tag:theconversation.com,2011:/us/topics/lifestyle-diseases-835/articles
Lifestyle diseases – The Conversation
2022-04-13T12:13:53Z
tag:theconversation.com,2011:article/179169
2022-04-13T12:13:53Z
2022-04-13T12:13:53Z
ALS is only 50% genetic – identifying DNA regions affected by lifestyle and environmental risk factors could help pinpoint avenues for treatment
<figure><img src="https://images.theconversation.com/files/456422/original/file-20220405-14-ks7fbg.png?ixlib=rb-1.1.0&rect=0%2C0%2C2309%2C1299&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Epigenetics is how behavior and environment affect gene expression.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/the-dna-spiral-royalty-free-image/1293534045">Iryna Dobytchina/iStock via Getty Images Plus</a></span></figcaption></figure><p><a href="https://medlineplus.gov/amyotrophiclateralsclerosis.html">Amyotrophic lateral sclerosis</a> is a devastating neurodegenerative disease that affects about <a href="https://dx.doi.org/10.1038%2Fncomms12408">1 in 50,000 people</a>. Well-known people who suffered from ALS include baseball player <a href="https://www.als.org/understanding-als/lou-gehrig">Lou Gehrig</a>, who lived two years after he was diagnosed, and scientist <a href="https://www.nbcnews.com/health/health-care/stephen-hawking-had-als-55-years-how-did-he-do-n857006">Stephen Hawking</a>, who lived for an extraordinary 55 years after his diagnosis. While the severity and speed of disease progression <a href="https://www.als.org/understanding-als">vary from person to person</a>, most people with ALS die within two to five years after diagnosis. <a href="https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Amyotrophic-Lateral-Sclerosis-ALS-Fact-Sheet">No effective therapy</a> currently exists.</p>
<p>Little is known about what causes or increases someone’s risk of developing ALS. Researchers think it’s only <a href="https://doi.org/10.1001/jamaneurol.2019.2044">around 50% genetic</a>, indicating that there are strong environmental and lifestyle risk factors affecting disease development. But very few of these risk factors have been identified.</p>
<p><a href="https://www.researchgate.net/profile/Ramona-Zwamborn-2">We</a> <a href="https://www.researchgate.net/profile/Paul-Hop-2">are</a> <a href="https://www.researchgate.net/scientific-contributions/Jan-H-Veldink-39091027">a</a> team of <a href="https://www.projectmine.com/country/the-nederlands/">neuroscientists</a> with a special interest in <a href="https://medlineplus.gov/genetics/understanding/howgeneswork/epigenome/">epigenetics</a>, the study of how the environment influences DNA. By examining the epigenetics of ALS, we found that differences in metabolism, cholesterol and immunity may play a role in disease progression.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/xrIjFVMliOQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">ALS involves the progressive degeneration of the neurons involved in muscle movement.</span></figcaption>
</figure>
<h2>Nongenetic risk factors</h2>
<p>Epigenetics opens a window into the role environmental factors play in genetic diseases like ALS. One common type of epigenetic mechanism is <a href="https://doi.org/10.1007/978-1-61779-612-8_23">DNA methylation</a>, an on-off switch for certain regions of DNA that shift throughout a person’s lifetime. The ways these on-off patterns change are known to be shaped by environmental and lifestyle factors.</p>
<p>To unravel how DNA methylation affects ALS, we analyzed DNA samples and lifestyle questionnaire responses from almost 10,000 patients with and without ALS. This data was collected by <a href="https://www.projectmine.com/">Project MinE</a>, an international initiative creating a database of the genetic profiles of ALS patients. </p>
<p>We discovered <a href="http://dx.doi.org/10.1126/scitranslmed.abj0264">differences in methylation</a> patterns between people with ALS and people without ALS in 45 DNA regions. When we examined the specific genes located in these areas, we found that people with ALS mainly showed differences in methylation on genes that play a role in metabolism, cholesterol production and immunity. These findings support a recent <a href="https://doi.org/10.1038/s41588-021-00973-1">Project MinE study</a> that showed a causal link between high cholesterol levels and ALS.</p>
<p>Our team also examined DNA methylation patterns that reflect exposure to certain environmental or lifestyle factors (such as smoking or high body mass index), or biological processes (such as aging). Even after controlling for the effects of these other common risk factors, we found that metabolism, cholesterol and immunity were still associated with ALS.</p>
<p>Changes in methylation patterns for multiple DNA regions, and especially those related to immune processes, were also associated with survival rates for people living with ALS.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/456406/original/file-20220405-14-p1qj70.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram of DNA methylation and histone modification" src="https://images.theconversation.com/files/456406/original/file-20220405-14-p1qj70.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456406/original/file-20220405-14-p1qj70.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456406/original/file-20220405-14-p1qj70.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456406/original/file-20220405-14-p1qj70.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456406/original/file-20220405-14-p1qj70.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456406/original/file-20220405-14-p1qj70.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456406/original/file-20220405-14-p1qj70.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Environmental factors can affect genetic material through an epigenetic mechanism that involves methyl groups tagging DNA to turn it on or off.</span>
<span class="attribution"><a class="source" href="http://commonfund.nih.gov/epigenomics/figure">National Institutes of Health</a></span>
</figcaption>
</figure>
<h2>Next steps</h2>
<p>Currently, no cure exists for this devastating and deadly disease. Our study helps clarify the biological processes that underlie ALS risk factors and disease progression, and could potentially be used to develop new treatments or preventive interventions.</p>
<p>It is important to emphasize, however, that the epigenetic differences between people with and without ALS that we found were small. Our study also doesn’t prove that changes in genes involved in metabolism, cholesterol production or immunity cause or are influenced by ALS. More research is needed before physicians can confidently recommend lifestyle changes to help cut the risk of ALS.</p>
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<p class="fine-print"><em><span>Jan Veldink receives funding from the European Research Council (ERC) and Biogen (sponsored research agreements).</span></em></p><p class="fine-print"><em><span>Paul J. Hop and Ramona Zwamborn do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Genetic modifications to DNA regions involved in metabolism, cholesterol and immunity may play a role in ALS disease progression.
Ramona Zwamborn, PhD candidate in Neurogenetics, Utrecht University
Jan Veldink, Professor of Neurology and Neurogenetics, Utrecht University
Paul J. Hop, PhD candidate in Neurogenetics, Utrecht University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/156230
2021-04-20T12:33:27Z
2021-04-20T12:33:27Z
African countries must consider legal challenges to sugar taxes before pursuing policies
<figure><img src="https://images.theconversation.com/files/388523/original/file-20210309-23-1lnr2vd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Sales of unhealthy foods and beverages in sub-Saharan Africa are skyrocketing. This is leading to an <a href="https://www.sciencedirect.com/science/article/pii/S2211912420301206">increase in obesity related conditons</a> such as diabetes, hypertension and cardiovascular disease. </p>
<p>These diseases are projected to become <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30370-5/fulltext">the leading cause of death in sub-Saharan Africa by 2030</a>, overtaking communicable diseases like HIV and TB. The economic cost of noncommunicable diseases is immense. They result in significant disability, and can be very expensive to treat. In South Africa, the medical cost of diabetes was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012049/">R2.7 billion in 2018</a>. </p>
<p>But noncommunicable diseases are preventable. The economic and societal impact can be mitigated if governments take decisive action to reduce the availability of harmful products such as unhealthy food, alcohol and tobacco.</p>
<p>Sugar-sweetened beverages are among the most harmful food products to consumers. This is because <a href="https://www.sciencedirect.com/science/article/abs/pii/S1043276012001191?casa_token=mkh_7xDvoqUAAAAA:54Fjyj7MH3XZAsDWKBdWzLq9GvUIYEkYtrL1ruRSrlcE5nf3Bqf_OfhP7aenNpumeNMGtHtNfZE">liquid sugar is especially toxic</a> and these drinks have no nutritional value.</p>
<p>One of the key ways to address the growing public health impact of sugary drinks is by introducing laws, policies and regulations. These measures could limit the availability of unhealthy products and make it easier to encourage people to eat healthy food. But they must be implemented as a combined effort. </p>
<p>There are a number of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12580">proven interventions</a> to reduce the consumption of sugary drinks. These include limiting portion sizes, banning them from schools and checkout isles of supermarkets and taxing sugar-sweetened drinks. </p>
<p>But these measures have been challenged legally and by other means by the companies that produce and sell sugary drinks. </p>
<p>In 2012, then New York City mayor Michael Bloomberg introduced a regulation limiting the portion sizes of sugar-sweetened drinks sold around the city. The beverage industry and retailers <a href="https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302862">challenged this decision in court</a> and the policy was rolled back. South Africa’s efforts to introduce a tax on sugar-sweetened beverages <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00647-3">faced threats of legal challenges</a>. These were based on a range of technicalities from a lack of public participation to challenging the purpose of the tax. In this case, the objections only delayed the tax rather than stopping it. </p>
<p>Even if these law suits are unsuccessful, they can have a chilling effect on other actions to prevent noncommunicable diseases. Legal challenges to government efforts to address the availability of unhealthy food and drinks can seriously undermine public health.</p>
<p>This is why countries must carefully consider the legal feasibility of an intervention before deciding how to implement it. We <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1884358">developed</a> a way in which countries can consider doing this. It involves an assessment of the potential legal barriers to, and as well as the facilitators of, the proposed intervention.</p>
<h2>The landscape</h2>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1884358">study</a> looked at the legal feasibility of introducing a tax on sugar-sweetened beverages in seven sub-Saharan African countries: Botswana, Kenya, Namibia, Rwanda, Tanzania, Uganda, and Zambia. We looked at four different types of sugary drinks taxes that had been introduced around the world and whether these could be introduced in each of these countries.</p>
<p>We assessed each country’s legal barriers and facilitators. These included their legal and taxation regimes. We also examined broader regional agreements and the infrastructure needed to implement such a tax. </p>
<p>We considered <a href="https://openknowledge.worldbank.org/bitstream/handle/10986/33969/Support-for-Sugary-Drinks-Taxes-Taxes-on-Sugar-Sweetened-Beverages-Summary-of-International-Evidence-and-Experiences.pdf?sequence=6&isAllowed=y">taxes implemented in various countries around the world</a> and chose to evaluate the four taxes adopted in Mexico, Colombia, the UK and South Africa under this study. The tax introduced in Mexico added a fixed amount on each litre of soft drink. The taxes in South Africa and the United Kingdom link the amount of tax payable to the sugar content of a drink. And Colombia decided to remove a value added tax exemption from sugar-sweetened beverages. With the exception of Colombia’s approach, most of these taxes are introduced as an excise tax.</p>
<p>Our research showed that all seven sub-Saharan African countries had existing excise tax legislation. And five countries already taxed sugar-sweetened beverages. However, these existing taxes worked to generate revenue for governments rather than improve public health as the taxes did not differentiate between sugary and non-sugary drinks. For example, Rwanda had a tax of 39% on carbonated beverages but sugary drinks remained a cheap beverage option.</p>
