We live in an environment that differs in many important respects from the environments in which our ancestors lived and to which they became more or less well adapted. We live in large, culturally diverse, and socioeconomically stratified communities of genetically unrelated individuals; we eat different foods; we are exposed to different sets of pathogens and toxins; and we have different patterns of physical activity than did our ancestors. These culturally constructed or man-made environmental changes have resulted in an epidemiologic transition. As deaths from famine and infectious diseases decreased, and life expectancy increased, the burden of disease has shifted to chronic, noncommunicable diseases such as diabetes, coronary heart disease, and stroke. These diseases, which are often referred to as Western diseases, are more appropriately thought of as man-made diseases. Changes in diet, particularly increases in the consumption of sucrose, high fructose corn syrup, and salt, have led to increases in obesity, diabetes, and hypertension. Reducing the prevalence of these diseases requires interventions that reduce risk factors in the entire population. According to the hygiene hypothesis, reduction in exposure to helminths and other pathogens has resulted in an increased risk of allergic and autoimmune diseases. This hypothesis has led to novel, helminth-based treatment of patients with these diseases. Finally, socioeconomic disparities in physiological capital and in psychosocial stresses have led to health disparities. Reducing socioeconomic disparities is the most promising approach to ameliorating health disparities.
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