removing affluence, of course. Or, put another way, saving money can sometimes save lives.

Population-wide interventions (in this case severe austerity) reduced chronic disease burden in the very unique case of Cuba’s “special period,” an economic catastrophe that struck a society that is peculiarly undemocratic, resilient, and underpinned by strong public health resources (and thus has excellent data). From Richard Schiffman in The Atlantic, summarizing an article by Manuel Franco, Usama Bilal, et al in BMJ:

that the health of Cubans actually improved dramatically during the years of austerity… based on nationwide statistics from the Cuban Ministry of Public Health, together with surveys conducted with about 6,000 participants in the city of Cienfuegos, on the southern coast of Cuba, between 1991 and 2011. The data showed that, during the period of the economic crisis, deaths from cardiovascular disease and adult-onset type 2 diabetes fell by a third and a half, respectively. Strokes declined more modestly, and overall mortality rates went down… The Cuban experience suggests that to seriously make a dent in these problems, we’ll have to change the lifestyle that helps to cause them. The study’s authors recommend “educational efforts, redesign of built environments to promote physical activity, changes in food systems, restrictions on aggressive promotion of unhealthy drinks and foods to children, and economic strategies such as taxation.” […] If the United States want to stem the rise of diabetes and heart disease, either we get serious about finding ways for to become more physically active and to eat fewer empty calories — or we wait for economic collapse to do that work for us.

The authors (and I) do not condone replicating the Special Period crisis, but as a data-collection exercise it is unique in providing a look at the effects of unprecedented, population-scale, sudden change in both diet and exercise. The primary cause of removing fossil energy had a secondary effect of removing food energy from the economic system, as well, and increasing its expenditure to make up for the lost fossil fuel. The accompanying video (at the BMJ site) has interesting graphs of how the entire population’s BMI shifted both during and after the Special Period.