<p>In addition, countries have an obligation to introduce measures to protect the health of their citizens. These obligations are set out in treaties like the <a href="https://www.achpr.org/legalinstruments/detail?id=49">African Charter on Human and Peoples’ Rights</a> and domestic constitutions which contain rights to nutritious food or health. </p>
<p>Our research also showed that there were existing laws that could be used as a foundation to adopt a sugar-sweetened beverage tax to improve public health. For example, <a href="https://www.theguardian.com/global-development/2018/oct/26/tax-on-drinks-to-raise-funds-for-hiv-treatment-in-uganda">Uganda</a> had a dedicated HIV fund which was funded entirely by a 2% levy on drinks (including soft drinks and bottled water). Both <a href="https://www.kilimo.go.tz/index.php/en/stakeholders/view/sugar-board-of-tanzania-sbt">Tanzania</a> and <a href="http://kenyalaw.org/kl/fileadmin/pdfdownloads/bills/2019/TheSugarBill_2019.pdf">Kenya</a> had an agricultural levy on sugar, the proceeds of which were used to support sugar farmers. </p>
<p>The existence of supportive legal frameworks such as human rights could also be used to defend against potential challenges to a public health measure like this. </p>
<p>The introduction of taxes on sugar-sweetened beverages in <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/did-high-sugarsweetened-beverage-purchasers-respond-differently-to-the-excise-tax-on-sugarsweetened-beverages-in-mexico/37DBC66A6F1E19F74942888814EB1EA3">Mexico</a> and <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/abs/assessing-sugarsweetened-beverage-intakes-added-sugar-intakes-and-bmi-before-and-after-the-implementation-of-a-sugarsweetened-beverage-tax-in-south-africa/050AA9D1D8F9B12026C0F7836D1B4F09">South Africa</a> resulted in the reduced consumption of sugar and sugary drinks consumption within a year or two after the implementation of the tax. These reductions can lead to significant <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/assessing-sugarsweetened-beverage-intakes-added-sugar-intakes-and-bmi-before-and-after-the-implementation-of-a-sugarsweetened-beverage-tax-in-south-africa/050AA9D1D8F9B12026C0F7836D1B4F09">health benefits</a>, particularly in people who consume a lot of sugary drinks. In addition, these taxes are a particularly good intervention because they can help governments generate additional tax revenues. </p>
<h2>Looking ahead</h2>
<p>Our research shows that sugar-sweetened beverage taxation in the seven countries is legally feasible. Existing laws can provide a strong starting point for the introduction of a sugar-sweetened beverage tax. In addition, the adoption of such a tax is a way for governments to meet their human rights obligations without having to worry about legal challenges undermining the intervention.</p>
<p>Legal feasibility and the health impact of these interventions are only one part in the complex political economy of adopting noncommunicable disease prevention interventions. Research has shown that <a href="https://www.tandfonline.com/doi/abs/10.1080/23288604.2019.1669122">the political environment</a> and <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00647-3">industry pushback</a> against measures like sugar taxation are also important hurdles that need to be overcome. </p>
<p>Governments must take urgent action to prevent noncommunicable diseases from becoming an uncontrollable epidemic in sub-Saharan Africa. Sugar-sweetened beverage taxation offers a potential solution.</p><img src="https://counter.theconversation.com/content/156230/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Safura Abdool Karim is supported by the South African Medical Research Council Centre for Health Economics and Decision Science - PRICELESS SA. The research referenced in this article was supported by the International Development Research Centre, Canada.</span></em></p><p class="fine-print"><em><span>Karen Hofman is supported by the South African Medical Research Council Centre for Health Economics and Decision Science - PRICELESS SA. The research referenced in this article was supported by the International Development Research Centre, Canada.</span></em></p>
Governments must take urgent action to prevent noncommunicable diseases from becoming an uncontrollable epidemic in sub-Saharan Africa. Sugar-sweetened beverage taxation offers a potential solution.
Safura Abdool Karim, Senior researcher, University of the Witwatersrand
Karen Hofman, Professor and Programme Director, SA MRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the Witwatersrand
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/156216
2021-04-20T12:32:08Z
2021-04-20T12:32:08Z
Why African countries need reliable local data on sugary drinks taxes
<figure><img src="https://images.theconversation.com/files/388205/original/file-20210308-18-779b17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Appropriately designed taxes on sugar-sweetened beverages would result in proportional reductions in consumption.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Diets in sub-Saharan Africa are <a href="https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/nyas.12433">changing</a> as more countries advance from low-income to middle-income status. People’s eating habits are shifting from food rich in starchy staples, vegetables and fruits to a more <a href="https://theconversation.com/whats-driving-sub-saharan-africas-malnutrition-problem-55579">westernised diet</a> high in sugar, saturated fats and oils. This shift to unhealthy foods is <a href="https://www.who.int/news-room/fact-sheets/detail/healthy-diet">fuelling</a> obesity related chronic, noncommunicable conditions such as heart disease, diabetes and cancer.</p>
<p>Preventive measures are more critical than ever to curtail this tsunami that is overwhelming health systems.</p>
<p>One area that must adjust is the food and beverage sector in sub-Saharan Africa. The processed food industry is promoting the region as a <a href="https://www.mdpi.com/2071-1050/11/16/4306/htm">growth market</a> for its products. </p>
<p>To discourage consumption and reduce health risks, an increasing number of low- and middle-income countries have imposed <a href="https://openknowledge.worldbank.org/bitstream/handle/10986/33969/Support-for-Sugary-Drinks-Taxes-Taxes-on-Sugar-Sweetened-Beverages-Summary-of-International-Evidence-and-Experiences.pdf?sequence=6">taxes on sugar-sweetened drinks</a>. Across the globe and especially in <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1231">Latin America</a> and the <a href="https://www.sciencedirect.com/science/article/pii/S0091743517302608?via%3Dihub">Caribbean</a>, taxing sugary drinks to reduce consumption has been effective.</p>
<p>The World Health Organisation (WHO) has <a href="https://africa-health.com/news/world-health-organization-wants-sugar-taxes/">called on</a> African governments to follow this example, and to ease the burden of noncommunicable diseases. </p>
<p>In <a href="https://www.who.int/dietphysicalactivity/publications/fiscal-policies-diet-prevention/en/">2015</a>, a WHO panel of public health experts found that: </p>
<blockquote>
<p>appropriately designed taxes on sugar-sweetened beverages would result in proportional reductions in consumption, especially if aimed at raising the retail price by 20% or more. </p>
</blockquote>
<p>Some African countries such as South Africa, Botswana and Zambia already tax sugary drinks. But others have been slow to act. The <a href="https://www.who.int/dietphysicalactivity/publications/fiscal-policies-diet-prevention/en/">WHO</a> attributes this, in part, to evidence gaps. </p>
<p>Credible local data are essential to determine what taxes can and cannot achieve. </p>
<p>We wanted to get an understanding of what data are available to support the design, implementation, monitoring and evaluation of a sugary drinks tax. We focused on seven sub-Saharan African countries: Botswana, Kenya, Namibia, Rwanda, Tanzania, Uganda, and Zambia. These economies are growing and their marketing industries are low-cost. Regulation of unhealthy commodities is also weak. </p>
<p>In combination, these factors represent a growth opportunity for the industry. They will also fuel diet-related noncommunicable diseases.</p>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2020.1871189">research</a> highlighted the urgent need for new indicators on unhealthy diets, including sugary drinks consumption and purchase patterns. Without this evidence, countries might underestimate the consumption figures. They might then miss the potential of sugar-sweetened drinks taxation as a public health intervention.</p>
<h2>Our research</h2>
<p>We interviewed stakeholders such as representatives from government agencies, including those in health, commerce, development, agriculture, education and academia. All individuals underscored the importance of local evidence on sugary drinks consumption and purchasing behaviours, as well as fiscal evidence to compare the cost and benefits of a tax. This is because policymakers need to take into account evidence for coherent economic arguments to discuss sugar-sweetened drinks taxes in policy circles.</p>
<p>The potential health benefits, the revenue of such a tax, as well as the monitoring and evaluation of its implementation, requires appropriate baseline data at the outset particularly across income levels, and age groups. </p>
<p>Our study highlights that such information is missing in all seven countries.</p>
<p>We looked at a range of publicly available data sources to establish the rate of sugary drinks consumption and the impact on people’s health. </p>
<p>We found that national survey data does not adequately track either the intake of sugar-sweetened drinks, or household spending. Fiscal data is lacking regarding sugary drinks tax revenue, value added tax from sugary beverage sales, and the corporate income tax and customs duty revenue.</p>
<p>Accurate information on the soft drinks industry was not easily accessed either. Unlike in countries such as Mexico, it was difficult to find information on a number of fronts. The number of companies in industry sectors, beverage industry forecasts, drinks prices, package sizes, number of low- or no-calorie beverages, and sugar content were unavailable. </p>
<p>Kenya, Zambia, Rwanda, Tanzania and Uganda had taxes on non-alcoholic beverages. But only Zambia had a differential sugar-sweetened beverages tax – 3% on imported beverages and 0.5% on local drinks. Botswana recently introduced a tax that is very similar to the health promotion levy in South Africa.</p>
<h2>Going forward</h2>
<p>Timely, easily understood, concise, and locally relevant evidence is needed to inform policy development on sugary drinks. The relevant data are drawn from multiple sectors. Cross-sector collaboration is, therefore, needed. </p>
<p>Indicators to measure sugar-sweetened drinks and added sugar consumption should be developed. These must be included in current data collection tools such as national income dynamics studies. This would ensure monitoring and evaluation of taxation. </p>
<p>There’s no consensus on how best to capture data for new indicators. But a useful point of departure would be to complement existing data sources. These include population-based surveys that ask questions related to sugary drinks taxation. This would lead to improvement in tracking the intake of sweet drinks, and the effectiveness of taxation.</p>
<p>Establishing robust, accurate baseline data to inform evidence could enable governments to accelerate political and public support for sugar-sweetened beverage taxation and related policies. Finally, greater transparency of industry data is essential.</p><img src="https://counter.theconversation.com/content/156216/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Agnes Erzse receives funding from the South African Medical Research Council/Centre for Health Economics and Decision Science PRICELESS SA, University of Witwatersrand School of Public Health, Faculty of Health
Sciences, Johannesburg South Africa (D1305910-03). The research was supported by the International Development Research Center grant (#108648-001)</span></em></p><p class="fine-print"><em><span>Karen Hofman is supported by the South African Medical Research Council Centre for Health Economics and Decision Science - PRICELESS SA. The research referenced in this article was supported by the International Development Research Centre, Canada.</span></em></p>
Without reliable, local and timely data, countries will miss the potential of sugar-sweetened beverage taxation as a public health intervention.
