Commercially motivated surveys may be unreliable, but, when it comes to sex, it is more frequently observed that those surveyed might be the ones being economical with the truth. This possibility affects any survey, but the suspicion tends to be raised most often with sex surveys. Men often exaggerate their experience whereas women downplay theirs. Anglo-Saxons might expect Latin lovers to brag about their conquests. There is no way of knowing unless an expert closely questions the respondents directly, but then the pollsters do not need to have the true picture in order to generate media interest.
All this represents something of a wasted opportunity. Data on sexual attitudes, properly gathered and analysed, could inform social and healthcare policies rather than merely satisfying our prurience. They might even have something useful to say about the divergence of birth rates in different countries. It is one thing to have young survey respondents boasting of their promiscuity, for example, but establishing how this behaviour – and underlying attitudes – relates to sexually transmitted infection and teenage pregnancies requires expert collection and analysis of the data. For fear that it will offend sponsors or advertisers, no popular survey is likely to have much to say about these or other important topics where little is known, such as the extent of sexual ignorance, harmful practices and violence related to sex.
Academic surveys that do tackle these trickier issues have their own troubled history. Alfred Kinsey’s 1948 report ‘Sexual Behavior in the Human Male’ opened the floodgates for sex research. But Kinsey’s follow-up study of women in 1953, and a British survey by the social anthropology project known as Mass Observation in 1949, which included both sexes, were both regarded as shocking because they reported a high proportion of women having premarital sex and affairs once married. The latter study did not see the light of day until fifty-six years later, when the BBC promptly dubbed it ‘Britain’s secret sex survey’. One in four men said they had had sex with a prostitute. One in five women admitted to having affairs outside marriage, and more than half of both men and women had had sex before marriage. Homosexual activity, then illegal, was also reported by 20 per cent of both sexes.
Trying to find out what really goes on in bedrooms remains controversial today. In 1990, a National Survey of Sexual Attitudes and Lifestyles in Britain by epidemiologists and social researchers at the University of London was reported to have been banned by Margaret Thatcher’s Conservative government; it was eventually funded by the Wellcome Trust and published in the usual way. The survey was repeated in 2000 with less attendant fuss. As well as providing important information about the prevalence of HIV, AIDS and other sexually transmitted infections, the surveys showed an increase in various promiscuous behaviours over the decade. Nevertheless, by 2000 more people were using condoms, including on their first time of sexual intercourse, and the number of girls under sixteen having sex had stabilized. The 2000 report also found, in marked contrast to the Mass Observation findings, that only 2.6 per cent of respondents reported homosexual experiences while 4.3 per cent of men had paid for sex.5
The media gave the findings the serious consideration they give to any sex survey, combining moral indignation with facetiousness. The Mail on Sunday reported the finding that ‘one in 20 married men had been unfaithful in the past year, while only one in 50 married women had strayed’, using the figures to confirm ‘the received wisdom that men commit much more adultery’ – which is not quite what they say. The tone of the words ‘unfaithful’, ‘strayed’, ‘commit’ and ‘adultery’ is to be contrasted with the researchers’ more neutrally phrased questions about whether married persons had taken ‘new partners’.
Such national surveys can now be put together to build an international picture of sexual activity – a picture that turns out rather different from the debauch painted by Durex. In 2001, Kaye Wellings, one of the authors of the British survey, and colleagues in France, South Africa and the United States gathered survey data for fifty-nine countries.6 Unlike Durex, they did not ask about threesomes, bondage or sex on the beach. They found, boringly, that there was no global trend towards earlier sexual intercourse and that married people have the most sex. There was a global increase in premarital sex – mainly because people are getting married later. Unlike the heavily marketed Durex survey, this global study prompted only one newspaper story, under the drearily predictable headline ‘Sex with many partners? No thanks, we’re British’.
Some curiosities might have aroused more media interest. Promiscuity was generally increasing in developed countries, nowhere more than among Australian women, who have caught up and are overtaking men in making full use of their single years. Everywhere, men reported more multiple partners than women, but in Brazil the disparity was so great that the researchers could only explain the result by men’s over-reporting of their prowess due to the ‘Latin macho culture’.
As these contrasting examples show, you learn what you want to learn from sex surveys. Academics have, in Wellings’s words, ‘a historically unique opportunity to describe patterns of sexual behaviour and their implications for attempts to protect sexual health at the beginning of the 21st century’. For Durex, the priority is to represent sex as a recreational activity. The beautiful twenty-somethings beaming smiles from its website and telling us about their favourite sex enhancers make that clear enough. For Pfizer and other pharmaceutical companies, sex is a huge new market opportunity. But for this market to come about we must see sex not as a mystery or as fun but as a medical problem that can be solved with the aid of drugs.
