really?

Speaker C: Exactly.

Speaker B: That's right.

Speaker C: Health literacy faces a whole new set of challenges. You know, it used to be literacy is your ability to read and process information, but everybody already is processing information. But much of it is misinformation, disinformation, and mal information. And that's a massive problem because then you have to dissuade people from these fixed perceptions and beliefs. We were talking a little while ago about our Secretary of Health. I think a big part of the problem, though, this is someone who is sort of ideologically inclined and just bought into certain sources of information and just believes them and they're not valid or reliable. But in order to get the person who's now heading up all of our health agencies in this country to do the right thing consistently, we have to get him to give up some of his fixed beliefs. That's hard, but that's an element of literacy, too. We face a massive challenge as we work to overcome what social media has done. Uh, the Internet initially and then social media now. AI. So you and I have miles to go before we sleep, that's for sure.

Speaker B: We certainly do. Well, I appreciate the way you articulate the challenges and the translation, some of your points of view, even the way you talk about the elephant. Not many people talk about the idea of your consciousness around the sustainability of what you eat, let alone the fuel and the, uh, energy and the construction elements that it has. So you bring so much to the table. Before we close out, what should we emphasize? What do we miss? What are a couple big messages before we close out?

Speaker C: Do you think, you know, you just brought one in that I didn't have time to address but is profoundly important to me every day. You, uh, know, it's the thing that keeps me awake at night. We're destroying our planet. You know, I devoted my career to clinical medicine and then preventive medicine and nutrition and lifestyle. One of my best friends is a wildlife veterinarian and conservationist. He was the lead wildlife veterinarian for the country of Botswana for a number of years. He was with World Wildlife Fund. He's now an endowed professor at Cornell in the veterinary school, focused on wildlife conservation, mostly in Africa. And year after year after year, he would rib me and say, dave, are, uh, you sure you're on the right team? I mean, the species whose life you're looking to extend is destroying the rest of the biosphere. You're sure you're on the right team? It did start to trouble me. I thought, we really are soiling our nest quite badly. And I advocated all along for doing everything possible to add years to life and life to years. And then I started thinking, we have some hope of being healthy, vital people on a healthy, vital planet, or we have no hope of being healthy, vital people at all. I would say that was a message we didn't get to today. And I think that needs to be factored into every discussion of health. So if we're talking about health literacy, if you're literate about health, you need to understand the indelible connections between the health of people and the health of the planet and ecosystems and the climate and biodiversity and all of that. So I've been ranting for years to anyone who would listen. I don't think you can call yourself a health professional anymore if you don't advocate fiercely, frequently, and with passion for the health of the planet. So thank you for bringing that up. I'd say that's a critical piece of the message.

Speaker B: Well, and I really resonate to it because I'm going on almost 50 years of vegetarianism, and that's my main motivation, was the environment.

Speaker C: I'm mostly vegan. About the same amount of time, too. And that's a huge part of my motivation. I gave up beef as a teenager. First, I learned from John Robbins what we were doing to the animals and what it was doing to the planet. And, yeah, I mean, there are health implications too, but I'm really partial to this planet. I'd like to take better care of it.

Speaker B: Yeah, exactly. Well, thank you again for your time, your insights, the work you do, your passion you're caring for all of us. We really appreciate it.

Speaker C: Back at uh you Seth. Thanks so much for having me. I really appreciate it.

Speaker B: Thank you everyone for listening and take care.

Speaker A: Thanks for joining us today on the Health Literacy 2.0 podcast. The podcast series from Edlogix where we talk with business, hr, health and community leaders and explore unique data driven and effective behavior changing solutions that can help impact improve people's health literacy and increase their engagement with health and wellness programs. Remember, for show notes and bonus resources visit www.edlogix.com podcast. We'd love it if you subscribe and share the show with your colleagues. Thanks and see you soon.