New lifestyles, new diseases / by Muhammad Al-Khateeb

New Hfestyles, new diseases ahmood was in his early forties, an op- timistic, happy-go- lucky sort of man. He never gave much thought to the additional kilo- grams he had put on lately. He did not practice any sport and indeed felt irritated if obliged to park his car at sorne distance from his destination. He had moved from one clerical job to another and was currently working as an accountant in a private-sector firm. He repeatedly failed to give up smoking, but eventually turned to low-tar, law-nicotine cigarettes which appeared in the country after legisla- tion laid clown that nicotine and tar conten( in cigarettes should not exceed 0.8 mg and 12 mg respectively. One day, Mahmood returned home from work, ate his lunch and played for a while with his young daughters before going for his usually short afternoon nap, after which he would return to the office for the 22 by Muhammad AI-Khateeb evening work period. Suddenly he felt a strange pain in his chest. He tried to ignore it, but it kept getting worse. A heavy lump seemed to be perching on his chest, and severe pain radiated from the sternum area to his left shoulder. He was short of breath and sweating heavily. When he could not Dr Muhammad AI-Khateeb is the Head of Health Educa- tion at the Ministry of Health, Bahrain . bear it any longer, he cried for help. His wife ran to his rescue, an ambulance was summoned and Mah- mood was rushed to hospital. After a preliminary examination, the doctors sent him to the intensive care unit for treatrnent of his coronary condition. A coronary is the widely-used term denoting insufficiency of blood supply to the heart. It is a syndrome that occurs either in the form of angina, myocardial infarction or acute circula- tory failure. Mahmood's case is typical. We ali hear about such cases, and the pre- vention of coronary conditions features regularly in the world press. The disease, which is ratper new to developing communities, is creeping steadily into ali our lives. A study published in 1988 by Al Bahrain Research Centre revealed that in 1984 cardiovascular diseases were responsible for 26.35 per cent of mortality in Bahrain, but by 1986 the figure had risen to 33.35 per cent. Just 4 7. 7 per cent of the patients belonged to the 40-59 age group; 77.9 per cent suffered from obesity, 83.5 per cent had a family history of cardiac diseases, and 86.2 per cent were smokers, of whom 42 per cent got through more than 20 cigarettes a day. ln Oslo, during World War Il, coronary diseases were Jess prevalent WORLD HEALTH , July 1989 than during both the pre- and post- war periods, no doubt due to the change in diet imposed by war condi- tions. People had to eat less meat and clairy products, but more fish and fish products. Such a diet was similar to that found in the food of Eskimo tribes in Greenland, who are seldom afflicted with coronary heart diseases. Japanese fishermen too, whose diet depends almost totally on fish, very rarely suffer from such diseases. High-risk cases As for the link between smoking and cardiac diseases, it has been proved that nicotine and carbon mon- oxide are factors promoting arthero- sclerosis. This causes harmful fatty deposits to form in the internai lining of the arteries, which in turn lead to a narrowing of artery walls, or even an occlusion that obstructs the flow of blood. It is important to put such facts across to the general public in a simplified manner. Moreover, coro- nary heart diseases are aggravated by such factors as high blood cholesterol and hypertension. Indeed, a smoker who suffers from high blood choles- terol and hypertension is a high-risk case - a potential coronary patient. What is needed, in fact, is not a new scientific breakthrough, but rather a sound use of simple edu- cation of the public and a more humane and understanding approach by health care providers. The primary health care physician should give potential coronary patients a simple but thorough expia- nation of relevant facts. He should not ignore a patient's obesity, since overweight may be a factor in promot- ing hypertension, high serum choles- terol and diabetes. Everyone should know that natural weight gain ceases at the age of 30; from then on one should always guard against gaining any additional weight, for instance by increasing physical activity and re- fraining from eating high-calorie foods, particularly fats. Moreover, pre- vention programmes must be intro- duced early in childhood, since this is the formative stage during which habits are developed. Recent social development - such as bigger incomes and greater availa- bility of a wide variety of commodities - have led to changes in lifestyles that threaten health. Coronary diseases are on the increase because of changes in diets; people are eating more fats, carbohydrates and animal proteins; fast-food restaurants offer hamburgers, hot dogs and fried · chicken; the intake of salt from canned food is rapidly increasing; easy transport makes for a lack of WORLD HEALTH, July 1989 physical exercise; and stress is common in our daily !ife. The question is: How can we formulate prevention programmes? When faced with the threat of a contagious disease, we immediately set out to vaccinate people, even though many of them are not likely to contract the disease. Likewise, in order to combat coronary heart diseases we need to appeal to ali the population and urge them to change their eating patterns. Numerous experiments have proved that a posi- tive change of habits and lifestyle leads to a decrease of coronary cases. Prevention should come from within. Proper nutrition needs to be taught in schools at ali levels so that students develop the right eating habits. A great responsibility rests with primary health care physicians to identify cases of hypertension among their patients and provide them with treatrnent and follow-up care. Fast- food restaurants should be instructed to serve the kind of food that contains vegetable fibres and unsaturated fats. Individuals should be encouraged to practise sports, or at !east walk regularly if they are short of time for exercise. Indeed, prevention is crucial, and sound healthy practices should be weil inculcated in childhood. Our diet plays a key role in our long-term health - a fact that is olten forgotten when heavy fatty foods are set before us. Facing page: A pregnant woman has her blood pressure checked in Bahrain - a wise precaution. Photos WHO/A. Badawi and WHO Drawing up an integrated national strategy for the prevention of non- communicable diseases is both advis- able and economically justifiable. But prevention of such diseases cannot be achieved through the efforts of health officiais alone. Health education has to be made accessible to the entire population, and non-health institu- tions and the various mass media should be mobilised to this end. Research data yielded by national as weil as international studies show that early intervention can make the pre- vention of disease possible. Though the past four years have witnessed a significant drop in the rate of cigarette consumption, there are serious indicators that a large percen- tage of young people are smokers. We must try to get rid of such unhealthy habits which have recently afflicted our society. Perhaps we should not conclude without a word about Mahmood, whose case started this discussion of the effects a change in lifestyle may have on health. After spending sorne time in hospital, Mahmood was finally discharged. His health has generally improved and he has !ost weight. He now knows that he suffered from angina due to cardiac functional insufficiency. He is following a diet that is calculated to rid him of much of his excess weight and, on the advice of his physician, he has also started taking exercise. He managed to stop smoking, since he realised that the so-called safe cigarettes are not much safer than ordinary cigarettes. What's more, Mahmood is now a prominent figure in the Bahrain Anti- Smoking Society. • 23