Volume 4: No. 2, April 2007
FROM THE EDITOR IN CHIEF
Who Holds Up the World?
Lynne S. Wilcox, MD, MPH
Suggested citation for this article: Wilcox L. Who holds up the world? Prev Chronic Dis [serial online] 2007 Apr [date cited]. Available from:
This issue of Preventing Chronic Disease (PCD) is devoted to global
health and explores the efforts of several countries to respond to the
challenges of chronic disease and support the health and well-being
of their citizens. From earliest human history, people have created myths
that depict the sacred and at times terrible responsibility
of supporting the world. Although these myths vary from culture to culture ―
and the entities charged with the awesome responsibility of holding up the
earth range from deities to animals to the elements ― the underlying purpose
of all of them is to assure people of the world’s stability and order. In
the Haudenosaunee (i.e., Six Nations or Iroquois) (1,2), Hindu (3), and
Gabrielino Indian (4) religions, turtles and tortoises support the earth. The indigenous Japanese Ainu people describe the world as a vast
ocean resting on the backbone of a trout that creates the surging of the
tides each day by sucking in the ocean and spewing it out (5). In other
mythologies, a single entity is responsible for carrying the heavy burden of
the world. In Greek mythology, for example, Atlas was forced to support the
earth after fighting unsuccessfully against Zeus, the leader of the Olympian
gods. Hercules came to Atlas and requested that he obtain the Hesperides’
golden apples. Atlas agreed on the condition that Hercules would support the
earth while he was away. Atlas had no intention of accepting his eternal
burden again, but Hercules tricked him into taking it back (6).
Fortunately, countries throughout the world today are approaching their
responsibility to support their citizens’ health more willingly than Atlas
approached his task. In more recent years they have increasingly supported
efforts to address the growing worldwide burden of chronic diseases such as
cancer, diabetes, cardiovascular disease, and chronic respiratory illness.
The World Health Organization (WHO) estimates that chronic disease accounts
for 35 million deaths per year, 80% of which occur in low- to middle-income
countries (7). Countries that lose their citizens to early deaths from
chronic diseases face billions of dollars in reduced productivity.
In 2005, WHO published Preventing Chronic Diseases: A Vital Investment
to promote the health of the earth’s people (7). In it, WHO recommends that
efforts to reduce the prevalence and impact of chronic disease include three
steps (i.e., the STEPwise Program): 1) estimating population needs, 2)
developing a health policy, and 3) implementing programs (8). Use of the
STEPwise approach to support people’s health is illustrated in this issue of
PCD by Minh et al, who describe a survey in Vietnam, designed on the basis
of WHO’s surveillance recommendations, that was used to gather data on the
prevalence of risk factors for chronic disease in a rural population (9).
Research and surveillance are also important in developing health policy,
as McDonald demonstrates in examining a program’s efforts to use newspaper
advertisements to recruit participants into healthy-eating activities in
Ontario (10). This issue also contains two articles that describe efforts to
assess the health of two U.S. immigrant groups ― Mexican Americans with diabetes (11) and Filipino children (12)
― and another article that compares the relative effectiveness of the
antitobacco efforts of two countries by comparing the responses of U.S.
youths to American cigarette warning labels and announcements with their
responses to warning labels and announcements used in Canada (13).
The metaphor of supporting the earth is also reflected in the myths of
cultures that consider holding up the earth or the sky to be a shared
responsibility. According to the ancient Norse religion, four dwarfs —
Austri, Vestri, Sudri, and Nordri — held up the four corners of the earth
(14), while the Mayans believed that four gods, the Bacabs, supported the
sky (15). Several articles in this issue describe similar cooperative
efforts to support the health of a community. Robinson et al describe the
approach of seven Canadian provinces in disseminating information for the
Canadian Heart Health Initiative and their eventual decision to provide the
public with a wide variety of information about how to prevent chronic
disease and promote healthy living (16). Coalition and partnership building,
policy advocacy, and strategy development were key elements in the projects
they describe. Kunyk et al describe how Capital Health, a provincial health
authority in Edmonton, Alberta (17), adopted a smoke-free environment at all
of its facilities. Managers, policy makers, and frontline health care
professionals were all involved in designing educational programs for staff
members and in designing protocols for providing nicotine replacement
therapy to staff members as well as patients.
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- Haudenosaunee: people building a long house [cited 2006 Oct 31]. Available from:
- Bales R. Native American women: living with landscape. OAH Mag Hist
- Encyclopedia of myths. Hinduism and
mythology. Farmington Hills (MI): Thompson Gale;[cited 2006 Oct 31]. Available from:
- Torango Online. Tremor tales — the turtle story [cited 2006 Oct 31].
- NOVA Online. Ainu legends: trout. Boston (MA): WGBH Educational
Foundation;[cited 2006 Oct 31]. Available from: http://www.pbs.org/wgbh/nova/hokkaido/legtro.html *
- Odyssey Online. Herakles. Atlanta (GA): Emory University, Michael C.
Carlos Museum;[cited 2006 Oct 31]. Available from:
- Preventing chronic diseases: a vital investment. Geneva (CH): World Health
Organization; 2006. Available from: http://www.who.int/chp *
- STEPwise approach to chronic disease risk factor surveillance. Geneva
(CH): World Health Organization;[cited 2006 Oct 31]. Available from: http://www.who.int/chp/steps/riskfactor/en/index.html
- Minh HV, Byass P, Huong DL, Chuc NTK, Wall S. Risk
factors for chronic disease among rural Vietnamese adults and the
association of these risk factors with sociodemographic variables: findings from
the WHO STEPS survey in rural Vietnam, 2005. Prev Chronic Dis
[serial online] 2007 Apr.
- McDonald PW. A practical, cost-effective method for recruiting people into healthy eating
behavior programs. Prev Chronic Dis [serial online] 2007 Apr.
- Albertorio-Díaz JR, Notzon FC, Rodriguez-Lainz A.
hospitalization at the U.S.–Mexico border. Prev Chronic Dis [serial online] 2007 Apr.
- Javier JR, Huffman LC, Mendoza FS. Filipino child health in the United States:
do health and health care disparities exist? Prev Chronic Dis [serial online] 2007 Apr.
- O’Hegarty M, Pederson LL, Yenokyan G, Nelson D, Wortley P.
Young adults’ perceptions of cigarette warning labels
in the United States and Canada. Prev Chronic Dis [serial online] 2007 Apr.
- Kermode PMC. Traces of the Norse mythology in the Isle of Man [cited
2006 Oct 31]. Available from:
- Encyclopedia Mythica. "Bacabs." Encyclopedia Mythica Online;[cited 31 Oct
2006]. Available from:
- Robinson K, Farmer T, Elliott SJ, Eyles J.
From heart health promotion to chronic disease prevention:
contributions of the Canadian Heart Health Initiative. Prev Chronic Dis [serial online] 2007 Apr.
- Kunyk D, Els C, Predy G, Haase M.
Development and introduction of a comprehensive tobacco control policy in a
Canadian regional health authority. Prev Chronic Dis [serial online] 2007 Apr.
- McDevitt A. Shu. Ancient Egypt: the mythology;[cited 31 Oct 2006]. Available from: http://www.egyptianmyths.net/shu.htm *
- Encyclopedia Mythica. Shine-Tsu-Hiko. Encyclopedia Mythica Online;[cited 31 Oct 2006]. Available from:
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