A Conversation With Dr. Sanjay Gupta

December 22, 2022, Feature, by Kellie May and Vitisia Paynich

0123 feature a conversation with dr sanjay gupta 410

For an enhanced digital experience, read this story in the ezine.

CNN’s multiple Emmy®-award-winning chief medical correspondent and bestselling author discusses lessons learned from the coronavirus pandemic and the role of nature therapy in maintaining our overall health

On September 20, 2022, Dr. Sanjay Gupta stepped onto the stage in front of an enthusiastic audience of park and recreation professionals to present “World War C: Lessons From the Covid-19 Pandemic and How to Prepare for the Next One,” a talk based on his recently published book. Dr. Gupta served as the opening keynote speaker at the 2022 NRPA Annual Conference in Phoenix, Arizona. “When I was asked to do this particular event, I jumped at the opportunity because first of all, I just think it’s good to be back with people as we’re starting to see some glimmer of light near the end of this pandemic,” the practicing neurosurgeon and chief medical correspondent for CNN told the audience. “But the other reason I really wanted to be here [was] because I really value the work that you all do, and I value your mission. I think there’s an incredible story to tell here. It’s such an important one.”

While Dr. Gupta’s presentation proved both informative and engaging, NRPA and Parks & Recreation magazine wanted to learn more from this renowned health expert. Recently, Kellie May, NRPA’s vice president of programs and partnerships, sat down with Dr. Gupta to discuss lessons learned from the coronavirus (COVID-19) pandemic, why time spent in nature is vital to our physical and mental well-being, and how we can prepare for the next worldwide health emergency.

Kellie May: Your new book focuses on the lessons learned from the COVID-19 pandemic. What are the top lessons that people should learn from this global health crisis?

Dr. Sanjay Gupta: There’s a lot of lessons. I think a couple that really come to mind are that we are increasingly living in a world where…we’re going to keep coming in contact with new pathogens. Most of them aren’t going to be consequential, but every now and then, there will be something that’s more like a COVID. But while new pathogens are inevitable, I think pandemics are not. That’s one of the big lessons that we’ve learned. These don’t have to turn into pandemics. With what we know now [and] what we’re capable of doing now, we can contain these in ways that we probably couldn’t have even a hundred years ago. Emerging pathogens are inevitable, but pandemics are not.

I think another one is — and I talked about this in Phoenix — the idea that bad information can be more damaging and travel faster than the virus itself. We need to have reliable sources, trusted sources of information, and we’ve got to constantly provide the context around that…. And along those lines, I think we have to, as a society, be more comfortable with uncertainty. There’s a lot of desire for certainty in these situations, but [for those of us] in the medical [profession], we live in a probabilistic world. People think science is about proof; it’s about likelihood given evidence. And so, we need to constantly make sure we message things in a way that’s humble about what we know and what we don’t know.

May: Thinking about this pandemic — as you mentioned, the world really has changed around us forever — what does getting “back to normal” look like to you?

Dr. Gupta: It’ll take time to get back to “a normal” and define what that normal is exactly. We’re dealing with the flu and RSV [respiratory syncytial virus] now and things like that. But I’ve long used…a sort of weather storm…analogy when thinking about the normal. I think we were very accustomed to living our lives with a very huge, unpredictable thing, which is the weather. Is it going to rain today? Is it going to be sunny? Am I carrying an umbrella or not? How do you dress? We think about that kind of [thing] almost without thinking about it. Now you have a weather app or you may get it on the news, whatever.

[Thinking about] viral outbreaks and the idea…that these pathogens are going to continue to emerge, a new normal actually has a weather storm-like analogy here. In China, they have quality metrics that they put out there in terms of the air quality. And people will wear masks, or not, or go…do physical activity outside based on [those metrics]. I [believe] we’re going to be thinking about viruses the same way.

Right now, we sort of think about [a virus] like it’s going to come, there’s nothing we can do about it — hunker down, let it pass, and then re-emerge. We’re going to have to dance with these viruses as opposed to continuously just going into complete shutdown mode. And I think a lot of that is treating it like a weather thing. We don’t stop our lives when it rains outside; it’s the same thing. I think with regard to the technology around vaccines and the idea of having booster shots and flu shots — about less than half the country was getting a flu shot before the pandemic — the data is very clear on how protective those are, especially for people who are elderly and have pre-existing conditions. That’s just got to be a way of life. I don’t know [if] that means that they need to be mandated or anything — most healthcare is not mandated — but I think it’s just going to be normalized in a way that people are very comfortable with that.

