Prevention of cancer. ICCC4 congress, Seoul
Korea: Can ancient societies
retain their traditional values?
Which is it to be, in Korea? Fresh fish or else hot dogs (above)? Big Macs to go or else traditional vegetable-based meals (below)? Can traditions survive?
Members' news
From this month we publish regular stories by Association members with
news of their work, journeys, idea or initiatives. Please see Box 1
Geoffrey Cannon reports. Traditional Korean food systems are special. For one thing, they have survived and are protected. As a result, rates of bad food-related diseases are lower in South Korea than would be expected, given its rocketing material development. Leastwise, this is what I learned 10 years ago at a Bellagio conference on the 'nutrition transition' and its implications for health in 'the developing world' masterminded by Barry Popkin. (1).
The explanation given, is that the South Korean government, and influential health professional and civil society organisations have teamed up to make sure that original Korean dietary patterns, which have a 5,000 year continuous history (2), are not gobbled up by foreign fast food and snack products imported or encouraged by transnational Big Snack corporations. Well, that was a decade ago, and Dunkin Donuts parlours are all over Seoul now, together with other depressing evidence of US influence, very strong in South Korea for obvious reasons, as seen above. Still though, the street markets selling all sorts of fresh foods including fish, flourish in Seoul, as do restaurants specialising in traditional Korean vegetable-based main courses, also on show above.
Box 1
Kimche
Korean diets remain centred on a rich variety of vegetables (left).
(kimche), a staple food, is often bought in bulk (right)bulk (right)
Kimchi is an integral part of the Korean traditional culture that goes back certainly 5,000 and probably 8,000 years. Generically, the term refers to vegetables with a variety of seasonings, salted, stored in a jar, and left to ferment, often kept underground. The practical reason for its invention was to preserve vegetables throughout winter. The jars themselves, which can be enormous, are treasured family possessions, and the best are works of art. The most usual vegetables are varieties of cabbage, but many other vegetables can also be used together with cabbage or else as a basis. Fish or seafood may also be turned into kimchi. It is always served as a substantial side dish with Korean cusine. Conventionally, three types of kimchi are served with meals especially when offered to guests (3). So kimchi is intrinsic to traditional and established Korean ways of family life, and could disappear only if family culture is replaced by the cult of the individual
Is kimchi healthy? Koreans say so. There are research institute departments devoted to showing that kimchi has special powers – is in effect a wonder food. This is not likely to be because of its saltiness. More likely reasons are its role in maintaining a very high consumption of vegetables; the use of potent seasonings such as garlic; and also fermentation, one method of preservation that actually enhances the nutritional value of fresh foods. Sociable Koreans are likely to be familiar with scores and even hundreds of types of kimchi, whose variants include their ingredients, and also the intensity of salting and the length of fermentation.
For breakfast at the fancy Seoul Chosun Westin hotel (thank you again, mine hosts), I stayed with super-delicious stir-fried Korean vegetables accompanied by freshly brewed green tea, and sampled half-a-dozen varieties of kimche. To those not accustomed, some are very (very) salty, and others are somewhat stinky. But some are immediately extremely delicious and energising. I could learn to love kimche...
The Seoul congress at which I was a speaker (see Box 2) was locally organised with great style by the Korean National Cancer Centre, led by its president Jin Soo Lee, and organising secretary Sohee Park and many colleagues. Outstanding presentations were given by Dr Lee, and by my longstanding colleagues David Forman of the International Agency for Research on Cancer in Lyon, and Jon Kerner of the Canadian Partnership Against Cancer (CPAC) in Toronto. Also, by Eduardo Cazap, the charming president of the International Union for Cancer Control, Heather Bryant of CPAC, and as always by Renée Otter of the Comprehensive Cancer Control Centre in the Netherlands. Renée won a laptop as the first prize in the lucky dip draw. Altogether, a splendid and auspicious gathering. And yes, my good friend and colleague, Association membership secretary Fabio Gomes spoke at the congress. He gets everywhere!
Box 2
The International Cancer Control Congresses
Before the congress, spectacular dancing and drumming. Afterwards, a traditional feast. Yes, we also got a lot of work done
The first thing to say about Simon Sutcliffe, president of the International Cancer Control Congress organisation (pictures on the home page) is that he's got bags of style and stacks of dash, and commands meetings with gentle compelling authority. I am one of must be heaps of his fans. There have now been four ICCCs, in Vancouver (2005), Rio de Janeiro (2007), Como (2009) and now Seoul (2011). Their big idea is to alternate with the two-yearly congresses of the Union for International Cancer Control (UICC) and to introduce ideas and approaches for which the UICC will be ready – next time. This works. UICC presidents always are involved with ICCC congresses. In the picture above, right, current UICC president Eduardo Cazap is in the centre, with congress president Jin Soo Lee on his left and Catherine Sutcliffe, one of Simon's distinguished daughters, on his right.