Agnes Erzse, Researcher, SAMRC/Centre for Health Economics and Decision Science- PRICELESS SA, University of the Witwatersrand
Karen Hofman, Professor and Programme Director, SA MRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the Witwatersrand
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/152791
2021-01-20T13:32:01Z
2021-01-20T13:32:01Z
They don’t come as pills, but try these 6 underprescribed lifestyle medicines for a better, longer life
<figure><img src="https://images.theconversation.com/files/378940/original/file-20210114-17-2vf0g4.jpg?ixlib=rb-1.1.0&rect=8%2C22%2C2982%2C1976&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Families can prioritize learning more healthy ways to eat.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sheriss-chacon-and-her-brother-shawn-chacon-watch-as-eden-news-photo/893170?adppopup=true">Joe Raedle/ Getty Images News</a></span></figcaption></figure><p>The majority of Americans are <a href="http://dx.doi.org/10.15585/mmwr.mm6932a1">stressed</a>, <a href="https://www.cdc.gov/sleep/data_statistics.html">sleep-deprived</a> and <a href="https://www.cdc.gov/nchs/fastats/obesity-overweight.htm">overweight</a> and suffer from largely preventable lifestyle diseases such as <a href="https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death">heart disease, cancer, stroke and diabetes</a>. Being overweight or obese contributes to the <a href="https://www.cdc.gov/bloodpressure/facts.htm">50% of adults who suffer high blood pressure</a>, <a href="https://www.cdc.gov/chronicdisease/resources/publications/factsheets/diabetes-prediabetes.htm">10% with diabetes and additional 35% with pre-diabetes</a>. And the costs are unaffordable and growing. About 90% of the <a href="https://www.cdc.gov/chronicdisease/about/costs/index.htm">nearly $4 trillion</a> Americans spend annually for health care in the U.S. is for chronic diseases and mental health conditions. But there are new lifestyle “medicines” that are free that doctors could be prescribing for all their patients.</p>
<p><a href="https://www.lifestylemedicine.org/">Lifestyle medicine</a> is the clinical application of healthy behaviors to prevent, treat and reverse disease. More than ever, <a href="https://adventisthealthstudy.org/?rsource=publichealth.llu.edu/adventist-health-studies">research</a> <a href="https://www.nurseshealthstudy.org">underscores</a> <a href="https://sites.sph.harvard.edu/hpfs/">that</a> <a href="http://www.commissiononhealth.org/Home.aspx">the “pills”</a> today’s physician should be prescribing for patients are the six domains of lifestyle medicine: whole food plant-based eating, regular physical activity, restorative sleep, stress management, addiction reduction or elimination, and positive psychology and social connection. </p>
<p>We are a primary care <a href="https://www.workpartnersblog.com/workpartners-thought-leaders-to-present-at-2019-health-benefits-conference-expo/">preventive medicine physician</a>
and a <a href="https://mirm-pitt.net/our-people/faculty-staff-bios/yoram-vodovotz-phd/">computational immunologist</a>, both committed to applying state-of-the-art research to <a href="https://www.ardmoreinstituteofhealth.org/lmrsummit">inform the clinical practice of lifestyle medicine</a>. <a href="https://doi.org/10.3389/fmed.2020.585744">Our findings and recommendations</a> were just published. We highlight the key take-home points for each of the areas below. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/379039/original/file-20210115-15-17ils1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/379039/original/file-20210115-15-17ils1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/379039/original/file-20210115-15-17ils1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=473&fit=crop&dpr=1 600w, https://images.theconversation.com/files/379039/original/file-20210115-15-17ils1u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=473&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/379039/original/file-20210115-15-17ils1u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=473&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/379039/original/file-20210115-15-17ils1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=595&fit=crop&dpr=1 754w, https://images.theconversation.com/files/379039/original/file-20210115-15-17ils1u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=595&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/379039/original/file-20210115-15-17ils1u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=595&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Use the Healthy Eating Plate as an evidence-based guide for creating healthy, balanced meals.</span>
<span class="attribution"><a class="source" href="https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/">©2011, Harvard University</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
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<h2>Whole-food, plant-based eating</h2>
<p>Diets high in fruits, vegetables and whole grains and lower in animal products and highly processed foods have <a href="https://eatforum.org/content/uploads/2019/01/EAT-Lancet_Commission_Summary_Report.pdf">been associated</a> <a href="http://doi.org/10.1001/jama.288.20.2569">with prevention</a> of many diseases. These diets have also <a href="http://doi.org/10.1001/jama.288.20.2569">improved health</a> <a href="https://doi.org/10.7812/TPP/17-025">and even reversed</a> common <a href="https://www.cdc.gov/chronicdisease/about/costs/index.htm">cardiovascular, metabolic, brain, hormonal, kidney and autoimmune diseases as well as 35% of all cancers</a>.</p>
<p>We believe that future research should include larger trials or new research methods with <a href="http://doi.org/10.1001/jamainternmed.2020.2790">emphasis on quality of diet</a>. This would include more data on the micronutrient composition and protein sources of plant versus animal-based foods – not just proportion of fat, carbohydrates and protein. Such trials should include children, as many adult disorders are seeded as early as infancy or in utero. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/378939/original/file-20210114-17-1fhevh1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/378939/original/file-20210114-17-1fhevh1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/378939/original/file-20210114-17-1fhevh1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/378939/original/file-20210114-17-1fhevh1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/378939/original/file-20210114-17-1fhevh1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/378939/original/file-20210114-17-1fhevh1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/378939/original/file-20210114-17-1fhevh1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">First Lady Michelle Obama led a Let’s Move! initiative to help children grow up healthy.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/first-lady-michelle-obama-participates-in-a-yoga-class-news-photo/474864367?adppopup=true">Joe Raedle/Getty Images News/Getty Images</a></span>
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<h2>Regular physical activity</h2>
<p><a href="https://wonder.cdc.gov/wonder/prevguid/m0042984/m0042984.asp">For decades, surgeon generals’ guidelines</a> have emphasized that daily moderate-to-vigorous aerobic physical activity has both immediate and long-term health benefits. For example, why we age and the rate at which we age – chronological age versus biological age – is determined by multiple molecular processes that are directly influenced by physical activity. And now scientists are gaining a better understanding of the <a href="https://doi.org/10.1016/j.cmet.2015.05.011">cellular and molecular changes that exercise</a> induces to reduce disease risk. </p>
<p>Research priorities for scientists and physicians include obtaining a deeper understanding of the type, intensity and frequency of activity, and better insights into the molecular and <a href="https://doi.org/10.1016/bs.pmbts.2015.07.005">cellular alterations</a> <a href="https://doi.org/10.1016/bs.irn.2019.06.002">that occur with exercise</a>. </p>
<h2>Restorative sleep</h2>
<p>Sleep helps the cells, organs and entire body to function better. <a href="https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html">Regular uninterrupted sleep</a> of seven hours per night for adults, eight to 10 hours for teenagers and 10 or more for children is necessary for <a href="https://doi.org/10.5665/sleep.3298">good health</a>. </p>
<p>Though understudied, there is evidence that high-quality sleep can reduce <a href="https://doi.org/10.5665/sleep.3298">inflammation, immune dysfunction, oxidative stress, and epigenetic modification</a> of DNA, all of which are <a href="https://doi.org/10.1016/S1389-9457(08)70013-3">associated with or cause chronic disease</a>.</p>
<p>Therefore, research into the biological mechanisms that underlie the restorative properties of sleep could lead to environmental or population-based and policy approaches to better align our natural sleep patterns with the demands of daily life.</p>
<h2>Stress management</h2>
<p>Though some stress is beneficial, prolonged or extreme stress can overwhelm the brain and body. <a href="https://doi.org/10.1111/j.1467-8721.2006.00450.x">Chronic stress increases the risk of cardiovascular disease</a>, <a href="https://doi.org/10.1111/cns.12490">irritable bowel disease</a>, <a href="http://doi.org/10.1016/j.tem.2016.04.007">obesity</a>, depression, asthma, arthritis, autoimmune diseases, cardiovascular disease, cancer, diabetes, neurological disorders and obesity. </p>
<p>One of the most powerful mechanisms to reduce stress and enhance resilience is by <a href="https://doi.org/10.1056/NEJMp1917461">eliciting a relaxation response</a> using mind-body therapies and cognitive behavioral therapy. </p>
<p>More research is need to gain a better understanding of how these therapies work.</p>
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<img alt="" src="https://images.theconversation.com/files/378945/original/file-20210114-18-15aqmmn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/378945/original/file-20210114-18-15aqmmn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/378945/original/file-20210114-18-15aqmmn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/378945/original/file-20210114-18-15aqmmn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/378945/original/file-20210114-18-15aqmmn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/378945/original/file-20210114-18-15aqmmn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/378945/original/file-20210114-18-15aqmmn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Thousands of people participate in yoga to improve their physical and mental health.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/kate-steinberg-age-9-from-montreal-joins-thousands-of-news-photo/980365680?adppopup=true">Timothy A. Clary/AFP via Getty Images</a></span>
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<h2>Addiction reduction and elimination</h2>
<p>Many social, economic and environmental factors have fueled the national rise in substance abuse generally and, most tragically, the opioid epidemic. </p>
<p>Physicians and researchers are beginning to understand the underlying physiology and psychology of addiction. </p>
<p>Yet the <a href="https://doi.org/10.17226/25310">continued stigma and disjointed or absent access</a> to services remains a challenge. Clinicians and scientists need to explore how to predict who is more vulnerable to addiction and find ways of preventing it. <a href="https://doi.org/10.1080/00952990.2018.1546862">Treatment that incorporates integrated care</a> focused on all the patient’s needs should be prioritized. </p>
<h2>Positive psychology and social connection</h2>
<p>Maintaining a positive mindset through the practice of gratitude and forgiveness has a significant impact on psychological and subjective well-being, which are, in turn, associated with <a href="https://doi.org/10.1007/s10902-019-00082-1">physical health benefits</a>. </p>
<p>Social connectivity, namely the quantity and quality of our relationships, has perhaps <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674503816">the most powerful health benefits</a>. </p>
<p>Conversely, <a href="https://doi.org/10.1037/0033-2909.119.3.488">social isolation</a> – such as <a href="https://doi.org/10.2105/AJPH.2016.303431">living alone, having a small social network</a>, participating in few social activities, and feeling lonely – <a href="https://doi.org/10.1212/01.WNL.0000147473.04043.B3">is associated with greater mortality</a>, increased morbidity, lower immune system function, depression and cognitive decline. </p>
<p>Further study is needed to uncover how an individual’s biology and chemistry change for the better through more social interactions. </p>
<h2>Inflammation’s role in lifestyle-related diseases</h2>
<p>Unhealthy lifestyle behaviors produce a vicious cycle of inflammation. While inflammation is a healthy, natural way the body fights infections, injury, and stress, too much inflammation actually promotes or exacerbates the diseases described above.</p>
<p>The inflammatory response is complex. We have been using machine learning and computer modeling to <a href="https://www.springer.com/gp/book/9783030565091">understand, predict, treat and reprogram inflammation</a> – to retain the healing elements while minimizing the detrimental more chronic ones. Scientists are unraveling new mechanisms that explain how chronic stress can turn genes on and off. </p>
<h2>Overcoming challenges and barriers</h2>
<p>We and others who study lifestyle medicine are now discussing how we can leverage all of these approaches to improve <a href="https://www.frontiersin.org/files/Articles/585744/fmed-07-585744-HTML/image_m/fmed-07-585744-g001.jpg">clinical studies on the impacts</a> of lifestyle interventions. </p>
<p>At the same time we and our colleagues realize that there are environmental challenges and barriers that prevent many people from embracing these lifestyle fixes. </p>
<p>There are food deserts where healthier foods are not available or affordable. Unsafe neighborhoods, harmful chemicals and substances create constant stress. Poor education, poverty, cultural beliefs and racial and ethnic disparities and discrimination must be addressed for all people and patients to appreciate and embrace the six “pills.” </p>
<p>The application of lifestyle medicines is particularly important now because unhealthy lifestyles have caused a pandemic of preventable chronic diseases that is now exacerbating the COVID-19 pandemic, which disproportionately <a href="https://doi.org/10.1177/1559827620950276">afflicts those with these conditions</a>. </p>
<p>Ask your doctor to <a href="https://www.guidetogoodhealth.com/Articles/LifestyleMedicine.asp">“prescribe” these six “pills”</a> for a longer and better life. After all, they’re free, work better than or as well as medications and have no side effects! </p>
<p>[<em>The Conversation’s science, health and technology editors pick their favorite stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-favorite">Weekly on Wednesdays</a>.]</p><img src="https://counter.theconversation.com/content/152791/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yoram Vodovotz is a co-founder of, and stakeholder in Immunetrics, Inc.</span></em></p><p class="fine-print"><em><span>Michael Parkinson, MD, MPH is founder of P3 Health (Prevention, Performance & Productivity). </span></em></p>
Lifestyle medicine targets the root of chronic diseases like obesity, heart disease and diabetes. Experts explain why everyone should embrace these free prescriptions for good health.
