The epidemiologist Marina Pollán is promoting one of the largest studies in history in Spain: the IMPaCT Cohort, a follow-up of more than 200,000 people, for 20 years, with 35 million euros of funding, to find out the social, environmental and biological factors that determine the origin of diseases. Pollán was born 64 years ago in the Leonese town of La Bañeza, where her family had a chocolate factory. Since January, she is…
Subscribe to continue reading
Read without limits
The epidemiologist Marina Pollán is promoting one of the largest studies in history in Spain: the IMPaCT Cohort, a follow-up of more than 200,000 people, for 20 years, with 35 million euros of funding, to find out the social, environmental and biological factors that determine the origin of diseases. Pollán was born 64 years ago in the Leonese town of La Bañeza, where her family had a chocolate factory. Since January, she has been the director of the Carlos III Health Institute, the main Spanish public research organization in the field of health and biomedicine, with almost 500 million euros in annual budget. In this interview, Ella Pollán urges the authorities to prohibit smoking on bar terraces and to tax junk food and sugary drinks to increase their price. In her opinion, childhood obesity is “a shame” for Spain.
Ask. You drive tracking 200,000 people for decades. A similar study, that of the UK Biobank in the United Kingdom, associated watching television with suffering from cancer and cardiovascular diseases. Their data showed that if all participants limited their TV viewing time to two hours a day, almost 6% of all deaths could have been prevented or delayed. Does this fit you?
Answer. It may fit me because of my sedentary lifestyle. The absence of physical exercise is one of the most important risk factors for cancer and cardiovascular diseases. We are made to move. Furthermore, spending many hours sitting in front of the TV is associated with snacking on things that are normally unhealthy. There is an image that I like to use when I teach: it is a comic in which you see a chubby guy with a can of beer and eating a hamburger, lying around watching TV, and he is wearing a t-shirt that says “Free to be.” myself”. He is accumulating all the risk factors on himself. Watching TV is associated with all that, so it does fit me. A sedentary lifestyle explains around 15% of breast cancer.
Q. We can say that watching TV increases the risk of cancer.
R. It’s not watching TV, it’s spending many hours of inactivity. Less plate and more shoe, said the doctor in my town, and he was absolutely right.
Q. Speaking of cancer risk, the Carlos III Health Institute banned smoking on this campus in October 2023.
R. It was smoked, yes.
Q. It is striking that smoking was done in the heart of health in Spain. You saw people smoking even at the door of the National Cancer Research Center. How is it possible that it hasn’t been banned until October 2023?
R. Well, I don’t know, that regulation predates my arrival, but it seems perfect to me. I remember before the law [antitabaco]at the National Epidemiology Center, where I worked, they put up “Smoke-Free Space” signs and people smoked inside, next to the signs.
Q. Mariano Rajoy, when he was minister, in 1996, boasted that one day the Minister of Economy of the Andalusian Government showed up with a decree that prohibited smoking, but he smoked a cigar because the mandatory signs were not there. We come from there.
R. It’s true. Tobacco could be banned because it was already proven that passive exposure to tobacco smoke also causes cancer. Your habits are ruining my health. So there is a very good argument, from an ethical point of view, to say: “We have come this far.”
It is a shame that Spain is one of the countries with the most obese children
Q. As a cancer epidemiologist, do you think smoking should be prohibited on bar terraces?
R. Yes, I think it is important. I say this as a cancer epidemiologist and as a non-smoker: for those of us who do not use tobacco, going to a terrace is very unpleasant. And, on the other hand, it is a terrible example for children. I am in favor of prohibiting smoking on terraces and in common public spaces.
Q. How is it possible that Spanish politicians have not yet decided to ban smoking on terraces? Is there so much pressure from the hospitality industry?
R. There must be a lot of opposition from hoteliers, who think they are going to lose an important part of their clientele. However, now you don’t see empty restaurants because smoking has been banned inside. I believe that it is not a threat to your business, but I understand that there are competing interests. The same goes for sugary drinks. By now, they should have an excise tax, but they don’t yet. Because? Well, I imagine they will be commercial interests. Sugary drinks are cheap and increasing their price would possibly help reduce their consumption.
Q. You have drawn the map of obesity in Spain, thanks to the ENE-COVID study. What has caught your attention the most?
R. The socioeconomic differences caught my attention, especially in women, because obesity has gone from being a problem of those who have more money to exactly the opposite: it is the lower or less educated social classes that have a greater obesity problem. . It is a wake-up call for public powers to take action on the matter. The most dramatic thing is childhood obesity. It is a shame that Italy, Greece and Spain are the countries with the highest percentage of obese children, because we are countries in which, traditionally, we were supposed to have a Mediterranean diet. We have to do something.
Q. The prevalence of obesity in women without education reaches 37%, compared to 9% in women with university education, according to their data. It’s a brutal difference. In men it is lower: 29% compared to 13%.
R. The differences are very big. In men it is more attenuated, perhaps because work has been a factor of homogenization between classes. A large percentage of women at very low educational levels do not work and, therefore, their environment is much more socially restricted. It’s a hypothesis.
Q. 56% of adults residing in Spain are overweight and 19% are obese, according to their study.
R. Yes, and that is self-declared data and people tend to lose kilos. One out of every two Spaniards is overweight, that’s a lot. When I was at Johns Hopkins University in the ’90s, I saw obese people in Baltimore that I had never seen here. This type of obesity is already seen now in Spain.
Why do hamburgers have to be so cheap?
Q. You have seen greater obesity in people with lower incomes, with less education and in the southern half of the country. These are problems that are not solved by putting up an “Eat Broccoli” sign; they are solved rather by raising salaries, right?
R. Well it could be. The price of olive oil, for example, which is a key element of the Mediterranean diet, has increased a lot, but we are a country where eating vegetables and legumes is not expensive. Fruit can be more expensive. Maybe the problem is that the unhealthy diet is very cheap. And it is also true that for the working class—and particularly for women, who are usually in charge of making food—using convenience foods is a quick fix and life is not easy. Not everything is price, sometimes it is also time. If healthy foods reach prohibitively expensive prices, they should be subsidized or wagered so that everyone can eat them. And make unhealthy foods more expensive by imposing taxes. Why do hamburgers have to be so cheap?
Q. Working from 8:00 a.m. to 3:00 p.m. and earning 2,500 euros is not the same as having split hours cleaning a residence from 8:00 a.m. to 10:00 p.m. You often talk about these social determinants of health.
R. I think we have to intervene in both senses. The population must be better informed, because I believe that there are large sectors that do not know that obesity is associated with an increase in cancer. And then you have to take measures, such as verifying in school cafeterias that the meals are healthy.
Q. Can you quantify how much your cancer risk drops if you lose weight?
R. We have data on the attributable risk. If all obese and overweight people had a normal weight and we all also had a healthy diet, avoiding sugars and saturated fats, we would save between 30% and 35% of cancer cases.
You can write to us at [email protected] or follow SUBJECT in Facebook, Twitter, instagram or subscribe here to our bulletin.