Putting a higher value on health / by Norman Sartorius

Cover: "Escape into night- mare" : drawing by Peter Davies after Francis Bacon's "Lying figure with hypodermic syringe, 1963." IX ISSN 0043-8502 World Health is the official illustrated magazine of the World Health Organization. Editor: John Bland Deputy Editor : Christiane Viedma Art Editor: Peter Davies News Page Editor: Peter Ozorio World Health appears ten times a year in English. French. German, Portuguese. Russian and Spanish. and four times a year in Arabic and Farsi. Articles and photographs not copyrighted may be repro- duced provided credit is given to the World Health Organ ization. Signed articles do not necessarily reflect WHO's views. World Health, WHO. Av. Appia, 1211 Geneva 27, Sw itzerland. Contents Putting a higher value on health by Norman Sartorius . . . . . . . . 2 The big killer by David A. Player . . . . . . . . . . . 4 Smoking in the Third World by Uma Ram Nath . . . . . . . . . . . . . . . . 6 Banishing tobacco by William U. Chandler. . . .. . . . . . .. . . . . 8 Demon drink . . . . . . . . . . . . . . . . . . . 12 One for the road? by Alex lrving . . . . . . . . . . . . . . . . • . . . 14 Smoking, alcohol and drugs. . . • 16-17 Drugs are big business by Anthony W. Clare . . . . . . . . . . . . . . 18 Escape into nightmare by lnayat Khan. . . . . . . . . . . . . . . . . . . 22 "Glue-sniffing" . . . . . . . . . . . . . . . . . 23 Chewing khat by Peter Kalix .... . . . . .... . .. .... . Designer drugs by Roger Highfield. . . . . . . . . . . . . . . . 26 International control of drugs by B. Juppin de Fondaumiere . . . . . . . 28 • Departments. Lifestyles and health : Giving up the weed by John Wickett. . . . . . . . . . . . . . . . . . 11 Meeting the threat of drug abuse by Marcus Grant . . . . . . . . . . . . . . . . . 20 Books and publications : Like a thief in the family. . . . . . . . . . . . 15 News Page . . . . . . . . . .. .. a .. . . • . Puning a higher value on health by Norman Sartorius U he abuse of psychoactive sub-stances-including alcohol, to-bacco and narcotic and psycho- tropic drugs-causes enormous dam- age to the health and productivity of nations. It undermines the quality of life of individuals and their families , and threatens the welfare of com- munities. The health consequences of abuse are also grave , and range from violence and deliquency to liver cir- rhosis, brain damage and lung cancer. Treatment of dependence on psychoactive substances is still imper- fect, can take a long time and may be expensive . Its effects are all too often of short duration. Yet treatment re- mains a necessary part of society's response to the damage done. Some- times it will have to be repeated; sometimes it will be discouraged by failure. Nevertheless, it must be pro- vided to those affected, often to save their lives. Fortunately, research during the last 100 years has produced sufficient knowledge about the prevention of abuse of these substances. If it were not for three giant obstacles, preven- tion programmes could be crowned with success. To remember the obsta- cles may help in our search for ways to succeed in spite of them. The first and most important of these is the low value which the popu- lations of the world assign to health. Humans organise their lives in the framework of values which they attach to themselves , to ideas and concepts, to people and to things that surround W OR LD HEALTH, June 1986 Good health implies a harmonious balance at the physical, mental and social level. Photo W HO/E. Mandelmann them. On the scale of all these values, health ranks low. In the presence of disease and pain, people take steps to rid themselves of these; but such steps are motivated by the value attached to life and to the absence of pain, not specifically to health. Pleasure has a much higher value; so have patriot- ism, productivity, popularity, esteem of others, physical appearance and attractiveness. Health implies an exist- ence in which a harmonious balance has been found between the total environment and oneself, and in which physical, mental and social functioning complement each other in maintaining this balance. The value of health, de- fined in this sense, fares badly in comparison with other values which make up the framework for human action. The second giant obstacle to the prevention of substance abuse, is the pharmacological nature of the sub- stances themselves. They produce pleasurable effects, change one's per- ception of the world, of oneself and of one's immediate problems. The addic- tive nature of the substances also makes it necessary to use them in ever WORLD HEALTH, June 1986 increasing quantities, which eventually result in serious damage to the func- tioning of the human body. The be- havioural patterns and cycles in which dependence occurs and is reinforced, as well as its complex socio-economic parameters, have often been described in detail and are reflected in a number of articles in this issue. They interact with the pharmacological properties of a drug in complex but by now well- known ways. The third giant hindrance that stands in the way of success is the nature of the environment in which most people of the world live today. Sharing a cigarette or a drink after a strenuous day may often offer more in human values than anything else avail- able. It may be particularly important in situations where no other pretext for sharing time and feelings is avail- able, because of the poverty of the environment, restrictions of a societal nature or personal reasons. Drug death toll in UK In the United Kingdom alone in 1984, at least 2,000 people died each week from the misuse of drugs. Cigarettes killed 1 ,900 people every week, 60 died from medicines (analgesics or similar compounds accounting for five deaths), and 40 from alcohol, according to two phar- macologists at St. George's Hospital Medical School 1n London . The latter two obstacles do not lend themselves easily to attack. It is un- likely that we shall ever be able to do much about the nature of addictive substances. There will always be drugs of one type or another which, if taken by humans , will cause dependence. History abounds in examples of peo- ple's inventiveness in creating new drugs of abuse. The most recent exam- ple-the appearance of designer drugs -is just one more to be added to the list. There will be others. It is also unlikely that , in the foreseeable fu- ture, we can hope to enrich the human environment-social, physical or bio- logical-sufficiently to prevent situ- Tai chi in China; martial art in slow motion. Photo WHO/D. Henrioud ations in which taking a drug will seem highly desirable. But we are left with one major field of action. We can help people to understand what health is all about and thus contribute towards raising the value that people attach to it. This will require joint action by workers in many social sectors-education, social welfare , medicine , industry , the opin- ion-formers and many others. They can take action now to raise the value of health by example , by legislation, by education and by other means. Finding and promoting worthwhile social alternatives to addictive be- haviour means more than listing possi- ble hobbies. It also means more than merely imposing controls , whether by tightening of borders around drug- producing countries or by increasing prices of alcohol and tobacco. It means leaving choices open to people , once everything possible has been done to ensure that they understand what health is and why it may be important to value it. If people esteem their own health and the health of others suffi- ciently highly, it becomes less likely that they will indulge in practices that harm it or that they will allow others to do so. Most importantly , the motivat- ing force for action against abuse of psychoactive substances will then cease to be external power, pressure or persuasion; instead, the framework for people's decisions about the way in which they spend-or ruin-their lives will include health as a determinant with a high value attached to it. If this happens, we will efficiently and permanently wipe out not only the problems of drug abuse, but a whole series of other problems and evils as well. • 3