Yoram Vodovotz, Professor of Surgery, University of Pittsburgh
Michael Parkinson, Senior Medical Director of Health and Productivity, UPMC Health Plan & Workpartners, University of Pittsburgh
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/110456
2019-02-05T13:44:18Z
2019-02-05T13:44:18Z
Weighing up the costs of treating ‘lifestyle’ diseases in South Africa
<figure><img src="https://images.theconversation.com/files/256102/original/file-20190129-108364-17vwexn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Salty and fatty foods are driving up obesity.
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Economic growth, accompanied by a fall in infectious diseases over the past two decades, has changed the profile of the biggest <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32279-7/fulltext">threats</a> to the health of people living in low and middle-income countries.</p>
<p>At the turn of the century, the greatest threats were posed by <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31891-9/fulltext">infectious diseases</a> like diarrhoea, pneumonia, tuberculosis, and HIV. Today, the biggest threats are posed by so-called <a href="https://theconversation.com/lifestyle-diseases-could-scupper-africas-rising-life-expectancy-107220">“diseases of lifestyle”</a>. These include diabetes (high blood sugar), hypertension (high blood pressure), and hypercholesterolaemia (high cholesterol), which have been slowly and quietly rising around the world. </p>
<p>While diabetes, hypertension and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778427/">hypercholesterolaemia</a> often don’t cause symptoms, they have debilitating and deathly consequences which can include heart attacks, angina, heart failure, amputation, stroke, kidney disease, and blindness. These are now the most common causes of death and disability in many low and middle-income countries. But unlike many infectious diseases, there’s no course of antibiotics to treat them.</p>
<p>Obesity and lack of activity contribute to the rise of diabetes, hypertension, and hypercholesterolaemia. These are driven, in turn, by lifestyle changes, often biased towards foods that are convenient (sugary and fatty) and jobs that require less physical activity.</p>
<p>Strong policies are desperately needed to alter the environment to promote physical activity and prevent obesity. But there’s also a need to treat people who already have diabetes, hypertension, and hypercholesterolaemia– which are largely without symptoms – to try to prevent their consequences.</p>
<p>Unfortunately, <a href="https://theconversation.com/why-its-so-difficult-to-tackle-diabetes-in-sub-saharan-africa-81339">access to care</a> for people with these conditions is poor in many low and middle-income countries. South Africa is no exception. In our <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30450-9/fulltext">research</a> we set out to establish who suffers from these conditions, who has access to care and what the consequences would be if the access to care didn’t change. We also wanted to establish what the cost savings would be for the South African government if access to care improved.</p>
<p>After analysing our findings in relation to these questions, we concluded that South Africa should invest in care for treating diabetes, hypertension, and hypercholesterolaemia. This will, in the long run, save the country a lot of money.</p>
<h2>Managing risks versus treating the diseases</h2>
<p>As far as deathly and debilitating consequences are concerned, we found that poorer black men were at high risk and they had the worst access to care. </p>
<p>Overall, only 50.4% of people in the study community with hypertension were treated to acceptable levels. Just under 9% were treated adequately for diabetes and less than 1% for high cholesterol. </p>
<p>We estimated that if access to care continued at current levels, premature deaths due to cardiovascular conditions would be around 40 per 1000 people annually. Although HIV still causes the greatest percentage of premature deaths in South Africa, diabetes, stroke, and heart attacks are all in the top 10 causes, with diabetes rapidly rising through the ranks. More of these deaths would occur among those who are poor, black and male. There is also substantial risk for blindness and kidney disease. </p>
<p>We further estimated that the cost of treating all of these deathly and disabling consequences of diabetes, hypertension, and hypercholesterolaemia would be $34.2 billion a year. That’s roughly 10% of South Africa’s GDP in 2017.</p>
<p>We also found that if access to care for diabetes, hypertension, and hypercholesterolaemia was improved to levels seen in the UK or Germany, deaths and disability would be reduced. The benefits would also be seen among people who currently lack access to care, such as poor, black men. </p>
<p>If people are sceptical of South Africa’s ability to achieve access to care at the same level as the UK or Germany, it may be reassuring to note that <a href="https://elpais.com/elpais/2017/02/10/inenglish/1486729823_171276.html">Cuba</a> has managed to achieve these levels of access to care.</p>
<p>In addition to determining the costs of treating consequences of diabetes, hypertension, and hypercholesterolaemia, we calculated what it would cost to treat these conditions by improving access to care and implementing locally appropriate guidelines. We used two guidelines for our estimates: the World Health Organisation’s (WHO) <a href="https://www.who.int/nmh/publications/essential_ncd_interventions_lr_settings.pdf">Package of Non-Communicable Disease Interventions</a>, and the locally developed <a href="https://www.idealclinic.org.za/docs/guidelines/PC%20101%20Guideline%20v2_%202013%2014.pdf">South Africa Primary Care 101 Guidelines</a>. </p>
<p>We found that it was cheaper to improve access to – and treat these conditions – using either guideline than to stick with current levels of access and care and suffer the consequent diseases. In fact, implementing the WHO guidelines would save around US$125,000 per 1000 people and US$185,000 with South Africa’s guidelines. The local guidelines are more cost effective. They are also more equitable, with better improvements in treatment and reduction of risk in black people, men, and those who are poorer.</p>
<h2>What needs to be done</h2>
<p>Even though we have shown that rolling out the guidelines would save costs in the longer term, there still needs to be substantial investment in building programmes for treatment in the short term. And there needs to be monitoring and evaluation to ensure the guidelines are correctly implemented.</p>
<p>The balance is tipped in favour of widescale implementation of the guidelines because they are likely to lead to the well-being of individual patients. This would include reductions in death and disability, and improved equity, quality of life and accompanying cost savings.</p><img src="https://counter.theconversation.com/content/110456/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Justine Ina Davies receives funding from The Wellcome Trust. </span></em></p><p class="fine-print"><em><span>Ryan G Wagner does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
At the turn of the century, the greatest threats were posed by infectious diseases today, the biggest threats are posed by lifestyle diseases.
Justine Ina Davies, Professor of Global Health, Institute for Applied Research, University of Birmingham
Ryan G Wagner, Research Fellow, MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/99721
2018-07-13T11:46:12Z
2018-07-13T11:46:12Z
Health coaching might sound ‘new age’, but it could help you reach old age
<figure><img src="https://images.theconversation.com/files/227166/original/file-20180711-27039-hqc9z7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The new me. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-thanked-god-on-mountain-508483447?src=9KGJ8NGrKDowKyZL2Q1ymw-1-11">Deer worawut</a></span></figcaption></figure><p>There are two ways of tackling chronic lifestyle diseases such as cancer, heart disease and diabetes: discover new drugs and treatments or persuade people to make positive lifestyle changes to avoid developing them in the first place. </p>
<p>Health coaching is one of the most powerful ways of changing people’s mindsets for the long term. Practitioners are rapidly taking their place alongside executive coaches, life coaches and personal trainers as another means of making us better people through one-to-one improvement sessions. </p>
<p>It has only been around a couple of decades, but the techniques date all the way back to the 5th century BC – specifically Socrates’ <a href="https://www.law.uchicago.edu/socratic-method">famous method</a> of questioning his students to uncover truths. Coaches ask clients questions to help them gain a clearer insight into who they are and their potential. It’s a process of self-discovery that helps people to take actions that change their behaviour. </p>
<p>Specialists often group together the likes of cancer, heart conditions and obesity as the non-communicable diseases, meaning you can’t catch them from someone else. Together <a href="http://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases">they kill</a> some 40m people each year, about 70% of all deaths around the world – and poor lifestyles frequently increase the risks. This looks like getting worse – adult obesity levels are <a href="https://www.nhs.uk/news/obesity/half-of-uk-obese-by-2030/">forecast to</a> reach 40% by 2030 in the UK, for example, while diabetes prevalence is <a href="https://www.gov.uk/government/news/38-million-people-in-england-now-have-diabetes">expected to</a> rise by almost a third in the next couple of decades. </p>
<p>This is making healthcare expenditure unsustainable. UK <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/ukhealthaccounts/2016">spend was</a> £192 billion in 2016, for example, and is rising at around 4% a year. Long-term illnesses <a href="https://fullfact.org/news/how-much-nhs-budget-spent-treating-chronic-conditions/">account for</a> about 70% of spending. For this reason, the direction of travel in the UK and elsewhere is to focus on the common risk factors behind these diseases and work towards reducing them by promoting behaviour change. This is where health coaching comes in. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/227168/original/file-20180711-27015-boxtj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/227168/original/file-20180711-27015-boxtj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/227168/original/file-20180711-27015-boxtj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/227168/original/file-20180711-27015-boxtj5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/227168/original/file-20180711-27015-boxtj5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/227168/original/file-20180711-27015-boxtj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/227168/original/file-20180711-27015-boxtj5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/227168/original/file-20180711-27015-boxtj5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">OMG.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-thanked-god-on-mountain-508483447?src=9KGJ8NGrKDowKyZL2Q1ymw-1-11">Fred Ho</a></span>
</figcaption>
</figure>
<p>The modern coaching phenomenon dates back to Timothy Gallwey, an American tennis player who wrote a series of very successful books about sports coaching in the 1970s and early 1980s called <a href="https://www.buzzfeed.com/reeveswiedeman/the-inner-game-of-everything-why-is-a-four-decade-old-tennis?utm_term=.uoA2zJYWR#.uyX0Q712L">The Inner Game</a>. They were all about using techniques that focused on gameplay to prevent the brain from interfering with your performance. </p>
<p>Gallwey then began applying similar techniques to leadership, kicking off a whole new industry in executive coaching. <a href="https://www.primalhealthcoach.com/the-rise-of-the-health-coach/">Health coaching</a> grew out of this and began to spark interest from the early 1990s, but has only really taken off in the past five years. It is now common in the US and Australia, though still somewhat novel in the UK – but this looks set to change. </p>
<p>The NHS ran a health coaching <a href="https://eoeleadership.hee.nhs.uk/Health_Coaching_Training_Programmes">pilot</a> for training practice nurses in Suffolk at the beginning of the decade, which was then <a href="https://eoeleadership.hee.nhs.uk/Evaluation">rolled out</a> to nearly 800 doctors, nurses and other health professionals across the east of England in 2013. More recently, NHS England has <a href="https://www.telegraph.co.uk/news/health/11823490/NHS-to-provide-motivational-coaches-in-war-on-flab.html">launched</a> a wider programme for disseminating coaching techniques to health professionals. The intention is to offer nine-month coaching programmes to the five million people in England with blood sugar levels that put them at high risk of diabetes. </p>
<h2>What the research says</h2>
