In America, Two Pandemics at the Same Time

Do we have two pandemics circulating around the world under the same name? Covid-19, which is the name we all recognize, and a twindemic of the Western “lifestyle” disease states associated with Covid-19’s worst impacts?

The Covid-19 pandemic has been called the “great equalizer.” And yet in an unfamiliar twist, it is the most developed and Westernized societies that have experienced the highest Covid-19 mortality rates, despite their advanced biomedical systems. To a startling degree, the risk of poor outcomes and mortality from Covid-19 is enhanced by the panoply of conditions that have flourished in the West, known as “lifestyle diseases.” We know them intimately in the United States, because they are a part of most of our families: hypertension, diabetes, chronic kidney disease, and coronary artery disease.

Lifestyle diseases were originally called “diseases of affluence” in the early twentieth century due to their association with privileged access to rich foods and freedom from physical labor. They were renamed “lifestyle diseases” when it became clear, in the 1970s, that they were a generalized feature of the Western lifestyle. In recent decades in the U.S. and the United Kingdom, the original class alignment has flipped, and those experiencing socioeconomic burdens have become particularly prone to these diseases once associated with affluence.

But rich or poor, in the United States, we are all at high risk for lifestyle diseases like diabetes. Scientists have noted that higher death rates from the COVID-19 pandemic were preceded by “a silent but significant pandemic happening in the background, the obesity pandemic [….] Over 30% of adults are obese in the United States, the country with the highest number of COVID-19 mortality.” The COVID-19 pandemic intersected with this pre-existing metabolic pandemic caused by the Western style of capitalist development, and created a disease experience unique to culture.

For the generations living in a culture of junk food radically different from the dietary exposure of earlier eras, the creation of a lifestyle that will not be prey to lifestyle diseases is a highly intentional, often laborious, costly project, of uncertain long-term outcome. Lifestyle disease risk factors (smoking, unhealthy diet, physical activity) are theoretically modifiable, but structurally unavoidable. We are inevitably exposed to hyperpalatable, highly processed foods, to the aggressive marketing and omnipresent availability of addictive substances like alcohol and tobacco, to endocrine-disrupting chemicals in merchandise, and to occupational efficiency models that reinforce a sedentary lifestyle and screen time.

Let’s face a troubling reality: the globalization of dietary trends associated with Western development, is a pandemic in itself, spreading not microbially but through fast-food chains and the like.The comorbidities of Covid-19 have brought into dramatic relief an aspect of environmental change in the modern industrial era that has, in the space of less than a hundred years, altered the ecologies of our own bodies.

The costs of chronic lifestyle-related disease are extremely high, not just in the United States where they are especially prevalent, but globally. A recent report from the Global Panel on Agriculture and Food Systems for Nutrition “an annual loss of 10 percent of global GDP from diet-related illnesses.”

As we, a cohort of Gen Z students in a “Pandemic Humanities” class at Duke University, look towards the future, we see the potential for policy changes to bring concerns about lifestyle disease and health inequality to the forefront of planning. The westernized lifestyle pandemic is not inevitable if we recognize it for the recent, cultural, exportable phenomenon that it is. Societies with low rates of lifestyle diseases have experienced much less excess mortality among demographics older than 60 years during the Covid-19 pandemic. In contrast to the U.S., Japan, with a notably high aging ratio, has experienced far less excess mortality during the pandemic, because its aging population experiences less food-related chronic disease.

The notion of “lifestyle diseases” is a misnomer that blames individual lifestyle choices for structural health risks. Yet the chronic food-related diseases the expression points to are all too real, and all too important in our losses from Covid-19.

This essay was written as part of a Duke University course called “Pandemic Humanities.” It was co-authored by Professor Deborah Jenson, T.A. Hélie Vigor, and students Chantel Abdulai, Chinmay Amin, Sidd Amirneni, Isaiah Boyles, Anna Everhart, Natalie Kubicki, Eugene Lee, Anna Muthalaly, Sejal Patel, Alex Stickler, Charlotte Tannenbaum, and Hannah Zelinger.