I attended Rio and presented the 2007 executive reports of the World Cancer Research Fund/ American Institute for Cancer Research report on cancer prevention (4) for Spanish Latin America (partnered with PAHO) and the Brazilian version (with INCA, the Brazilian National Cancer Institute). In 2009, in Como, with report director Martin Wiseman, I presented the WCRF/AICR report on policy implications of cancer prevention (5). For Seoul, Simon and the UICC International steering committee invited me to give the opening keynote plenary presentation, on the prevention of cancer in the full and non-medical senses – stopping cancer before it starts. This involves policy and yes, politics, as does all public health reform. For me, with colleagues at WCRF International and AICR, led by president Marilyn Gentry, the invitation was an honour and a pleasure.
On a personal and social note... Once upon a time I arrived at congresses the afternoon before they started, and left in the morning the day afterwards. With first check-in to final customs times from Rio to Seoul of 22 hours normally and 31 hours if you travel Air France as I did, this is bad practice, and can lead to falling asleep in the middle of giving a presentation. Insist on two whole days before the action.
Also insist on at least one full day after the event. How silly and dull to travel round the world to work, and to take no time to savour the splendours and delights of the host country and city. A number of colleagues booked on the day trip to see the de-militarised zone that divides North and South Korea. Not me and Fabio. Our tour was of Seoul's historic palaces, mostly rebuilt with great skill and taste after invasions and destructions by Japan. See the pictures below in Box 3. On this slight experience, I reckon that South Korea, while it remains dependent on US support given the demonisation of North Korea as an 'evil empire' country, is not about to have its traditional culture and ways of life wiped out. 'Come and stay for a while, we'd like that' Jin Soo Lee invited me. Yes, I'd like that too.
Box 3
Members' news
Tranquil arbour, and palace 'guard' giving me the eye
(left and right). Yours truly (white jacket) with Simon Sutcliife, colleagues (centre)
Geoffrey Cannon reports. This is the first of what we hope will be a regular home page series: news – and impressions and views – of Association members. Your stories, which we invite, can arise from your own work, preferably in the field, or as here from participation in conferences, or other occasions. I decided to write this first one, to give an idea of what we want.
It's your website and your journal. For the last few months, the home page stories have focused on Association members, and their experiences, ideas and opinions, written in a style that also conveys useful information. This here is a variation on the theme. 'Members' news' should be written informally. It's OK to have an element of 'what I went and what I did on my travels', as long as the piece includes material of general professional interest.
Thus, I was privileged to participate and speak at ICCC4 in Seoul, thanks to the invitation of international president Simon Sutcllffe (next to me in the centre picture above) and of congress president Jin Soo Lee, also president of the Korean National Cancer Centre. What was also a privilege, and a revelation, was to learn a little about Korean history and culture.
I went to Korea almost completely ignorant, thinking that it was sort-of similar toJapan and China. This is like thinking that Italy is sort-of similar to Spain and Russia. Korea (the whole peninsula) has a 5,000 year known continuous history. Did you know that Korea has made more scientific and technical inventions than any other country, including China? Did you know that its 15th century CE King Sejong (the Great) himself invented the Korean written language, from first principles? Did you know that the 16th century CE Admiral Yi Sun-sin is the most successful master and commander in world history? I did not.
It is such history, revered and taught in schools, that helps to preserve the proud integrity of Korean culture. And what about topics directly relevant to public health and to nutrition? Well, I learned a bit more about kimche (see Box 1), believed in Korea to be a wonder food. Can this be true? Almost all varieties of kimche (there are myriads, many developed from unique family recipes over the centuries) are very salty, and rates of stomach cancer in men – and to a lesser extent women – remain very high. Whereas, rates of obesity (as distinct from overweight) are extraordinarily low, compared with other countries in Asia where average incomes has risen rapidly in recent decades. Greetings, Korea. Let's gain some Korean members.
Note and references
- The term 'non-communicable diseases' is very dull – and also incorrect, as UICC president Eduardo Cazap pointed out to me in Seoul. Why was it chosen? One rumour is that it was dreamed up by a genius from the Coca-Cola company, in one of those public-private invitation-only meetings that shaped the UN summit agenda. Nobody is going to get worried about NCDs. No media editor will want to turn it into a headline. Good rumour. Spread it!
- Lee M-J, Popkin B, Kim S. The unique aspects of the nutrition transition in South Korea: the retention of healthful elements in their traditional diet. Public Health Nutrition 2002; 5 (1A): 197-203
- Sook-he K. Kimchi. Traditional Korean food. Seoul: Ewha Women's University Press, 2010.
- World Cancer Research Fund/ American Institute for Cancer Research. Food, Nutrition, and Physical Activity: A Global Perspective. Washington DC: AICR, 2007.
- World Cancer Research Fund/ American Institute for Cancer Research. Policy and Action for Cancer Prevention. Food, Nutrition, and Physical Activity: A Global Perspective. Washington DC: AICR, 2009
