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Copenhagen. How can we public health nutrition professionals work more closely with family physicians? In many countries, the primary health care setting can crucially influence behaviour. The wider context is also important, but within ministries of health the public health approach operates through primary care. And family physicians, also known as general practitioners, are very influential. Generally they know little about public health nutrition, yet they are often the first and foremost professionals many people approach, to seek counsel concerning their general health, including their weight and their diet.

This is an issue WHO is wrestling with, right now, as part of its contribution to the UN Summit on prevention of non-communicable diseases this coming September. There won't be a quick or easy answer, and the only sustainable solution surely is to make public health and community nutrition part of the core training of medical students.

Tall or short stories?

This month's World Nutrition includes a commentary by the researcher and campaigner Thomas Samaras, whose member's profile is also published this month, together with a supportive editorial. The commentary proposes that it is better to be short, and this month's WN cover shows a picture of the French savant Voltaire, who was pocket-size even in his day.

It's no secret that WN editor Geoffrey Cannon is keen on this topic. He proposed the motion 'It is best to be small' at one of the debates held at the Porto public health nutrition conference last September, opposed by David Pelletier of Cornell University. Geoffrey was gratified that whereas the 'pre-vote' held before the debate showed that the number of people in the room who supported the motion he was proposing was 0 (zero), the final vote was almost a tie, at 13-14. I was more struck by that fact that most people abstained – they did not vote one way or the other. Perhaps this was because they felt uneasy about the whole very broad topic. Perhaps they even wondered whether it was appropriate to raise the issue. Colleagues of mine, inside and outside DOHaD (the Developmental Origins of Health and Disease) group, won't be surprised to know that I certainly feel uneasy.

We can all agree that very many short people are perfectly formed, as they say, and generally healthy. We can also agree that prejudice in favour of tallness, whereby people get promoted or become rich and famous partly simply because they are tall, is wrong. But the evidence that babies in lower-income countries who are born small are usually more vulnerable to disease, and may be liable to grow up physically and mentally impaired, is surely beyond dispute. Surely it is our job to protect the health of babies and young children, and all the more so if stunting in early life may impede development throughout life. I can't help wondering whether the 'small is beautiful' idea, applied to human height, is some sort of fad. Maybe it is valid in certain circumstances. But the overall notion I feel is too broad. What do you think?

Pocket-size footie stars

There again... I was debating this issue with Geoffrey Cannon, who accepts that he knows nothing about football while being an Arsenal fan. He advanced the ridiculous argument that the best attacking footballers are short, because they have a lower centre of gravity. Diego Maradona, for instance, is 1 metre 65 (5 foot 5), and as Geoffrey pointed out, could also 'head' balls into goal with his hand when the ref was unsighted. Pelé is 1 metre 73 (5 foot 8), as was George Best. The Brazilian George Best, Garrincha, was 1 metre 69 (5 foot 6.5), and Romario, a neighbour of Geoffrey's in Cabo Frio, is 1 metre 67 (5 foot 6).

Geoffrey and I then started to banter about teams, and as fans do, he swanked about Arsenal beating Barcelona, the best team in the world. But this was the Arsenal home game. I then pointed out that the three players now nominated as the best in the world are all from Barcelona. Here they are above, in the front row: Lionel Messi (left), Xavier (Xavi) Hernandez (third from left), and Andres Iniesta (fourth from left). Heights? Um.... Respectively, 1 metre 69 (5 foot 6.5), 1 metre 70 (5 foot 7), and 1 metre 70 (5 foot 7). Not stunted of course, but short-arses, every one. If they stood up straight this would be evident. Of course, this head-counting is completely not scientific.

Commitment

In the last few weeks I have been teaching or marking Masters students, and supervising PhD students. This is very rewarding when students are actively engaged. But when students don't feel the need to come to sessions properly prepared, discussions are depressing and frustrating. Increasingly when discussing the causes of malnutrition in low and middle income countries with students from Europe, I find that students rarely have thought about the wider global and environmental issues.

Few undergraduate or postgraduate courses include philosophy of science. So students are not well prepared for thinking logically, and have little idea about concepts like 'cause' or 'truth'. Medical students particularly like facts that prove things, because for them they feel they need to know the answer and that when they become doctors they have to tell people what to do. So if I say 'I don't know' they become very uncomfortable.

My preferred approach is Socratic. Here is how it is described. 'The classic Socratic method uses creative questioning to dismantle and discard pre-existing ideas and thereby allows the respondent to rethink the primary question under discussion (such as "What is virtue?")... The weight of the actual deconstruction of a definition rests in the respondent's own answers to more questions, which refute the respondent's previously stated answer to the primary question. The result... is, by definition, a failure to find a satisfactory answer to the primary question in a conversation. This failure produces a realisation of ignorance in the respondent (Socratic effect) which can, it is hoped, inspire the respondent to dig deep and think about the question with a new freedom' ( http://www.socraticmethod.net/ )

This approach often makes students feel that it is all too complicated and beyond their capacity to understand, let alone address. Take the basic or upstream causes of malnutrition. When I start to ask questions about the European Common Agricultural Policy (CAP), terms of trade and protectionism, and the World Trade Organization, most MSc students look at me blankly as if seeming to think that I am crazy. Recently I was marking third year medical student essays. They were supposed to see a patient, go through a clinical history, and then use that as a basis to explore the epidemiological evidence and the public health implications. This is meant to get them to think beyond treatment, and to think about how the problem may have arisen. One student, describing a problem that was primarily rooted in nutrition, said that he was not interested in behavioural issues as these were the responsibility of the individual. After I stopped ranting and raving (to myself) I could hear the same words being said by the current UK Prime Minister. To get this student to link climate change and the CAP to the clinical problem being addressed, was going to be a challenge!

Each term we run a global health module for third year medical students. It is optional. Over the course of the year we may get about 10 per cent of the year group to come along. Well, I think, at least that's one in ten. If we could get that many people across Europe to think about these issues, and see the links between their lives in Europe and the lives of people in Africa, we could make some progress. You might suppose that all our Masters students in Public Health Nutrition would be interested in exploring and thinking about 'big picture stuff'. Sorry to say, this is not so.

What Egypt shows us

Is this a Western European or high-income country complacency? Sometimes I think so, yes. Look at what has been happening in Tunisia and Egypt. Young and old together have somehow reached the point where they have said enough and no more, and poured out onto the streets and defied controlling regimes. It is amazing to see so many people together peacefully casting off years of tyranny. As I write, Libya is a darker story.

What was the tipping point? When you talk to people from these places they say words to the effect of 'We have been working away slowly and quietly over many years toward these days now. It seems to be a sudden thing, but it has been built on many years of people being beaten up and held in prison without trial. And very often the oppressive regimes have been supported by European and US government who are there to support their own interests'.

Gaining wide knowledge and seeing the big picture is powerful. This enables us to see the impact of what happens at one time and in one place has at other times and in other places – from uneven and unfair distribution of food, water and fuel, to unfair trade practices that make it hard for poor producers in lower-income countries to get a fair return for their crops. It's said that the next big wars will be fought over water. Maybe I'll give my students a real challenge and, in their next courses, ask them why.