The last thing I would say, in terms of getting back to normal, is almost a philosophical thing. We’re still at about 300 deaths a day from COVID. That’s like a jumbo jet crashing every day. That’s a lot. Are we willing to accept that? I think [we have to be] real honest about what we’re willing to accept.

May: You’ve already said that there’s a probability that new variants will emerge. They will continue to spread. What can we do as a country to prevent the next pandemic? And what can we do as local government, local government agencies and representatives of local government to build resilience in our communities, to prevent or to prepare for the next pandemic?

Dr. Gupta: When I was writing the book, I thought a lot about the fact that many countries think of this [pandemic] almost from a Department of Defense [DoD] mode. Right now, [the United States] probably [has] a dozen aircraft carriers that are circumnavigating the globe…. We have more aircraft carriers than any other country in the world; we’re five percent of the world’s population. We don’t [often] think…that those aircraft carriers are out there. We think about us as being a relatively safe country to live [in], and there are all these things that are happening in the background to make that the case.

The aircraft carrier is one example, but all these things are happening. We do have to think about what is arguably the greatest threat to the nation — which comes in the form of a tiny virus — the same way. We have to apply almost a DoD mentality to these things. So, the planning is the biggest thing at all levels: individual level, societal level, government level.

I do think the other big thing…[is]…how we evaluate risk. Most people are not very good at evaluating risk. You’re willing to drive down the road in a multiple-ton vehicle at 75 miles an hour, but you’re unwilling to do “X.” It would make no sense if you were to look at this just in terms of the human being’s risk for whatever the situation may be.

In the world, there may have been around 6 million confirmed deaths due to COVID and about a million of them happened in the United States. And we are a country that spends $4 trillion [a year] on healthcare, and we got hit hardest in terms of overall deaths per capita. Now, there’s a lot of reasons for that, but I think one of them that probably doesn’t get enough attention is just our overall health.

As citizens going into this pandemic, we knew the people who were diabetic, people who were obese, people who had chronic diseases were at greater risk of this disease. And I think there’s a real wakeup call to improve our underlying health to make us more resilient to…future variants or brand-new viruses altogether.

May: In your keynote address at the NRPA Annual Conference in Phoenix, you said that “70 to 80 percent of chronic diseases are preventable,” while sharing your observations of the Amazon region’s Tsimane people as a prime example. Can you explain how their way of life and relationship to nature are a model for maintaining good physical and mental health?

Dr. Gupta: It’s kind of stunning to think that 70 to 80 percent of chronic diseases in the United States are preventable. I mean, just to sit back and think we spent $4 trillion on healthcare, [and yet] life expectancy is going backwards. And I would even say that most of that 70 to 80 percent is related to how we nourish ourselves, our diets. So, I give the Tsimane example, and I always want to make sure I frame it properly because I’m not suggesting people can go live as an Indigenous people in the middle of the Amazon rainforest.

But what I think is interesting is that they essentially don’t have most of the chronic diseases that we’re talking about when defining that 70 to 80 percent. There [were] three main things that sort of jumped out at me about them. And again, I tried to put this in terms that I could understand, [like] their movement. Running is probably not a very human…[or the] most efficient way of actually moving; it expends a lot of energy for not as much return on that expenditure. The healthiest people down there don’t run, they walk a lot and…we actually tracked [it] and it was about 17,000 steps a day. It’s a lot, but it seemed doable.

Their diet is mostly food that comes out of the ground or what they hunt. Seventy percent of what they eat are carbs, [which have] a really bad reputation. But it’s not the carbs, it’s the processing of the carbs that’s causing almost all the problems. And then [third], they sleep a lot. They were sleeping about nine-and-a-half hours a night on average — no devices, no connectivity, obviously. So, it’s just a very different sort of lifestyle.