<p>Health coaching is not the same as counselling, therapy or handing out advice. Typically a first session would be about helping the client to arrive at an overall health or lifestyle goal – cutting their weekly alcohol intake in half, say. The health coach would use the questioning technique to uncover what that goal means to the person in terms of their personal values, and draw up a specific action plan for reaching it. </p>
<p>Coach and client would look at what makes change a good thing and what is getting in the way – avoiding “why” questions, which are seen as judgemental. The emphasis is about turning barriers into opportunities, focusing on the future rather than the reasons why the person got into that cycle of behaviour. </p>
<p>Over a few follow-up sessions, clients come back and discuss their progress, what they have found challenging, how to proceed and so on. If they are succeeding, the coach may get them to start working on another goal – running twice a week, for example.</p>
<p>There are certainly research findings to support this new approach to healthcare. Health coaching has been shown to be one of the most effective methods for managing lifestyle diseases. It helps people make physical changes such as losing weight and lowering their cholesterol and blood pressure. </p>
<p>Health coaching has been found to help diabetic sufferers to take more responsibility for their condition and change their behaviour. One <a href="https://www.ncbi.nlm.nih.gov/pubmed/26827684">review article</a> from 2016 found it to be an effective way of improving blood sugar levels, for example. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/227169/original/file-20180711-27036-pjbax7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/227169/original/file-20180711-27036-pjbax7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/227169/original/file-20180711-27036-pjbax7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=715&fit=crop&dpr=1 600w, https://images.theconversation.com/files/227169/original/file-20180711-27036-pjbax7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=715&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/227169/original/file-20180711-27036-pjbax7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=715&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/227169/original/file-20180711-27036-pjbax7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=899&fit=crop&dpr=1 754w, https://images.theconversation.com/files/227169/original/file-20180711-27036-pjbax7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=899&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/227169/original/file-20180711-27036-pjbax7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=899&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Diabetic benefits.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/midsection-diabetic-young-woman-injecting-stomach-363111923?src=UjdX8runirZuserww9aGLw-1-63">Andrey_Popov</a></span>
</figcaption>
</figure>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/28913928">more recent study</a> in which I was involved in Turkey and Denmark found that around 150 diabetic patients receiving health coaching for a year reduced their three-month blood glucose levels by 6%, while a similar-sized group who received health education saw little improvement. The International Diabetes Federation considers a 1% reduction in three-month blood glucose to be a significant improvement in diabetes management. </p>
<p>I <a href="http://www.ijpcm.org/index.php/IJPCM/article/view/511">have</a> also <a href="https://www.ncbi.nlm.nih.gov/pubmed/24914427">looked</a> at <a href="https://www.ncbi.nlm.nih.gov/pubmed/24362589">health coaching</a> beyond diabetes, including in my own original specialism, dentistry. My co-authored work has found that it can enhance people’s oral health, help them to take more exercise, eat better and improve their <a href="http://www.who.int/mental_health/media/en/76.pdf?ua=1">quality of life</a> – again we studied Turkey and Denmark, suggesting that health coaching may be benefical regardless of differences in healthcare systems. </p>
<p>In short, health coaching appears to have a bright future. One thing that doesn’t exist yet in the UK is professionally accredited health coaches – a step beyond the NHS training in England which requires at least 100 hours of training. </p>
<p>To that end, I’m trying to get a masters programme in health coaching off the ground at the University of Dundee, in association with the World Health Organization Collaborating Center. If we are going to create a new workforce of health coaches, we will need evidence-based academic training that meets international standards across the country.</p><img src="https://counter.theconversation.com/content/99721/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ayse Cinar receives a Global Challenges Research Fund Travel Grant. She is also an International Coaching Community Coach
and a Marshall Goldsmith Stakeholder Centered Coach.
</span></em></p>
Health coaching looks like more than a fad – it comes with impressive research findings and is winning over the NHS.
Ayse Cinar, Senior Researcher, Health Coaching, University of Dundee
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/92114
2018-02-22T08:42:17Z
2018-02-22T08:42:17Z
Thinking of taking a walk everyday? Six reasons why it’s good for you
<figure><img src="https://images.theconversation.com/files/207460/original/file-20180222-152348-7vxv1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>South Africa’s new president Cyril Ramaphosa has been the talk of social media with his early morning walking routine. In addition to personal walks along a Cape Town beachfront, Ramaphosa has also <a href="https://www.iol.co.za/news/politics/pics-ramaphosas-tummymustfall-walk-attracts-scores-13378660">led a walk</a> in the city from the townships of Gugulethu to Athlone to promote exercise as a key part of healthy living.</p>
<p>While many South Africans have been bemused by the fact that the busiest man in the country has time for a morning walk, studies show that walking is a good way to tackle burgeoning rates of obesity and other lifestyle diseases. These have reached epidemic proportions in developed countries and are dangerously on the rise in developing countries like South Africa which has the highest levels in Africa. With more than 8 million people diagnosed as obese, it’s joined the likes of global heavyweights such as Mexico and the US.</p>
<p>These diseases are linked to specific dietary and lifestyle changes which include patterns of increased eating, drinking and smoking along with reduced physical activity, and a shift to a diet high in sugar, salt and saturated fat.</p>
<p>There is no doubt that movement is essential for well being. The general guidelines are that 30 minutes or more of walking every day at a speed of between <a href="http://bjsm.bmj.com/content/bjsports/49/11/710.full.pdf">five and eight kilometres per hour</a> can improve health. </p>
<p>And studies show that even when people don’t quite manage to walk for the recommended 30 minutes a day the <a href="https://www.academia.edu/14725829/The_association_between_daily_steps_and_health_and_the_mediating_role_of_body_composition_a_pedometer-based_cross-sectional_study_in_an_employed_South_African_population">benefits</a> can still accrue. This proves that some walking is better than none at all. </p>
<p>For those who still need convincing, here are six reasons to take up a daily outdoor walk.</p>
<h2>It doesn’t cost a thing</h2>
<p>Walking outdoors is ideal when resources are limited, as a <a href="https://espace.library.uq.edu.au/view/UQ:323162">study</a> in low income communities in South Africa shows. The community the research focused on was a high risk area for chronic lifestyle diseases. </p>
<p>The study showed how physical activity that promoted participation of rural communities is feasible – and accessible. The activities in turn addressed the growing burden of chronic diseases.</p>
<p>Walking in groups also adds an important element of safety. And it helps with motivation, as another <a href="http://bjsm.bmj.com/content/bjsports/49/11/710.full.pdf">meta-analysis</a> which evaluated 42 studies found: when people walk in groups outdoors, they are less likely to give up too easily. </p>
<h2>It prevents (or delays) Type 2 diabetes</h2>
<p>The American Diabetes Association provides strong <a href="http://care.diabetesjournals.org/content/39/11/2065">evidence</a> of the benefits of walking for people who have pre-diabetes, Type 2 Diabetes, or even Type 1 Diabetes. </p>
<p>Type two diabetes is the most common and is linked to insulin resistance (or a lack of it). Type one diabetes occurs when the body does not naturally produce sufficient insulin, and generally presents in childhood. It is not necessarily related to lifestyle habits.</p>
<p>About 7%, or 3.85 million South Africans between the ages of 21 and 79, have diabetes. A large proportion remain undiagnosed.</p>
<h2>Decreases blood pressure</h2>
<p>High blood pressure is a direct risk for stroke and heart-related illnesses and threats. Walking demonstrably <a href="http://bjsm.bmj.com/content/bjsports/49/11/710.full.pdf">reduces</a> systolic and diastolic blood pressure. Systolic blood pressure is the “first number” obtained when blood pressure is measured, and represents the pressure in the arteries at the moment the heart is actively pumping blood into the system. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/207296/original/file-20180221-132660-4jcl4o.jpeg?ixlib=rb-1.1.0&rect=0%2C17%2C1128%2C940&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/207296/original/file-20180221-132660-4jcl4o.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/207296/original/file-20180221-132660-4jcl4o.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/207296/original/file-20180221-132660-4jcl4o.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/207296/original/file-20180221-132660-4jcl4o.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/207296/original/file-20180221-132660-4jcl4o.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/207296/original/file-20180221-132660-4jcl4o.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">South African president Cyril Ramaphosa takes a morning walk in Cape Town.</span>
<span class="attribution"><span class="source">Twitter</span></span>
</figcaption>
</figure>
<p>Diastolic, the “second number”, represents pressure in the arteries during the heart’s rest period. In other words, it stands to reason that this pressure should be considerably lower than systolic and if it isn’t, it represents certain risk for cardiovascular event.</p>
<p>The reduction can be statistically significant enough to save a life. For example, if a person’s diastolic blood pressure is 90 mm Hg they would be at considerable risk of blood pressure related events. Reducing the figure by 5 mm Hg shifts them from the “mild hypertension” category of risk to “high normal”. </p>
<p>Current <a href="http://www.heartfoundation.co.za/blood-pressure/">statistics</a> show that one in three South African adults have high blood pressure. <a href="http://www.heartfoundation.co.za/">Ten</a> South Africans suffer a stroke every hour. </p>
<h2>It decreases body fat</h2>
<p>Humans were designed to move for optimal functioning, and were designed to handle walking great distances over many hours.</p>
<p>Walking can contribute to improved body composition, with statistically significant <a href="http://bjsm.bmj.com/content/bjsports/49/11/710.full.pdf">reductions</a> in body fat. To put this into perspective, this doesn’t include any dietary changes, and evidence shows that exercise <a href="https://www.sciencedirect.com/science/article/pii/S2212267214010557">combined</a> with a change in diet produces greater changes to body composition than exercise alone.</p>
<h2>Reduces symptoms of depression</h2>
<p>Rates of depression have risen <a href="http://www.sadag.org/index.php?option=com_content&view=article&id=2782:20-increase-in-global-depression-in-a-decade&catid=61&Itemid=143">20%</a> globally in a decade. This places depression as one of the leading causes of disability worldwide. </p>
<p>Walking has been recommended for managing symptoms of depression for a long time. It’s been identified as an <a href="http://bjsm.bmj.com/content/bjsports/49/11/710.full.pdf">effective strategy</a>, particularly when combined with the positive effects of sunshine and fresh air, as well as the social cohesion experienced when in a group.</p>
<h2>No adverse side effects</h2>
<p>Probably the best news: when individuals around the world participated in various walking programmes based on the <a href="http://bjsm.bmj.com/content/bjsports/49/11/710.full.pdf">review of these studies</a>, no notable adverse side effects were reported.</p>
<p>Walking is safe for children, adults and older adults alike. The take home message here is that there is nothing to lose from trying it out, and plenty to gain.</p><img src="https://counter.theconversation.com/content/92114/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janet Viljoen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
There are many benefits to walking - whether you do it in a group or on your own.