This reframing is already beginning to happen with the unthinking collusion of the media. Pfizer and Boots announced a trial scheme in three Manchester branches of the high street pharmacy whereby men might obtain Viagra over the counter without a prescription. The news made the papers in typical fashion on St Valentine’s Day: ‘Roses are red, tablets are blue’. The media coverage was larky and by and large approving – it did not dwell on the curious circumstance of a drug designed to treat the specific medical condition of erectile dysfunction being made available without the involvement of applicants’ doctors.
The pharmaceutical industry has new plans for drugs to treat premature ejaculation, heighten the intensity of orgasms or simply make you want more sex. Though ostensibly aimed at bringing help to a minority of genuine sufferers from sexual dysfunction, these seem destined to follow the path taken by Viagra, further encouraging the public to regard sex as a problem for which drugs are the cure. If this happens, the sex surveys and the media’s giggling uncritical attitude towards them will have played a large part in getting us there.
2. Health
Unless confronted by immediate danger, we generally regard our health as our prime concern. Our fear of illness is exploited by governments, who want to protect us in the most cost-effective ways, by companies who want us to pop their pills and by food manufacturers who would like us to believe that their provender is health-giving. But whether or not we worry about our health, we still die. It’s worth remembering that we do so on average at a greater age than in the past, with less suffering and fewer declining years.
The Fat Thing
‘The fattest children in the world’ The Times
Obesity is a favourite panic story – the media love everything to do with the subject. Even responsible newspaper editors find stories on the subject as resistible as a child finds a chocolate bar. The story might be serious – obesity shortens life and costs national health systems substantial funds – but there is also a lighter side – stories suggesting that we will all soon be too fat to fit into airline seats and too heavy to be carried to our graves on pallbearers’ shoulders.
‘The fattest children in the world’ was the attention-grabbing headline of an article that told us that one-third of Scottish twelve-year-olds are overweight and that one-fifth are obese. The kids are fuelled by fizzy drink and unfamiliar with fresh fruit, it seems. The Scottish rate of child obesity is above that in the US at 16 per ce
nt, and much higher than in other European countries (for example, Ireland 9 per cent, Spain 9 per cent, France 4 per cent, Sweden 5 per cent, Denmark 2 per cent). A spokesman for the International Obesity Taskforce was quoted as saying, ‘The obesity epidemic is escalating totally out of control in Scotland,’ adding that this ‘is more than just a warning signal, it’s a red light’.
The terms overweight and obesity are generally used loosely but they do have a statistical definition, relating height to weight. A person who is 5 ft 9 inches tall (1.75 metres) would be categorized as overweight at 169 pounds (76 kilos) and obese if they weighed over 203 pounds (92 kilos). The thresholds are sometimes expressed in terms of a body mass index (BMI, or Quetelet index, after the Belgian who established the measure 170 years ago), an indirect measure of the amount of body fat. It is calculated by taking the bodyweight in kilograms and dividing it by the height in metres, squared.
Someone is overweight with a BMI of over 25 and obese with a measure of over 30.1 At the extremes, a measure of over 40 is described as morbidly obese, while under 18.5 is thought to be underweight and might well indicate malnutrition or an eating disorder. As the measure becomes more widely used, with doctors using it for medical diagnosis, so the controversy surrounding the measure’s accuracy in relation to levels of body fat has increased – it can be distorted by factors such as fitness level, muscle mass, bone structure, gender and ethnicity. Yet for all its faults, for most people it gives a broadly accurate assessment and it is often the measure used to create data.
The facts behind the bold headlines are scary. A few Arab countries and some Pacific islands have exceptionally high rates of obesity, but among developed countries it is the US that tops the table as obesity among adults has risen significantly in the US during the past twenty years. Nearly one-third of American adults – over 60 million people – are obese, and the proportion of young people that are obese has more than trebled since 1980. The US authorities want to halve the prevalence of adult obesity by 2010, but the situation continues to worsen. Louisiana, Mississippi and West Virginia might be the fattest states, but only four have an obesity prevalence rate of 20 per cent or less.
The obesity plague has not visited every developed country but it has gone global – the developing world is suffering as a result of changes in diet, physical activity, health, urbanization and nutrition, with the bitter irony that, while some developing countries continue to focus their efforts on reducing hunger, others face the problem of obesity. As poor countries become more prosperous, they acquire some of the problems along with some of the benefits of industrialized nations. A hundred years ago just 10 per cent of the world’s population inhabited cities. Today, that figure is around 50 per cent. Cities offer a greater range of food choices, generally at lower prices, and urban work often demands less physical exertion than rural work. Traditional diets featuring grains and vegetables are giving way to mass-produced meals high in fat and sugar. Being overweight used to be a sign of wealth, but now it often marks poverty. The number of overweight individuals worldwide now rivals those who are underweight.
