Candy Addicts: Using literature as a predictor, and a remedy, for what ails us
On break from work, I headed out for a snack. Easier said than done, despite putting aside my vegan lifestyle while in Mongolia.
Across the street from The UB Post offices is a community building for the promotion of sport and physical health. But as I walked down the neighborhood’s plaza on the prowl for food, I found only vendors selling chocolate bars, soda, packaged ice cream, candy and cookies of all sorts, and pubs (some with unsavory or unfortunate names). If not for the melting (tip to vendors: put the candy bars in the ice cream freezers) and the nuts, I’d have ended up with chocolate.
It wasn’t until I reached the first major intersection that I found an acceptable snack: gelato. The selection of flavors was encouraging, as was the price: 1,000 MNT for a double scoop that was very much to my liking, about half of a baby scoop back home in New Hampshire.
I sat down on a bench back on the plaza to do some serious licking, and watched people go by. I watched a lot of people. Not large numbers of people, but numbers of large people. Cutting to the chase, obesity is an issue in UB. The contents of the packaging strewn along Mongolia’s byways in my last article, “Trash Talk” isn’t disappearing into thin air – it’s ending up in the bodies of Mongolians.
Aesthetics aside, obesity -and not just extreme obesity- can mask a hidden danger: pre-diabetes. According to a Mongolian epidemiologist I met last weekend (now living and working abroad), diabetes is among the non-communicable disease epidemics about to descend upon Mongolia the way it has upon India.
It’s not just her opinion. According to a recent article in the medical journal BMC Public Health entitled “Exploring knowledge, attitudes and practices related to diabetes in Mongolia: a national population-based survey” (Demaio et al. ,biomedcentral.com/1471-2458/13/236), “Non-communicable diseases (NCDs) are now the leading causes of mortality in Mongolia, and diabetes, in particular, is a growing public health threat.”
This study, sampling individuals from 3,540 households, found that “up to fifty percent of Mongolian sub-populations, and one in five of the total population, had never heard the term diabetes prior to surveying” and “also highlights a high level of misunderstanding around the symptomatology and natural progression of diabetes; for example, one-third of Mongolians were unaware that the disease could be prevented through lifestyle changes.” Further, the “study suggests that a low proportion of Mongolians have received counseling or health education about diabetes, with lowest access to such services for the urban poor and least educated sub-populations.” The research pointed to a “low prevalence of diabetes-related health-knowledge among Mongolians. In this light, health-education should be part of any national strategy on diabetes.”
Diabetes is not just about good health in general and a trim waist. It is about possibly losing your eyesight, your kidneys and maybe even your freedom. Individuals at risk for late diagnoses of the disease can become permanently dependent on medications, including insulin injections or delivery through a permanent pump.
I know from personal experience with an acquaintance who was blind, had a kidney transplant and was dependent on insulin injections, that this isn’t the least of the issues. During a diabetic crisis, an individual can become irrational, combative, argumentative, and even delusional. This can cause quite a bit of disruption to social stability and family life. Diabetes isn’t the kind of disease that can be “cured” with a pill, injection, or transplant. It has effects that spill over, beyond someone’s physical health, to their social health and, naturally, their financial health as well.
The problem is bigger than the individual. The authors of the Mongolian study cited previously, relate that non-communicable diseases, including their risk factors, “are reflections of wider social, economic and environmental determinants, rather than simply a result of poor lifestyle ‘choices’.” Often, healthy food choices aren’t available. Look at my experience trying to find a snack. Prices are also steep, even when healthy options can be found. My language teacher explained that this year’s vegetables cost many times more than last year’s, and in any case, food shopping needs to be done every couple days for fear of power outages and spoilage. Lack of time, opportunity or knowledge is often cited when it comes to exercise.
In 2009, it was estimated that diabetes affected nine percent of Mongolians in urban areas and four percent in rural regions, while pre-diabetes (which is often asymptomatic) affected 12 percent of urbanites and 7.3 percent of those residing in the countryside.
But how can we have that difficult talk with our loved ones or friends without seeming so superficial as to judge them for those extra pounds: when they choose from the menu, or bring home sugar and fat-laden foods from the market, take the elevator instead of the stairs, try to grab that drink with 100 or more calories from the cooler at the cafe, or when they claim that they don’t have the time or energy to exercise? Fear, shame and guilt are rarely the answer, and education alone isn’t really sufficient to change what amounts to a social problem.
Maybe one method might be to use humor. I admit I have some bias, in that my main motivation in coming to Mongolia was to collect current literature of all kinds: short stories, poetry, lyrics, graffiti, advertisements, news articles, film scripts, etc., to build a research corpus used for detecting public health, environmental, and social issues before they reached epic proportions that could be identified via more traditional, quantitative measures. (This project is to be the foundation of my doctorate research to commence in 2014. For more information, or to contribute text to the corpus, please contact me at email@example.com.)