Janet Viljoen, Course coordinator for postgraduate level Certificate in Ergonomics, Rhodes University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/73776
2017-04-18T15:19:52Z
2017-04-18T15:19:52Z
South Africa needs more than a sugar tax to get to the bottom of obesity
<figure><img src="https://images.theconversation.com/files/164297/original/image-20170406-16660-1apadzq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People are leading more sedentary lifestyles and eating calorie dense foods fuelling obesity.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>South Africa has been wrapped up in public and parliamentary debates on the value of South Africa’s proposed sugar tax. These highlight that the growing obesity epidemic has been fuelled by people consuming high levels of sugar. </p>
<p>Obesity shortens a person’s lifespan and affects their quality of life. It leads to lifestyle diseases that result in among others strokes, blindness, amputations and kidney failure.</p>
<p>Obesity has become a global epidemic with more than <a href="http://www.who.int/mediacentre/factsheets/fs311/en/">600 million adults</a> worldwide classified as obese. The US leads the pack with a 34% obesity prevalence, followed by Mexico (30%) and New Zealand (about 26%). </p>
<p>In Africa, the World Health Organisation reports that South Africa has the highest obesity levels with 26.8% of people classified as obese. Seychelles has a 26.3% obese population while Botswana follows closely with 22.4%.</p>
<p>In South Africa obesity related lifestyle diseases rival HIV/AIDS and TB in terms of their impact. Research shows that chronic diseases result in one death every hour. About 40% of women and 11% of men suffer from obesity in the country. And 25% of teenage girls in rural South Africa are overweight or obese.</p>
<p>But blaming sugar for obesity neglects the many factors that are at play in this complex health issue.</p>
<p>Global studies show there are several other factors responsible for someone developing obesity. These include <a href="http://www.obesity.ulaval.ca/obesity/generalities/genetic.php">genetic links</a>, <a href="http://obesity.ygoy.com/environment-causes-obesity/">lifestyle changes</a>, <a href="http://healthyeating.sfgate.com/caloriedense-vs-nutrientdense-food-5391.html">calorie-dense diets</a>, <a href="https://www.hsph.harvard.edu/nutritionsource/sleep/">sleep deprivation</a> and <a href="https://www.theatlantic.com/health/archive/2015/12/sexual-abuse-victims-obesity/420186/">psychological problems</a>. </p>
<p>South Africa would need to investigate these links as part of its plan to tackle skyrocketing obesity rates. </p>
<h2>Genetic factors</h2>
<p>Scientists have established a genetic basis for obesity but defining the genetic contribution is still a challenge. Bio-medical research has made some headway.</p>
<p>Global <a href="https://academic.oup.com/epirev/article/29/1/49/437222/Genetic-Epidemiology-of-Obesity">research</a> has shown that some populations have a <a href="http://www.nature.com/nrg/journal/v10/n7/full/nrg2594.html">genetic predisposition</a> to obesity. For example, studies show that in the US and Europe, some populations are genetically prone to <a href="https://ghr.nlm.nih.gov/condition/bardet-biedl-syndrome#statistics">Bardet-Biedl syndrome</a>.
People who have this condition have <a href="http://www.webmd.com/children/bardet-biedl-syndrome">disproportionately distributed</a> fat on their abdomens and chests rather than their arms and legs. </p>
<p>Similarly <a href="https://ghr.nlm.nih.gov/condition/prader-willi-syndrome">Prader-Willi syndrome</a> – a complex genetic condition where people develop an insatiable appetite, which leads to chronic overeating and obesity – affects an estimated 1 in 10,000 to 30,000 people worldwide.</p>
<p>But studies into specific conditions in Africa are rare. And more generally, there have been limited genome-wide association studies on African populations. </p>
<h2>Technology and lifestyle changes</h2>
<p>As the world moves toward an information based economy, adults and children have increased the amount of time they spend on mobile phones, watching TV and on computers or tablets – taking sedentary lifestyles to a new level.</p>
<p>For children this shift means they have little time for unstructured play or physical activity – and it directly links to an increase in chronic, non-communicable diseases.</p>
<p>According to a <a href="http://www.milkeninstitute.org/publications/view/531">study</a> by the Milken Institute in the US, every 10% investment in information and communication technology results in a one percent increase in obesity. </p>
<p>In the US, for example, according to research, children spend between <a href="http://www.sciencedirect.com/science/article/pii/S1555415516305050">five and 10 and a half hours daily</a> sedentary watching TV, playing video games and engaging with their iPods, tablets, smartphones and social media. As a result, 17% of the paediatric population in the US are obese. </p>
<h2>Calorie-dense diets</h2>
<p>In addition to technology, <a href="http://ajcn.nutrition.org/content/82/1/265S.full">people’s daily diets</a> have seen massive changes in the past few decades. Energy dense foods have more calories than nutrients. A high intake of empty calorie foods may cause people to gain weight, especially if they take in more calories than they burn. </p>
<p>Many working parents have to make long commutes to work and rely on convenience foods packed with salt, sugar and fat instead of home cooked meals made from fresh ingredients. Many of these products also contain high levels of gluten.</p>
<p>A growing body of research links gluten – a protein found in grains such as wheat – with potentially harmful effects on gut health, inflammation, fat regulation, metabolism and fat storage. </p>
<p>In a <a href="http://www.naturalnews.com/038699_gluten_weight_gain_wheat_belly.html">Brazilian study</a> researchers link gluten to obesity. Researchers <a href="http://www.huffingtonpost.com/dr-mark-hyman/wheat-gluten_b_1274872.html">argue</a> the modern way wheat products are processed means they contain amylopectin and gluten additives that are fattening, inflammatory and addictive. These drive obesity, diabetes, heart disease, cancer and dementia.</p>
<h2>Sleep deprivation</h2>
<p>The prevalence of obesity in the last several decades has been paralleled by a trend of reduced sleep in adults and children. </p>
<p>Worldwide, <a href="http://blogs.webmd.com/sleep-disorders/2010/10/sleep-deprivation-around-the-world.html">85%</a> of people suffer from insomnia. Too little sleep disrupts the normal functioning of our bodies. This includes the hormones that regulate hunger and satiety -– which can result in overeating.</p>
<p>Chronic, even partial sleep loss, <a href="https://www.purelyb.com/be-mindful/get-informed?view=entry&id=297">affects hormones</a> including those which regulate hunger and satiety-related hormones such as ghrelin and leptin. </p>
<p>There’s a close link between how much people sleep and how much they weigh. A group of researchers <a href="http://onlinelibrary.wiley.com/doi/10.1038/oby.2007.118/full">studied</a> about 60,000 women for 16 years, asking them about their weight, sleep habits, diet, and other aspects of their lifestyle. </p>
<p>At the start of the study, none of the women were obese. After 16 years, those who slept five hours or less each night had a 15% higher risk of becoming obese compared to women who slept seven hours each night. </p>
<p><a href="https://www.hsph.harvard.edu/obesity-prevention-source/obesity-causes/sleep-and-obesity/">Studies</a> spanning five continents have looked at the link between sleep duration and obesity in children. Most of these studies have found a <a href="http://pediatrics.aappublications.org/content/pediatrics/133/6/1013.full.pdf">convincing association</a> between too little sleep and increased weight.</p>
<h2>The psychology around obesity</h2>
<p>A <a href="https://www.sciencedaily.com/releases/2014/09/140902092947.htm">meta-analysis</a> carried out on previous childhood sexual trauma studies, which included a total of 112,000 participants has shown that being subjected to abuse during childhood entails a markedly increased risk of developing obesity as an adult.</p>
<p>Such <a href="http://onlinelibrary.wiley.com/doi/10.1111/obr.12216/full">studies</a> have shown that victims of childhood sexual abuse are far more likely to become obese adults.</p>
<p>And <a href="http://www.iowaaces360.org/ace-study.html">new research</a> shows that early trauma is so damaging that it can disrupt a person’s entire psychology and metabolism. This also links to stigma. For example, local researchers found that the stigma attached to HIV/AIDS and weight loss or “thinness” could be fuelling the obesity epidemic among some women. <a href="https://www.hindawi.com/journals/jtm/2009/145891/">Studies in Sub-Saharan Africa</a> have shown that being thin is associated with being HIV positive. </p>
<p>What this adds up to is that if the South African government goes ahead with its plans to implement the sugar tax, it also has a responsibility to fund research into obesity patterns in the country as well as educate consumers and create supportive community environments to assist people to make healthier lifestyle choices.</p><img src="https://counter.theconversation.com/content/73776/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nellie Myburgh receives funding from the Bill and Melinda Gates Foundation. </span></em></p>
South Africa has the highest obesity levels in Africa but blaming sugar neglects the many factors at play in this complex health issue.
Nellie Myburgh, Senior researcher at the Wits Health Consortium, University of the Witwatersrand
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/74568
2017-03-28T15:08:23Z
2017-03-28T15:08:23Z
Why palpitations or an irregular heartbeat need urgent attention
<figure><img src="https://images.theconversation.com/files/160917/original/image-20170315-5344-1h2l4eg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A normal heart rate is between 60 and 100 beats per minute.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>When your heart’s rhythm is faster than the recommended 60 to 100 <a href="http://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/heart-rate/faq-20057979">beats</a> per minute, it’s time to listen to it. The Conversation Africa’s Health and Medicine Editor Joy Wanja Muraya spoke to Dr Harun Argwings Otieno on why your heart is sending those chaotic electric signals and how this can be managed.</em></p>
<p><strong>What causes an irregular and often rapid heart rate? Why is it so dangerous?</strong></p>
<p>When your heart has an irregular or abnormally slow or fast rhythm, it fails to pump blood around your body as efficiently as it should. </p>
<p>This condition known as <a href="http://www.nhs.uk/conditions/atrial-fibrillation/Pages/Introduction.aspx">atrial fibrillation</a> is characterised by a rapid, irregular pulse and has a significant association with an underlying heart disease.</p>
<p>Though the exact cause isn’t clearly understood there’s evidence that the abnormal electrical signals arising from the left atrium lead to the chaotic, disorganised beats that are characteristic of<a href="https://www.bhf.org.uk/heart-health/conditions/atrial-fibrillation"> atrial fibrillation</a>. There’s a strong association with high blood pressure, ageing, diabetes mellitus, valvular heart disease and coronary artery disease. </p>
<p>In <a href="http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Coronary-Artery-Disease---Coronary-Heart-Disease_UCM_436416_Article.jsp#.WMjv_W-GPIU">coronary heart disease</a>, your arteries are narrowed or blocked by a build-up of cholesterol. Lack of treatment can lead to heart attacks.</p>
<p>In <a href="http://www.hopkinsmedicine.org/heart_vascular_institute/conditions_treatments/conditions/valvular_heart_disease.html">valvular heart disease</a>, a defect or damage to one of the four heart valves allows blood to leak abnormally. </p>
<p>The valves may either be too narrow to open fully, or they are unable to close completely thus blood flow in and out of the heart is uncoordinated. Valvular heart disease may require surgical treatment to correct the defect. </p>
<p>Atrial fibrillation frequently develops in patients with severe rheumatic heart valve disease involving the mitral valve. </p>
<p><a href="http://www.world-heart-federation.org/press/fact-sheets/rheumatic-heart-disease/">Rheumatic heart disease</a> which is caused by an untreated streptococcal throat infection is another culprit that affects the heart this way.</p>
<p>Some lifestyle <a href="http://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/dxc-20164936">conditions</a> like excessive alcohol intake and abnormalities of the thyroid function can also lead to atrial fibrillation. </p>
