Obesity, high blood pressure, high cholesterol, alcohol and tobacco consumption are major causes of the new health scourge - the chronic, lifestyle diseases - World Health Report 2002.
IN MANY ways, global health has never been better life expectancy in many countries extends beyond 70 years, total fertility rate is on the decline (now less than three in Jamaica) and as a result of the introduction of mass immunisation campaigns, many young people will only read in history books of such dreaded communicable diseases as poliomyelitis, leprosy, yaws, smallpox, tuberculosis, measles and others such as lice infestations.
The single invention of vaccines has not only saved millions of lives but impacted quality of life, though health experts have been heard to remark that it is ironic that these health gains of the last century are contributing to the current public health scourge, the chronic, lifestyle diseases the cardiovascular diseases, heart disease, cancers, hypertension, diabetes, obesity. The argument is that the longer people live, the greater the risk for developing the lifestyle diseases.
It is hardly possible that a vaccine will be invented to stomp out the new health scourge the health battle must be fought on different terms. Paradigms are shifting the patient and the general population must begin to actively participate in healthcare and prevention.
It is in this context of shifting paradigms and the changing global health scourge that the World Health Report 2002 should be recognised as an important document. It identifies 25 preventable risk factors and lists the top 10 as childhood and maternal underweight; unsafe sex; high blood pressure; tobacco consumption; alcohol consumption; unsafe water; sanitation and hygiene; high cholesterol; indoor smoke from solid fuels; iron deficiency and overweight/obesity.
The control of most of these risk factors are within the reach of most individuals who choose to accept responsibility for the state of their health and adopt more healthy lifestyles. The power to maintain health and well-being is more in the hands of individuals and less so, in the control of their physicians.
The Report indicates that the preventable risks, if effectively tackled, could extend life expectancy by between five and 10 years. All together these preventable risk factors account for about 40 per cent of the 56 million deaths globally. The WHO researchers have gone further to identify five of the factors obesity, high blood pressure, high cholesterol, alcohol and tobacco as major causes, independently and in combination, of the chronic, lifestyle diseases.
Where do we locate Jamaica in this global health scenario of shifting disease pattern? The 10 leading causes of death in Jamaica are chronic, lifestyle diseases cerebrovascular accidents, diabetes, ischaemic heart disease, hypertensive heart disease, heart failure, cancer, homicides, HIV/AIDS disease, acute respiratory tract infection and chronic, lower respiratory tract infection. The 2001 Lifestyle and Health Survey (Jamaica) indicates that more than 50 per cent of all deaths are due to these chronic, non-communicable diseases and occur as follows:
Cardiovascular diseases 184 of every 100,000 deaths
Cancer 85 of every 100,000 deaths
Heart disease 84 of every 100,000 deaths
Cerebrovascular diseases 64.6 of every 100,000 deaths
Diabetes 60 of every 100,000 deaths
Hypertension 32 of every 100,000 deaths
Disease trends have been linked to dramatic lifestyle changes more people are more sedentary as access to technology increases; they eat more fast foods and take diets rich in fats, sugar and salt; they drink too much alcohol, smoke and engage in risky sexual behaviour.
The Report's recommendations
Governments, especially health ministries, should play a stronger role in
formulating risk prevention polices, including more support for scientific
research, improved surveillance systems and better access to global information.
Countries should give top priority to developing effective, committed policies
for the prevention of globally increasing high risks to health such as tobacco
consumption, unsafe sex in connection with HIV/AIDS, and, in some populations,
unhealthy diet and obesity.
Cost-effectiveness analyses should be used to identify high, medium and
low priority interventions to prevent or reduce risks, with highest priority
given to those interventions that are cost-effective and affordable.
Intersectoral and international collaboration to reduce major extraneous
risk to health, such as unsafe water and sanitation or a lack of education,
is likely to have large health benefits and should be increased, especially
in poorer countries.
Economic burden of chronic diseases
Some 31 per cent of curative clinic visits in Jamaica is dedicated to the
treatment of hypertension and diabetes, with patients making an average of
four visits per year.
More than 200,000 hospital days are used by patients suffering from chronic
diseases.
Drugs and doctors' visits for an estimated hypertensive population of 195,640
cost some $632.4 million annually
Hospital costs (including surgery and diagnostic tests only) for some 10,565
patients with diseases of the circulatory system stood at $786.1 million in
1999.