For example, in the case of diabetes, one would expect that prior evidence of the problem would emerge in literature here in Mongolia, prior to any dramatic rise in the rate of official diagnoses or morbidity reports that would document a problem only when it’s already out of hand. In short, my theory is that the author-writer, as an artist, has fine-tuned his or her connection to the greater consciousness, and that trends in any society will be reflected in its emerging literature prior to being officially documented. For the skeptical, please visit The Victims of Political Persecution Museum and learn about the writers who were executed for highlighting such issues. I’m not alone in my hypothesis about the usefulness of a country’s literature to predict issues and to formulate policy in advance of emerging trends that negatively affect populations: semantics analysis is being used in many fields, including finance and political science. So why not public health as well?
Still, I was surprised when evidence of my theory dropped itself in my lap. I encountered the expat Mongolian epidemiologist by chance, and also by chance, was referred to two expat writers: one Oliver Claycamp (firstname.lastname@example.org) and one Cooper Baltis (email@example.com, cooperbaltis.com). Together they wrote an entire series of a Mongolian sitcom, with a script both in Mongolian and English, translated by Khash Erdene and Kh. Khongorzul. The sitcom deals with the experiences of an expat man and his Mongolian girlfriend, and also with the family life of the Mongolian girlfriend. The episode that fell into my lap was entitled “Candy Addict”. You can pretty easily guess what the topic of hilarity was.
I sat in a cafe, laughing as I read the script. The Mongolian mother of the urbanite family decides that everyone in the household has had way too much sugar. So she attempts to cut off -and thereby control- access to it, and to increase healthy ways. As it turns out, the study published in BMC Health found that it’s the urban women who are most knowledgeable about the negative health effects of obesity and diabetes. It’s unlikely that Claycamp and Baltis consulted the scientific literature when scripting “Candy Addicts”. And yet, they nailed the problem. What’s more, in the style of the American sitcom, “The Office”, the characters have cameos where they reveal what they’re thinking.
The first scene of the “Candy Addicts” episode begins with a slow pan of the family’s kitchen: “We see many different sugary products in the kitchen: Choco Pies on the counter, candy in a bowl, a bottle of Coca-Cola. On the fridge is an advertisement for TALK TALK ENGLISH. It shows several Caucasian people dressed in suits.”
At one point, the family (other than the mom) turns the house upside down looking for candy. The father is dismayed because his candies hidden in the bathroom (“for pooping”, a fact which is revealed in his inner-thought cameo) are gone, and they turn to the aged Russian chocolates next to the deceased grandfather’s altar. “Batta, the son, asks, ‘Aren’t those for Grandpa?’ and Batbileg, who is a retired wrestler making his living by doing commercials, quickly replies, ‘He never really liked sweet things when he was alive. I can’t imagine his tastes changing now’.”
Besides being a harbinger of an obesity and diabetes epidemic, could it be that a sitcom, like the one conceived by Claycamp and Baltis, might find its ultimate purpose, not as a profit center for a media corporation, but instead in the public health and social welfare sector? It’s easier to deal with a problem when you can get close to it, and what better way to get close to it than through humor?
I grew up in an era when public health and safety films were commonly shown in educational settings. My favorites are: “Duck, and Cover” in the event of a nuclear bomb, and “Don’t touch that, it’s radioactive!” announced by the narrator of some films shown in my sixth grade science class, highlighting advancements in current research. But usually these films are boring, and I’d be the last to point fingers at anyone who changed the channel when faced with “…an important message from the health department…” because it’s invariably followed by something along the lines of “…regarding your lack of initiative in eating well and exercising…” Avoiding negative information is a human specialty.
So, it would make sense for NGOs or public health and welfare departments to turn to humor to address issues that will be costly, not just in terms of currency, but also in terms of human lives and quality of life/lost potential. Besides, a good sitcom is, well, as addictive as candy. Look at the popularity of “Friends”, “Seinfeld” and others. Claycamp and Baltis’s sitcom is as yet unpublished, due to issues in commercial media and broadcasting that deserve their own separate article. Parties interested in their work may contact them directly, whether for public health use or otherwise (for example, a unique and fun way for corporations to conduct cultural education for newly arrived expats.)
Coincidentally, reading the “Candy Addicts” script and becoming informed about candy kept for ancestors, kept me from raiding a small stash tucked away in a special vase in my host family’s home when I arrived home from that trip to the countryside “starved” for chocolate. Instead I ate the last sugar-coated, twisted fried-bread biscuit that I’d bought at the market earlier in the week. I was grateful for not being able to translate the nutritional information on the package.
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