<p><strong>How does the heart work and how does this disease affect its functionality?</strong></p>
<p>The <a href="http://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/heart-rate/faq-20057979">normal</a> heart rate lies between 60 and 100 beats per minute.</p>
<p>This function originates from the top side of the heart known as the atrial pacemaker that sends signals to the bottom of the heart, ventricles, in a coordinated fashion, known as <a href="https://www.uptodate.com/contents/normal-sinus-rhythm-and-sinus-arrhythmia">normal sinus rhythm</a>.</p>
<p>When the heart is affected, some of the <a href="https://www.heartfoundation.org.au/your-heart/heart-conditions/atrial-fibrillation-arrhythmia">prominent symptoms </a>of the disease includes an irregular heartbeat, easy fatigability, fainting or dizziness.</p>
<p>The real danger with atrial fibrillation is that it may lead to a stroke.</p>
<p><strong>What’s the situation of atrial fibrillation in Kenya?</strong></p>
<p>Kenyan data on this heart condition is scarce. But between 2008 and 2010, we conducted a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734872/">study</a> at the Aga Khan University Hospital Nairobi.</p>
<p>We recruited 162 patients with confirmed atrial fibrillation from 22,144 general hospital medical admissions over a three year period. The average age of patients was 67 years. We analysed them for risk factors and treatment. </p>
<p>Close to 70% of them had high blood pressure, 38% had heart failure, 33% had diabetes mellitus and 19% coronary artery disease. A third of the patients experienced palpitations, dizziness or fainting but 15% had a serious complication of a stroke or an abnormal blood clot.</p>
<p>About 6% died within six months and about 12% were readmitted to hospital.</p>
<p><strong>What needs to be done in the long term to prevent it?</strong></p>
<p>The best management measures are prevention and maintaining a <a href="http://www.mayoclinic.org/healthy-lifestyle">healthy lifestyle</a> which includes balanced meals, regular exercise, proper stress management and quitting smoking and alcohol. </p>
<p>Controlling blood pressure, cholesterol and preventing diabetes are other tips to keep fit.</p>
<p>When the heart condition occurs, seeking a medical consultation to establish the underlying cause is paramount. It’s important to get an ECG (electrocardiograph) to diagnose atrial fibrillation. When ever you experience palpitations, make sure you have your heart checked.</p>
<p>A medical consultation with a cardiologist will advise on how to control the heart rate to prevent worsening of symptoms.</p>
<p>Prescription of strong <a href="https://medlineplus.gov/bloodthinners.html">blood thinners</a> to prevent a stroke is another option to prevent this devastating complication. </p>
<p>In some cases, when detected early, cardiologists can use a <a href="http://www.webmd.com/heart-disease/electrical-cardioversion-defibrillation-for-a-fast-heart-rate">controlled electrical shock</a> to the heart to restore the normal heart rhythm. Medication is also used sometimes for this purpose. </p>
<p><strong>How does new research promise to solve atrial fibrillation?</strong></p>
<p>New medications called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4742513/">direct or novel oral anticoagulants</a> are used to prevent stroke. </p>
<p>They work better than the older medication because one doesn’t need to have regular blood tests to check for the effectiveness of the blood thinner. </p>
<p><a href="http://www.webmd.com/heart-disease/electrical-cardioversion-defibrillation-for-a-fast-heart-rate">Warfarin</a>, a prescription medication used to prevent harmful blood clots from forming or growing, is commonly used.</p>
<p>But its use must be monitored frequently as the medication warns to stay away from certain foods or medications which could interfere with the effectiveness of the blood thinners.</p>
<p>New approaches to treatment include <a href="http://www.webmd.com/heart-disease/atrial-fibrillation/radiofrequency-catheter-ablation-for-atrial-fibrillation">atrial fibrillation ablation</a>, where an electrical current or cold therapy is delivered directly to the heart through specialised plastic tubes or catheters and restores the normal heart rhythm. </p>
<p>This technology is only just maturing and is performed by highly trained heart specialist doctors called <a href="http://www.everydayhealth.com/heart-health/do-you-need-an-electrophysiologist.aspx">electrophysiologists</a>. These doctors manage the heart’s electrical system or heart rhythm disorders. </p>
<p><a href="http://circ.ahajournals.org/content/116/7/782">Genetic studies</a> may reveal underlying factors associated with this condition. </p>
<p>In all, the most important factor in atrial fibrillation is stroke prevention, through careful risk assessment, safe and effective use of blood thinners , controlling the heart rate and restoration of normal rhythm when possible.</p><img src="https://counter.theconversation.com/content/74568/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harun Argwings Otieno does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Atrial fibrillation is a condition that causes a
rapid and irregular heartbeat. The normal heart rate lies between 60 and 100 beats per minute.
Harun Argwings Otieno, Senior Lecturer of cardiology, Interventional Cardiologist, Aga Khan University Hospital
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/73000
2017-02-23T21:07:32Z
2017-02-23T21:07:32Z
Physical inactivity is hurting the health of people in countries like Kenya. There’s a solution
<figure><img src="https://images.theconversation.com/files/157302/original/image-20170217-10200-nxg2se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Exercise and a healthy diet provide an overall sense of well being.</span> <span class="attribution"><span class="source">Reuters.</span></span></figcaption></figure><p>Getting physically active is important no matter where you live: <a href="http://www.who.int/mediacentre/factsheets/fs311/en/">obesity</a> and physical inactivity are <a href="http://www.who.int/dietphysicalactivity/pa/en/">serious public health</a> problems – in both developed and developing countries. </p>
<p>In sub-Saharan Africa the crisis of inactivity can be linked to the industrial and electronic revolutions taking place in the region. There’s been a marked shift from high activity lifestyles to a more sedentary pace. Known as <a href="http://journals.humankinetics.com/doi/abs/10.1123/jpah.9.4.554">physical activity transition</a>, the process has already been seen in developed countries. The transition is always marked by a shift in people’s behaviour. They migrate from high energy expenditure workplace environments such as <a href="https://www.britishmuseum.org/research/publications/online_research_catalogues/paper_money/paper_money_of_england__wales/the_industrial_revolution.aspx">mining, forestry and farming</a> to more relaxed occupations and lifestyles.</p>
<p>Now sub-Saharan Africa is experiencing similar changes and challenges. The result is that countries like Kenya are now fertile environments for <a href="http://www.who.int/mediacentre/factsheets/fs355/en/">non-communicable diseases</a> like diabetes and cancer. </p>
<p>Given this, it’s become more important than ever to understand the twin relationship between the change in the foods we eat and how often we exercise.</p>
<h2>Benefits of physical activity</h2>
<p>Some of the benefits of being physically active include: </p>
<ul>
<li><p>Increased efficiency of heart and lungs;</p></li>
<li><p>Reduced cholesterol levels;</p></li>
<li><p>Increased muscle strength;</p></li>
<li><p>Reduced blood pressure; and</p></li>
<li><p>Reduced risk of major illnesses such as diabetes and heart disease.</p></li>
</ul>
<p>Regular physical activity gives you more energy to perform daily chores. It helps you to deal with stress better and improves the quality of your sleep.</p>
<p>You are also guaranteed a <a href="http://www.smh.com.au/lifestyle/diet-and-fitness/chew-on-this/does-exercise-rev-up-your-appetite-20100927-15tm3.html">better appetite</a>, better skin and muscles that are better toned. Importantly, regular physical activity can help with the management of already existing medical conditions. </p>
<p>Regular exercise regimes also mean that adults have a lower likelihood of dying from coronary heart diseases, high blood pressure and stroke. They are also more protected from developing type 2 diabetes, metabolic syndrome colon, breast cancer and depression. </p>
<h2>Environments that invite unhealthy behaviour</h2>
<p>Sadly the physical activity transition happening globally is catching up with many <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0092846">developing countries</a> including <a href="https://www.ncbi.nlm.nih.gov/pubmed/21946838">Kenya</a>. This is true even among children.</p>
<p>It hasn’t always been like this. Engaging in daily active play and physical activity is a cornerstone of the lives of people in Kenya, and elsewhere on the continent, since time immemorial.</p>
<p>A healthy and active way of life can be traced back to most African communities that religiously led a <a href="http://news.softpedia.com/news/Paleolithic-The-Old-Stone-Age-81543.shtml">Palaeolithic lifestyle </a> that encouraged a <a href="http://history-world.org/paleolithic2.htm">hunter and gatherer</a> way of life.</p>
<p>The nomadic way of life consisted of <a href="http://robbwolf.com/what-is-the-paleo-diet/">feeding</a> on roots, tubers, nuts, fruits, vegetables, white meat and engaging in physically demanding activities like farming or walking long distances during herding. </p>
<p>But rapid urbanisation has changed all that. The rising concern about obesity in <a href="http://link.springer.com/referenceworkentry/10.1007/978-3-319-11251-0_5">sub-Saharan Africa </a> is directly related to rapid urbanisation and a reduction in physical activity. More and more people are are living in <a href="http://www.bbc.com/news/blogs-magazine-monitor-27601593">obesogenic environments</a>. These promote gaining weight but are not conducive for weight loss. This can be at home or in the work place.</p>
<p>In addition, in countries like Kenya the fight against the negative health effects of physical inactivity is being slowed down by the <a href="https://books.google.co.ke/books?id=1W2M1lnHeccC&pg=PA43&lpg=PA43&dq=obesity+in+african+society+and+symbol+of+prestige&source=bl&ots=wDOBa71d0I&sig=LwCuwMvdQvF1aSwVuouBX4sKovo&hl=en&sa=X&redir_esc=y#v=onepage&q=obesity%20in%20african%20society%20and%20symbol%20of%20prestige&f=false">strong social cultural beliefs</a>. In many developing countries roundness (or fatness) is often a symbol of wealth, good life and therefore deserves prestige. </p>
<p>The situation is being exacerbated by increasing use of technologies like <a href="http://www.ca.go.ke/index.php/what-we-do/94-news/366-kenya-s-mobile-penetration-hits-88-per-cent">mobile phones</a>, computers, the <a href="http://www.cnbcafrica.com/news/east-africa/2014/09/09/kenya-leads-internet/">internet</a> and satellite television. All have reduced the need and desire for children, youth and even adults to engage in physical activity.</p>
<p>At the same time as people are doing less exercise, they’re eating more energy dense food. This is exposing them to major risk factors associated with lifestyle triggered diseases like heart attacks and strokes, cancers, chronic respiratory diseases and diabetes. </p>
<p>These diseases already disproportionately affect low and middle income countries which account for nearly three quarters of non-communicable disease deaths – <a href="http://www.who.int/mediacentre/factsheets/fs355/en/">about 28 million</a> – in the world.</p>
<h2>The way forward</h2>
<p>There has been an urgent global call to address the serious public health challenges posed by poor eating habits and lack of exercise. One of the interventions is the United Nations <a href="http://www.un.org/sustainabledevelopment/sustainable-development-goals/">Sustainable Development Goals.</a>. Kenya has set its own targets under its <a href="http://www.vision2030.go.ke/about-vision-2030/">Kenya Vision 2030</a>.</p>
<p>But to reverse the current trends people need to get active. The recommended physical activity for health and wellness is 60 minutes of moderate to vigorous physical activity daily for those between the age of five and 17 years and for adults at least 30 minutes.</p>
<p>The onslaught of non-communicable diseases can only be reversed if we all observe healthy and active lifestyles.</p><img src="https://counter.theconversation.com/content/73000/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vincent O. Onywera has previously received funding from IDRC </span></em></p>
Regular physical activity energises you to perform daily chores, deal with stress better and improves your quality of sleep.
