Day 252 - 20 May 96 - Page 56


     
     1        have increased nutrient products with little or not
     2        nutritional value.  These foods rich in fat and sugar have
     3        become important socially, if not as yet in nutritional
     4        terms, and are now beginning to be substituted for better
     5        traditional foods."
     6
     7        This is talking about developing countries.  Would you
     8        accept that?
     9        A.   Well, I am not sure about "better traditional foods".
    10        I accept that these changes are taking place.  I would also
    11        point out that one does not always eat food purely for its
    12        nutritional content.  That applies to things like snacks
    13        and soft drinks and so on.
    14
    15   Q.   Well we can put that away, that report away that you have.
    16        I am sorry, on page 12 -- I did photocopy this at lunch
    17        time -- if I could had one to the Judge.  (Same handed)
    18
    19        On page 12, it talks about the various range of chronic
    20        diseases in the previous paragraph etc. It then says:
    21
    22        "The causes of these chronic diseases are complex" --. It
    23        is the top first paragraph on page 12-- "and dietary
    24        factors are only part of the explanation.  Individuals also
    25        differ in their susceptibility to the adverse health
    26        effects of specific dietary factors but within the public
    27        health context the focus  is to help the whole population.
    28        Public health interventions aim to lower the average level
    29        of risk to health of whole populations either because the
    30        whole population is at risk, or because the strategy to
    31        identify the minority of individuals at greatest risk, even
    32        if available, would only contribute to a modest public
    33        health improvement since much, if not most, of the disease
    34        in the population occurs in the more numerous individuals
    35        at moderate to low risk."
    36
    37        Could you accept that?
    38        A.   Yes, that is probably correct, yes.
    39
    40   Q.   So the people who are what are defined as "moderate to low
    41        risk" are the bulk of the people who contract these chronic
    42        diseases?
    43
    44   MR. JUSTICE BELL:  No.  They are the bulk of the population,
    45        what happens to them affects public health in a greater
    46        degree generally.
    47
    48   MR. MORRIS:  So the bulk of the population is at risk, what they
    49        define as "low to moderate risk" and there are other people
    50        that are high risk sections of the population? 
    51        A.   Yes. 
    52 
    53   Q.   But the high risk sections are substantial sections of the
    54        population?
    55        A.   I think they tend to be a minority in the population.
    56        I do not know if you have thought of people with something
    57        like severely elevated blood cholesterol blood level, they
    58        represent fortunately a comparatively small population, but
    59        a large portion of the population have elevated blood
    60        cholesterol.

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