The one thing I’ll say…[is] if you live in a rainforest almost your entire life, you live with some degree of parasitic disease — hook worm, round worm, Giardia [and] things like that. And you usually get an infection early in life and you get sick. Most people recover after some days of illness. And then you basically cohabitate with that parasite your entire life, which is kind of a wild thing to think about, but for most of human existence, that is just how it was. The idea of anti-parasitic medications is a relatively new thing. I bring it up only to say that when we think about these chronic diseases, what is…becoming clear is that our own immune systems are either igniting or exacerbating a lot of these chronic diseases as well — even things like heart disease and diabetes. We know about things like rheumatoid arthritis and a lot of the obviously autoimmune-type diseases, but just about every chronic disease has some component of autoimmunity to it. Our immune system turns on ourselves, and if you talk to the scientists who really study the Tsimane [people], they believe that the parasitic infection actually gives the immune system something else to occupy. So, it’s not increasingly focusing its attention inward on the human body and igniting or exacerbating these diseases. Again, I’m not suggesting that people should go out and get a parasitic infection, but I do think understanding how our own immune systems factor into this [is] a big deal. And I think that relationship with our environment is a part of that.

If you’re living outside in nature, what your body is comprised of — in terms of your microbiome, the organisms that live on your skin, even things like parasites — is very different than if you’re living inside in a hygienic bubble. And it’s pretty clear that people who live outside [reflect] how we [as] humans lived most of our existence. And it gives us greater protection against some of these chronic diseases.

May: What can park and recreation professionals do to provide more upstream preventative care solutions that combat these chronic diseases?

Dr. Gupta: Part of the reason I jumped at the opportunity to be able to give that talk to your organization at this time is because I think we have really been reminded during this pandemic of just how important and healthy it is for us to be outside. I talked about the Shinrin-yoku forest bathing example in Japan and how [scientists] collected this really remarkable data on how quickly people’s cortisol levels dropped and blood pressure dropped.

And there was a study that came out today…that basically said four weeks of mindful, intentional movement outside in nature was the same outcome as four weeks of anti-anxiety medications for the same individuals over that time. That’s great!

One of the things I was talking about with some folks in Arizona was that people fundamentally get the idea that we want to preserve nature. But I think the idea of really being able to intermingle that with the preservation of us as well makes those two things sort of part of the same. In saving nature, we save ourselves. I don’t want to dramatize it, but I’m just saying that it’s all linked, and we shouldn’t think of the preservation of nature as some isolated thing. It’s really important for what it is, but it’s all linked. From a messaging standpoint, it’s something I’ve thought a lot about as I talk about just being outside, exercising, outside, climate change, whatever it might be like. It’s really about preservation of everything that we know.

And then I finally say [on] a more specific note, is I’ve lived in several places around the country, and I think there [have] been some places where it’s far more accessible to be outside in a meaningful way. And…that’s part of it as well — making sure that it’s accessible for all people…some of what we’re talking about here. So continuing to encourage people to get outside, showing the evidence of why it’s helpful and they need it, tying these messages together about the preservation of nature and us, and making sure it’s available to everyone.

May: You spoke about the importance of getting the message out and access to physical activity. What role do you believe that the medical field, or doctors like yourself, play in prescribing physical activity to individuals? What is the recommended dose?

Dr. Gupta: I did a podcast all about ParkRx, and we got into some of these issues, even the one that you’re raising, which is how do you dose something like that? And, the reality is we’re not necessarily there at the point where they can get that granular about that sort of thing. But…going back to the evidence, one could argue that doctors should just be doing this now, prescribing nature and even understanding the mechanism of phytoncides [the organic compounds derived from plants] and how they’re affecting our bodies and all of that. But I do think the data helps, because it helps people [to] be able to point to something and say, “Look, four weeks of intentional activity outside is worth four weeks of anti-anxiety medications.” Whatever it may be…it makes it far more objective, something for people to hang their hat on. From the medical community standpoint, insurance companies might even reimburse [for these types of programs], which I think would create a real movement around some of that.

I think the medical role is to…as always, to try and do the best thing for the patient. But we know that doing the best thing for the patient more and more might be prescribing a dose of nature as opposed to a dose of medication. And now the evidence is becoming increasingly clear.

I’m trying to do my part. I think a lot of people are trying to do their part, getting the word out there, and I think…we’re going to hear about that sort of thing more and more from the medical community.

May: Are there any final comments that you want to share with us?

Dr. Gupta: I really enjoyed being at your [conference]; it felt very necessary to be able to talk to this audience about something that’s so fundamental to all of us — just being able to be outside in nature and all the benefits that come with that…. I think the pandemic was a big reminder for a lot of people, myself included. I kind of saw being social as a luxury, being outside as a luxury, and now I see it as a necessity.

Kellie May is Vice President, Programs and Partnerships at NRPA. Vitisia Paynich is Executive Editor and Director, Print and Online Content at NRPA.