Adult overweight and obesity rates, selected countries from around the world, percentages
* * *
Male Female
Overweight Obese Overweight Obese
* * *
Australia 48 19 30 22
China 30 2 29 6
Czech Republic 49 25 31 26
England 44 23 35 24
Germany 53 23 36 23
India 4 1 4 1
Ireland 46 20 33 16
Italy 42 9 26 9
Japan 24 3 17 3
Russia 31 10 27 22
Saudi Arabia 42 26 32 44
Scotland 43 22 34 26
Tonga 37 47 23 70
US 40 31 29 33
* * *
Source: www.iotf.org. Age ranges covered vary between countries. Data are latest available in October 2007 and mostly relate to a year between 1999 and 2003. Some countries, such as Canada and France, are excluded as their surveys are ‘self-reporting’.
The increasing rates raise concern because of their implications for health. As one newspaper put it, the weight gain ‘has been so fast and so extreme that experts believe these children will suffer a lifetime of horrific and crippling health problems’. Being overweight or obese increases the risk of many diseases and health conditions, including hypertension, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep and respiratory problems and some cancers.2 It can also lead to inactivity and mood disorders.3 According to the World Health Organization, a good part of the heart, cancer and mental-disorder disease burden for the world, including that of most low-income countries, is rooted in the intake of excess sugar, fat and salt and a paucity of fruit and vegetables. Obesity is proving to be a ‘remarkable amplifier’ of diabetes, high blood pressure and high cholesterol levels particularly among Asian and Central American communities, it said.
Obesity is also linked to early death – although the closeness of the link is unclear. The uncertainties were highlighted in 2005, when two studies from the Centers for Disease Control and Prevention in the US produced two very different estimates for the number of deaths due to obesity – 1,000 deaths a day or only 26,000 a year. As being overweight does not kill you directly, the way a heart attack might, we will always be left with a – probably wide – range for the number of deaths caused by obesity. Even so, the message would seem to be clear. The chairman of the National Obesity Forum in the UK said that obese children are twice as likely to die by the age of fifty,4 while a Canadian paper explained that today’s children will be the first generation of kids who are not going to live as long as their parents. The World Health Organization estimates that more than one in ten deaths in developed countries is already due to overweight and obesity, suggesting a figure of about 50,000 deaths per year in England.
The ‘public health time bomb’ of obesity will bring a ‘vast’ cost to national health services around the world, in addition to the direct financial and economic consequences faced by afflicted individuals. One study suggested that the medical expenses associated with overweight and obesity amounted to over 9 per cent of the total US medical expenditures – and that was a decade ago, when the problem was less pressing. Estimates of the direct costs are only illustrative in most countries, and up-to-date figures simply do not exist. Most such analyses acknowledge that published figures are likely to be underestimates.
Measuring indirect costs is even more difficult, but they are widely thought to be several times higher. If the World Health Organization’s estimate of early deaths is broadly correct, it would imply the loss of several tens of thousands of years of working life in England, and associated earnings, in addition to the cost of incapacity benefits paid to those unable to work. One official report estimated that obesity was responsible for 18 million days of sickness absence in England and that, on average, each person whose death could be attributed to obesity lost nine years of life.
Despite the very real nature of the problem, policy initiatives around the globe are modest and of limited success, reflecting in part that the explanations for the trend are complex and uncertain. Generally higher obesity levels are put down to a rising consumption of fast or unhealthy food and an increasingly sedentary lifestyle in front of television and computer screens. But there is no shortage of alternative explanations paraded in the media – obesity has been linked to a virus, meaning you can ‘catch fat’ from other people, too little sleep and eating just one plain biscuit a day. One American article said, ‘The obesity epidemic in our country has spared no age-group, even our very youngest children,’ reporting the rise in the number of children under six classified as overweight. And, of course, poor reporting can confuse. The lack of policy progress could also be due to excess political correctness and the nervousness of people across society to speak openly about weight issues with fat people. Many British doctors apparently shy away from
discussing weight with children for fear of hurting their feelings.
The policies being followed include food-labelling schemes, encouraging food manufacturers to reduce the amount of salt, sugar and fat in pre-prepared meals and healthy eating advice, along with a raft of measures for schools, including improved school lunches, changes to the way children play, increased sessions of sport and the reintroduction of home economics classes, with the curriculum being used to reinforce messages about healthy eating. Television ‘junk food’ advertisements are being progressively banned for programmes with a significant proportion of younger viewers. The change in standards has led to some food companies introducing self-imposed guidelines on junk food marketing.
But in the face of poor progress, other more desperate measures are being dreamed up: higher taxes and insurance premiums for overweight people; a restriction on government-subsidized health care for people who refuse to lose weight; new building codes that would force people to walk further as they go about their daily lives; and the use of taxes and subsidies on bad and good foods to encourage healthy eating patterns. It has even been suggested that the advertising of weight-loss dieting fads should be banished on the grounds that they give unfounded hopes and obscure the relatively simple messages that public health professionals would like to convey.
Panicology Page 5
