MAJOR HEALTH PROBLEMS IN THE
NEXT MILLENIUM
ACTION PLAN
Prof B M Hegde
Vice Chancellor
MAHE University
Manipal - 576119
| "Take up the White Man's
Burden The savage wars of peace - Fill full the month of famine And bid the sickness cease." Rudyard Kipling. |
People
all over the developed West are trying hard to sell to the third world the idea
of a potential health disaster for us in the new millennium in the form of major
degenerative diseases like heart diseases, high blood pressure, diabetes and
strokes. On the surface it looks both frightening and insurmountable, unless we
follow their action plan of screening for these in society and be ready with the
drugs and hi-tech surgical techniques to combat the menace. Efforts are on to
buy some of our good brains to spread this logic all over the third world,
especially in India and China, where there are large untapped potential markets
for drugs and technology.
They
do not bother about our own drugs and health delivery systems, not to speak of
the enormous potential of the available remedial preventive measures, even if
the threat is real, instead of the top heavy palliative (not curative) measures!
It
is true that the population growth in our country is still not arrested while in
many western countries it is either decreasing or is, at least, not increasing.
They envisage a large chunk of their population in the next millennium to be in
the above sixty category (70% of the population). Naturally, they could expect
to see degenerative diseases go up exponentially there. That would be their real
problem. Our scenario would be totally different.
More
than sixty per cent of our population in the next millennium would be in the
second decade. We would have totally different type of problems of adolescence
viz.: AIDS, drug addictions, infective diseases, nutritional disorders,
violence, tobacco and alcohol related diseases, and road accident deaths in
place of their load of degenerative diseases.
Our
priorities at the moment are: clean drinking water to our masses, toilet
facilities in all our villages, avoidance of animal and human excreta getting
mixed with human food, reducing atmospheric pollution in our metropolitan
cities, and avoiding cooking fumes from getting into the houses in the villages
endangering young childrens’ lungs, in addition to increasing our food output.
The last is the most important since hunger is one of the main causes of death
and disease in the poorer sections.
Poverty
is now known to be the mother of all degenerative diseases, since the greatest
human distress is not knowing where your next meal comes from. In addition,
poverty also is a double-edged weapon. While it increases the incidence of all
ailments from common cold to cancer, it makes the victim lose his working days
by further pushing him into the bottomless pit of perpetual want. Third world
countries should work overtime to economically empower their masses in the
villages. These measures would, to a great extent, look after our immediate
threat in the new millennium.
Modern
medical wisdom comes in handy here for us to avoid any future threat of
degenerative diseases should they show up when our present generation of
children grow to the sixth and seventh decades in the third world. Most, if not
all, degenerative diseases get born in the mother’s womb in the first
trimester of her pregnancy. It is there that the foetus forms its heart, blood
vessels and pancreas, to name a few. These structures, if not formed well, could
encourage the onset of heart diseases, high blood pressure, diabetes and other
vascular accidents in adult life! It is known now that mother’s nutrition in
the first trimester of pregnancy is of vital importance to avoid this menace.
The
next period in life when these diseases get their encouragement is childhood and
adolescence when bad food habits, alcohol and tobacco could further ensure the
progress of degenerative diseases in later life.
| Action Plan | |
| 1. | The comprehensive village development plan should include water supply, toilets, education about common foods available in the village, and also some methods to uplift the economic condition of the villagers. Smokeless choolas should be supplied to all houses. |
| 2. | Pregnant
mothers should get special attention regarding their diet, more so in the
first trimester. Proper nutritional advice should avoid undernourishment
during that crucial period in the life of the foetus. |
| 3. | Compulsory
breast feeding education to be given to all mothers. In case the breast
milk is inadequate other human milk, if available, is good enough but not
cow’s milk! Instead the baby could be given fruit juices and cereals in
an easily digestible form. This could avoid many other diseases in later
life, like the auto-immune diseases. |
| 4. | Effective
education, to keep tobacco and alcohol at bay, aimed at the adolescents
using different methods suitable to different set-ups, should be started. |
| 5. | Our
primary education should change in such a way that it inculcates the
essence of Indian education of the yore-humility. Humility begets better
life habits. Anger, pride, jealousy, hatred, and ego get suppressed to
give place to love, compassion, and camaraderie. The former are now known
to be important risk factors for major degenerative diseases. |
| 6. | Proper
health education of children in school about the dangers of alcohol,
tobacco, and also sexually transmitted diseases will go a long way in
reducing the future problems of drug addiction and AIDS, which are going
to be our big problems in the next millennium. |
| 7. | Better
roads and stricter licensing procedures should decrease road accident
deaths. Coupled with a war on alcohol this should yield better results.
