Will Los Angeles go the way of Paris? The City of Angels can learn a lot about public health from the capital of croissants.Not long ago, I came across a book about the trials and tribulations of a giant city. This city was reeling from a seemingly endless migration of rural peoples from its south. Its traditional family structure was strained - papa and mama both had to work. Most of them had to live in housing close to sources of polluted air. Infectious disease was rampant but largely untreated. Most had known hunger in their lifetimes. Their mothers likely experienced some kind of trauma while pregnant, thus predisposing their children to chronic disease.
Will Los Angeles go the way of Paris? The City of Angels can learn a lot about public health from the capital of croissants.
This book was not about Los Angeles. It was about Paris in 1901. Instead of palm oil and high fructose corn syrup, the culprit in Paris was pasteurized milk, so inexpensive that young mothers, adrift without the traditional wet nurses, tended to overfeed infants. That resulted in chronic diarrhea — and Europe's highest infant mortality rate. Some of the first medical observations of childhood obesity were recorded in Parisian free clinics. Tuberculosis, driven by pest-filled living quarters, was rampant.
L.A.'s challenges are both less dire and more complex. But Paris offers a model for thinking strategically about a metropolitan community's health. To some extent, of course, city policy can't substitute for accepting individual responsibility. As the French knew, children get fat because parents feed them too much bad food. Pierre Budin, a prominent obstetrician, shocked the 1903
Conference on Hygiene with his views, and liked to tell his medical students, "I always prefer to err by giving a little too little than by giving too much."
Anyone familiar with the vast public health bureaucracy in Los Angeles knows that such governmental activism is bound to confront deeply felt opinions to the contrary. Yet I suspect that most Angelinos — new and old — have made a commitment to their city, and to all the experimentation that entails. The Parisians of 1900 did too.
Not long ago, I came across a book about the trials and tribulations of a giant city. This city was reeling from a seemingly endless migration of rural peoples from its south. Its traditional family structure was strained - papa and mama both had to work. Most of them had to live in housing close to sources of polluted air. Infectious disease was rampant but largely untreated. Most had known hunger in their lifetimes. Their mothers likely experienced some kind of trauma while pregnant, thus predisposing their children to chronic disease.
Their children, confronted with the cheap, filling food of the city, grew fat and sick. Health officials were at a loss about what to do.
This book was not about Los Angeles. It was about Paris in 1901. Instead of palm oil and high fructose corn syrup, the culprit in Paris was pasteurized milk, so inexpensive that young mothers, adrift without the traditional wet nurses, tended to overfeed infants. That resulted in chronic diarrhea — and Europe's highest infant mortality rate. Some of the first medical observations of childhood obesity were recorded in Parisian free clinics. Tuberculosis, driven by pest-filled living quarters, was rampant.
Paris in the early 1900s faced public health concerns similar to Los Angeles today.
The difference between Paris then and L.A. now was that French authorities actually viewed all this as a threat to national security. The Franco-Prussian war had decimated an entire future generation of soldiers. Fixing the birth rate was priority one — no kids, no cannon fodder. Using inforrmal 'schools for mothers' and other public education programs, they curtailed the overuse of milk. Using taxing authority, the Paris municipal government coaxed industry into providing rooms for breast-feeding mothers during breaks and lunchtime. Primitive but effective early detection clinics were set up to deal with tuberculosis.
The consequences were fairly swift and far-reaching. France's infant mortality rate plummeted, as did deaths from TB. Perhaps just as importantly, moderated dietary habits became ingrained, a key to the lower rates of obesity, diabetes and heart disease in the kingdom of brie and croissant.
L.A.'s challenges are both less dire and more complex. But Paris offers a model for thinking strategically about a metropolitan community's health. To some extent, of course, city policy can't substitute for accepting individual responsibility. As the French knew, children get fat because parents feed them too much bad food. Pierre Budin, a prominent obstetrician, shocked the 1903
Conference on Hygiene with his views, and liked to tell his medical students, "I always prefer to err by giving a little too little than by giving too much."
But innovative city policy planning can make for healthier residents. If Los Angeles wants to build, we have to find a way to lessen the insult to our health. That means conducting city-specific research on smog and emissions, and debating the timeless calls for a denser city — low-income housing advocates and environmentalists have never honestly argued the issue.
Preserving our health also requires smarter commercial regulation - like only issuing liquor licenses to neighborhood stores that purvey fresh fruits, vegetable and meats. Forget about wooing supermarkets, or give them incentives to invest in small, neighborhood venues.
The city can also follow modern France in finding ways to make health care portable. Because one doctor simply does not know what another has done or is doing to any given patient, the French created a simple tool, in use today: a traveling medical record on a card, required of anyone seeking care. Here in Los Angeles, the California Community Foundation is already experimenting with programs that 'travel' from clinic to home. In the case of an asthmatic child, for example, clinics send field workers to the patient's home to see if the allergens — mold, mites — reside in often poorly maintained old housing stock.
Anyone familiar with the vast public health bureaucracy in Los Angeles knows that such governmental activism is bound to confront deeply felt opinions to the contrary. Yet I suspect that most Angelinos — new and old — have made a commitment to their city, and to all the experimentation that entails. The Parisians of 1900 did too.
Greg Critser is a science and medical journalist. A version of this article first appeared in Zocalo magazine.
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