Tom Frieden

And the idea is that small changes across large populations make a bigger difference than big changes across small populations.

And that can go in either direction, small benefits or small harms.

I'll mention two.

We talked about lead.

Just a little bit of lead less throughout all of society causes

creates massive benefits, economic, educational, cardiovascular, kidney, but no one person may know that they've been benefited.

However, the industry that had to get the lead out may lobby and block those changes.

Similarly,

decreasing potassium or increasing, I'm sorry, increasing potassium or decreasing sodium.

If we just do that a little bit across all of society, no one's going to notice, but it may prevent thousands or hundreds of thousands of heart attacks and strokes, but the companies that have to change are going to oppose.

So this prevention paradox is really important for two reasons.

One is

It's an example of why we don't see reality so effectively, so accurately.

We don't see what's really driving health because we can't see the things that are making a big difference because they're making a little difference for a lot of people.

But that has a political corollary, which means...

Basically, you're going to have tobacco, lead, food, alcohol, the polluting industries, a very concentrated and powerful opposition to benefits that will be for everyone diffusely.

So public health...

has the odds stacked against it.

We're always going to have to fight uphill.

We're always going to have to say, listen, this is good for everyone a little bit and bad for a few groups a lot, and we're going to have to mitigate those few groups and organize the people who benefit from it because the prevention paradox is a very important concept.