The only truly avoidable deaths are accidental deaths. Punishment for
careless driving should be more stringent to persuade rich kids from rash
driving in larger cities. |
| 8. | Family
planning should be pursued on war footing. In the villages, where the bulk
of India lives, men are at fault. The best way to educate the men in the
village is to catch the village barber. The latter is an incessant talker
and also has a lot of influence on all the men in the village. If we could
properly educate the barbers and then give them an incentive, that could
work wonders in addition to the conventional methods followed. |
| 9. | Screening whole populations for high blood pressure, heart disease and diabetes to get them under the net of doctors, drug companies, and instrument manufacturers to fix the defect would look good on paper. It can work in the laboratory, but it does not work in the population, and it is definitely not cost effective. |
| 10. | In
addition, screening apparently healthy populations could even be
counter-productive. “It could seriously damage the health of the
population”. Past experience has shown that screening increases sick
absenteeism in society making more people sick! It also increases false
positives. |
| 11. | Screening
a population of one billion is not feasible. Screening only the urban
elite is also not going to help. This would certainly net more people into
the system for treatment and also get more hapless victims for
intervention in the present top heavy hi-tech medical field, but would not
change the scenario as far as the imaginary threat of the degenerative
disease epidemics, as predicted. Predicting the future is impossible.
“We have been predicting the unpredictable”. |
| 12. | Reliable
studies even in the West have shown that the so-called epidemic rise of
certain degenerative diseases and their subsequent fall has been spurious
and flawed heavily. |
| 13. | Life
style modifications have been palpably more effective in containing these
diseases even in the West. While the effect of life style modifications
has been 59.4% effective in reducing the incidence of coronary artery
disease, interventional methods have only been effective to the tune of
3.4%. The story is not different in the field of drug therapy, either. The
famous MRC study of mild to moderate hypertension treatment, which has
85,000 patient years of experience, clearly showed that to save one
life from stroke we have treat 850 apparently healthy people in society
with anti-hypertensive drugs unnecessarily. |
| 14. | These
speak volumes about the very effective role of life style modifications in
altering the future incidence of degenerative diseases. |
| 15. | Coupled
with the prohibitive cost of population screenings and their attendant
dangers to human health it makes lot of sense for third world countries to
concentrate all their efforts in modifying the life style of their
populace to contain these dreaded diseases even if they were expected in
the next millennium. |
| 16. | Here
the role of tobacco and alcohol has to be stressed. We have to fight
the powers-that-be that try and push these two evils on society with all
our might. |
| 17. | Another
area is the field of diet for our adolescents. Indian vegetarian diet has
a lot to recommend it to them in place of the modern junk non-vegetarian
food, which seems to be invading the world of the young in a big way.
Nutrition based education should start in the elementary school itself. |
| 18. | Need
to have physical exercise is the next area
to be stressed. This could be done in many ways aimed at the
younger generation. |
| 19. | The
need to keep the human mind filled with universal love to avoid hostility
and depression-the two most important risk factors for heart and vessel
diseases in addition to cancer –has to be stressed right from day one in
school. |
| 20. | Economic empowerment of our masses is of vital importance to avoid future epidemics of vascular degenerative diseases. |
The need of the hour is the courage to implement these right away and keep the pressures on population screening and mass drugging only to the symptomatic in society, thus bringing down the cost of curative medicine to affordable limits.
Would
someone listen please?
|
I’m
sick of gruel, and the dietetics, Thomas Hood, `Fragment’, c. 1844. |