The Transformative Power of Hot Dogs

Those who know me well know that I was raised vegetarian. I only started eating meat about a decade ago to make dinnertime easier in our blended family. Vegetarianism has been so deeply ingrained in my identity that my husband still chuckles when I order a slab of ribs. Although I've started eating meat, I really could live without it. When I'm on my own, I often opt for vegetarian meals.

Being a vegetarian today is so much easier than it was when I was growing up. Foods made with meat alternatives are actually tasty. When I was a vegetarian, the veggie products like soya cheese tasted pretty much like the plastic in which it was wrapped. In response, I took a practical approach and accepted that there were certain foods that I just couldn't enjoy. The New Orleans staple, gumbo, taunted me the most. Although we periodically ate seafood (who couldn't in New Orleans), a "seafood" gumbo was still risky since most New Orleanians don't count the meat that you don't consume. If a meal is cooked with meat (better known as seasoning), removing the meat before serving it makes it vegetarian in New Orleans.

When I was about 12-years old my mother took me to visit a good family friend. She offered us some gumbo. I was stumped because a) I did not smell any gumbo and b) I knew she was vegetarian. I figured that maybe she was like my parents who allowed us to infrequently indulge in seafood and so I readily accepted her offer. She placed a bowl in front of me that had strips of seaweed and an additional assortment of grossness. I was angry and felt duped. Despite the evidence on the surface, I dug into the "gumbo," pushing aside the seaweed in desperate search for shrimp, crab, or anything that would make the dish qualify as a gumbo.

My mother did not tolerate wasting food, so I knew I had no choice but to suffer through it. I took one bite and literally gagged. I decided in my mind that I would take whatever punishment she decided to mete out. I honestly don't remember whether I ultimately at the "gumbo," though I highly doubt I did. 

Once I left New Orleans, I got stricter with my vegetarianism. There were less culinary distractions and I began to incorporate meat alternatives into my diet. I tried a vegetarian hot dog when I was in college and thought that it wasn't that bad. I would bring them to cookouts so that I could have something to eat. Although I eat meat now, I sometimes eat veggie burgers, but I draw the line at hot dogs. Eating the real thing has spoiled it for me.When my husband grills, sometimes, the only meats I eat are hot dogs. Oh how I love a good, grilled hot dog! Imagine my dismay when the World Health Organization (WHO) announced that hot dogs and other processed meats are cancerous! Not only that, but grilling meats is apparently the worst way to eat them!

Finding on grilled meat and cancer-causing chemicals

I've read several books that asserted that meats cause cancer, but it was more of a conspiracy theory in my mind. I'd accepted that vegetarianism was the healthiest way to eat, but wasn't quite sure that I bought into the cancer argument. The WHO announcement made me take a hard look at myself. The truth is that becoming a meat eater has not been great for me. I've gained weight, sweat more easily, and have less energy. I  accepted these conditions though for the convenience of being a meat eater and for eating one family meal.



As a global health expert, I couldn't help but think about the implications the finding would have on the rest of the world. Non-communicable diseases (NCDs), like cancer, account for a growing share of disease burden in low-and middle-income countries. As countries become more affluent, processed foods become more plentiful and the diseases that they can cause, including hypertension, cancer and diabetes, become more common. In many countries, like Uganda and Rwanda, NCDs already cause more deaths than communicable diseases like HIV/AIDS, tuberculosis, and malaria.

According to World Health Organization (WHO) estimates, roughly three-quarters of the 38 million NCD deaths that occurred worldwide in 2014 were among people living in low- and middle-income countries. Projections indicate that without substantial action, NCDs could cause 52 million deaths by 2030. High NCD death rates in low- and middle-income countries are caused in part by inadequate access to NCD prevention and treatment services. Addressing NCD among poor populations in these areas also pose unique challenges. Partners in Health found, for example, that diabetic patients who face chronic food shortages may develop life-threatening hypoglycemia. Heart disease treatments are also less effective among malnourished patients

Sedentary lifestyles, consumption of processed foods, smoking, and alcohol abuse is a relatively new and growing phenomenon in many low- and middle-income countries. They lack technical expertise in identifying, preventing, and treating NCDs. The NCD Alliance was established in 2009 to raise awareness about the growing threat to global health and to generate support for building capacity in low- and middle-income countries to address this health problem.

While the United States and other donors recognize the looming threat of NCDs, most global health assistance is aimed at HIV/AIDS, tuberculosis and malaria. The international community is also coalescing around addressing maternal and child mortality, and a World-Bank managed Global Financing Facility is attracting funds to address this global health issue. The amounts raised through this mechanism, however, pale in comparison to the amount of resources raised to fight HIV/AIDS, tuberculosis, and malaria.

Without a doubt, NCDs are among the greatest health threats facing the world. The recent leveling of global health aid demonstrates, however, that there is little appetite for launching yet another health initiative. No one can deny that people need access to life-saving medicines that treat HIV/AIDS, tuberculosis, and malaria. I implore you to find someone who can turn a blind eye to women and babies dying during or soon after childbirth. And now that I've presented the looming threat of NCDs, what next? Shall we create a Global Fund for NCDs? The World Bank is considering that notion.

Do I believe countries need support to address NCDs, absolutely! Do I believe we should create a separate funding mechanism to address this challenge, not so much. The international community has developed several initiatives (the President's Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the Global Financing Facility) because health systems in many low- and middle-income countries were ill-equipped to address the related health challenges. Each of these initiatives have all come to incorporate health system strengthening. They all recognized the limited impact their efforts would have in weak health systems.

Let's think about this for a moment. If the systems are not capable of combating HIV/AIDS, providing adequate maternal and child health care, or preparing for other looming health threats, then doesn't it make sense to support the systems so that they can? In my view, seeing health initiatives as a means of strengthening health systems is like placing the cart before the horse. Let's say for example, that you want to improve your financial health. The very first thing a financial planner would do with you is to evaluate your finances, then develop a plan for using those resources to bolster your savings and grow your wealth. Investment vehicles would be seen as tools to be used to strengthen your financial health, not the solution to poor financial health. The same rationale applies to global health. The above mentioned initiatives should be seen as tools to use within a singular public health strategy.

It is high time that the international community coalesce around supporting countries to develop an overall health system plan. In September 2015, the World Heath Organization, Bill & Melinda Gates Foundation, and World Bank developed the Primary Healthcare Performance Initiative to improve primary healthcare in countries worldwide. I believe this is a step in the right direction. Countries need the capacity to address any health issue that may arise, not only those funded by donors. Investing in primary health is a long-term approach, but it may hasten graduation from health aid and help countries to prepare for unanticipated health issues, including those that may arise from the love of hot dogs.