Vincent O. Onywera, Professor of Exercise and Sports Science, Kenyatta University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/71763
2017-01-30T15:18:03Z
2017-01-30T15:18:03Z
How Africa can win the fight against childhood cancer
<figure><img src="https://images.theconversation.com/files/154521/original/image-20170127-30419-13g2n8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Better technologies should be adopted in sub-Saharan Africa to deal with childhood cancer.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>World Cancer Day is celebrated globally on February 4 under the tag line “We Can. I Can”. Increased awareness and education about childhood cancers means that more lives are saved. The Conversation Africa’s Health and Medicine Editor Joy Wanja Muraya spoke to Jessie Githanga on the challenges of diagnosing and treating childhood cancer in Kenya.</em></p>
<p><strong>What are the top cancers in Kenya, regionally and in Africa? What are the most likely causes?</strong></p>
<p>In Kenya, accurate data about the most common forms of cancer is unavailable because the country doesn’t have an updated population based <a href="http://afcrn.org/membership/members/101-eldoret">cancer registry</a>. It therefore has to rely on regional registries that are largely <a href="http://afcrn.org/membership/membership-list/85-nairobi-kenya">hospital based</a>. Though not comprehensive, it’s nevertheless still useful as most patients with cancer will eventually go to a hospital where data will be collected. </p>
<p>The top <a href="http://www.ajhsjournal.or.ke/?p=1120">childhood cancers</a> are lymphoma (a form of cancer affecting the immune system), cancers of the blood (leukaemia), brain, eye, kidney and muscle cells.</p>
<p>Regional differences in the top cancers is seen in <a href="https://www.ncbi.nlm.nih.gov/pubmed/25724211">countries</a> like Mozambique, Uganda, Zambia and Malawi where childhood HIV/AIDS is more common. This leads to AIDS related cancers like Kaposi’s sarcoma (a cancer of the blood vessels) and certain types of lymphoma.</p>
<p>In countries with high rates of malaria infection, Burkitt’s lymphoma is the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207091/">most common childhood cancer</a>. It’s less common in the developed world where signs and symptoms differ.</p>
<p><strong>Are childhood cancers different from adult cancers?</strong></p>
<p>Adult cancers are strongly associated with lifestyle related <a href="https://www.cancer.org/cancer/cancer-in-children/risk-factors-and-causes.html">risk factors</a> like unhealthy eating, being overweight and obesity, lack of exercise as well as increased tobacco and alcohol use.</p>
<p><strong>Are children in Africa receiving appropriate treatment? What are the challenges on the continent?</strong></p>
<p>In developed countries a child diagnosed with cancer has an 80% <a href="http://www.gov.za/childhood-cancer-awareness-month-2015">chance</a> or more of surviving whereas the <a href="https://www.researchgate.net/publication/223957025_Challenge_of_pediatric_oncology_in_Africa">survival rate</a> of children in Africa is less than 20%. </p>
<p>The causes are many and interrelated. One is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849966/">late diagnosis</a> due to lack of awareness of cancer in children among guardians, health care workers and the general population coupled with poor access to treatment facilities.</p>
<p>There’s also inadequate diagnostic capability and a disturbing paucity of <a href="https://www.ncbi.nlm.nih.gov/pubmed/22475119">treatment facilities</a> especially those designed for childhood cancer in most sub Saharan African countries. </p>
<p>The prohibitive cost of chemotherapy drugs, few <a href="https://qz.com/692584/cancer-is-on-the-rise-in-africa-just-as-some-of-the-few-radiotherapy-centers-fall-apart/">radiotherapy facilities</a> as well as a lack of bone marrow transplantation technology, compounds the problem making treatment expensive. </p>
<p>The problem of insufficient health care workers trained in paediatric cancer, especially oncologists, pathologists, surgeons, nurses, pharmacists and palliative care experts needs urgent attention. </p>
<p><a href="https://www.karger.com/Article/Pdf/315586">Treatment protocols</a> are rarely standardised, evidence based or adapted for each developing country’s capacity. There’s little research into local childhood cancers and especially <a href="https://www.ncbi.nlm.nih.gov/pubmed/22844968">clinical trials </a>. This is a sorry state of affairs given that the best treatments in cancer are often in the context of a clinical trial. </p>
<p>Current evidence shows that even where the types of cancer may be similar to those in developed countries there are <a href="https://www.ncbi.nlm.nih.gov/pubmed/26274016">biological differences</a> that have a significant impact on the treatment choices and outcomes. </p>
<p>It’s therefore imperative that further research including clinical trials to identify suitable treatments are done to improve treatment outcomes.</p>
<p><strong>What is Kenya doing about the gaps?</strong></p>
<p>Kenya has now woken up to the fact that cancer is a serious problem. Even though most attention has been given to the common adult cancers, such as those of the male and female reproductive tracts (breast, cervical and prostatic cancers), more attention is now being paid to childhood cancers through efforts of the government, Non-Governmental Organisations, professional bodies and civil society. </p>
<p>Some of these initiatives include the collaborative efforts by the <a href="http://www.health.go.ke/">Ministry of Health</a> and the <a href="https://www.cancer.gov/">National Cancer Institute</a> in the US, Kenya Network of <a href="https://kenyacancernetwork.wordpress.com/kenya-cancer-facts">Cancer Organisations</a> , Kenya Hospices and <a href="http://kehpca.org">Palliative Care</a> Association, <a href="http://kesho-kenya.org/">Kenya Society for Haematology and Oncology</a> and various independent donors and well-wishers. </p>
<p>Groups specifically targeting children have been set up, like the <a href="http://wechope.org/kenya/contact-kecct/">Kenya Childhood Cancer Trust </a> and <a href="http://hope4cancerkids.org/">Hope for Cancer Kids</a>. Health care financing for all aspects of treatment of childhood cancers are now being considered by the <a href="http://www.nhif.or.ke/healthinsurance/">National Health Insurance Fund</a>. </p>
<p>Studies in public hospitals have shown that children with cancer who have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710438/">health insurance funding</a> have better chances of survival than those who don’t. While there’s still much to be done, these efforts will yield fruit with time. More coordination of the various stakeholders needs to be made to avoid duplication of efforts.</p>
<p><strong>What is the way forward for Africa in dealing with cancer?</strong></p>
<p>Advocacy and creating public awareness are key points if Africa is to move towards <a href="https://www.ncbi.nlm.nih.gov/pubmed/23434340">tackling childhood cancers</a>. </p>
<p>Holding international and national cancer awareness days should be coupled with continuous awareness efforts. </p>
<p><a href="http://www.cancercontrol.info/cc2016/world-child-cancer-supporting-partnership-models-in-paediatric-oncology/">Twinning programmes</a> linking centres in resource-rich countries with those in resource-limited ones have worked well in <a href="http://www.cancercontrol.info/cc2013/challinor/">Ethiopia</a> and <a href="https://www.worldchildcancer.org/blog/twinning-visit-ghana-%E2%80%93-may-2015">Ghana</a> to improve capacity and patient survival.</p>
<p><a href="http://www.nature.com/nrclinonc/journal/v10/n10/abs/nrclinonc.2013.137.html">Clinical trials</a> that can improve survival as well as enhance capacity need to be performed.</p>
<p>The International Society for Paediatric Oncology offers <a href="http://www.cancerpointe.com/">training information</a>. Training can be more cheaply offered in other African countries with established training programmes including <a href="http://www.choc.org.za/childhood-cancer/awareness-and-detection.html">South Africa</a>, <a href="http://egyptcancernetwork.org/achievements-5/fellowship-program/">Egypt</a> and <a href="http://aslanproject.org/what-we-do/our-programs/12-programs/28-pediatric-cancer-program-at-jimma-university.html">Ethiopia</a>. <a href="http://www.cancercontrol.info/cc2015/a-partnership-model-for-the-training-and-professional-development-of-health-care-staff-in-low-resource-settings/">Twinning</a> could also help <a href="https://www.worldchildcancer.org/blog/twinning-visit-ghana-%E2%80%93-may-2015">less well established programmes</a> in other African countries.</p><img src="https://counter.theconversation.com/content/71763/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessie N. Githanga does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Better technology to diagnose, treat and manage the disease early enough is needed to improve the survival rates of childhood cancer in sub Saharan Africa.
Jessie N. Githanga, Prof, Haematology and blood transfusion, University of Nairobi
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/70153
2016-12-14T07:35:58Z
2016-12-14T07:35:58Z
What’s driving the worldwide obesity epidemic?
<figure><img src="https://images.theconversation.com/files/149464/original/image-20161209-31352-1iz19n7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/christopherdombres/7350782488/">Christopher Dombres/Flickr</a></span></figcaption></figure><p>The rise of obesity <a href="http://nyti.ms/2dTr00Z">around the globe</a> has led the World Health Organization (WHO) to <a href="http://www.nytimes.com/2016/10/12/health/sugar-drink-tax-world-health-organization.html?_r=0">urge countries</a> to impose a tax on sugary drinks, which are blamed for the spread of <a href="http://www.who.int/nutrition/topics/obesity/en/">the epidemic</a>. </p>
<p>Countries with such different food cultures as, say, <a href="http://www.worldatlas.com/articles/29-most-obese-countries-in-the-world.html">Mexico and Palau</a> are facing the same nutritional risks and following the same obesity trends. Our research aims to understand why, and we have examined the link between various facets of globalisation (trade, for instance, or the spread of technologies, and cultural exchanges) and the worldwide changes in health and dietary patterns. </p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/24880830">recent global study</a> reports that worldwide, the proportion of adults who are overweight or obese increased from 29% in 1980 to 37% in 2013. Developed countries still have more overweight people than developing nations, but the gap is shrinking. In Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa, obesity levels among women exceed 50% in 2013. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/149451/original/image-20161209-31375-bv86qe.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149451/original/image-20161209-31375-bv86qe.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=944&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149451/original/image-20161209-31375-bv86qe.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=944&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149451/original/image-20161209-31375-bv86qe.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=944&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149451/original/image-20161209-31375-bv86qe.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1186&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149451/original/image-20161209-31375-bv86qe.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1186&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149451/original/image-20161209-31375-bv86qe.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1186&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The number of people who are overweight is on the rise.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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<p>The <a href="http://www.who.int/mediacentre/factsheets/fs311/en/">WHO</a> identifies unhealthy nutrition patterns, along with increasing physical inactivity, as the main drivers of rising body weight around the world. Diets rich in sugar, animal products and fats constitute important risk factors for non-communicable diseases, such as cardiovascular diseases, diabetes, and different types of cancer. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/149466/original/image-20161209-31367-3kiawu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/149466/original/image-20161209-31367-3kiawu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149466/original/image-20161209-31367-3kiawu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149466/original/image-20161209-31367-3kiawu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149466/original/image-20161209-31367-3kiawu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149466/original/image-20161209-31367-3kiawu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149466/original/image-20161209-31367-3kiawu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Sugar consumption is still on the rise.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/destinysagent/1780291760/in/album-72157602743141416/">Steve Smith/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>In 2012, cardiovascular diseases killed 17.5 million people, making them the number one cause of death globally. Because more than three quarters of those deaths took place <a href="http://www.who.int/mediacentre/factsheets/fs317/en/">in low- and middle-income countries</a>, causing substantial economic costs for their public welfare systems, the WHO classifies food-related chronic diseases <a href="http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en">as a growing worldwide threat</a>, on par with traditional public health concerns such as under-nutrition and infectious diseases.</p>
<p>The Western world was the first to experience substantial weight gains of their populations, but the 21st century has seen that phenomenon spread to all parts of the globe. In a <a href="http://www.jstor.org/stable/2938388">widely cited 1993 article</a>, University of North Carolina’s Professor Barry Popkin attributes this shift to the “nutrition transition” by which diets became less dominated by starchy staples, fruits, and vegetables and richer in fats (especially from animal products), sugar and processed foods. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/149461/original/image-20161209-31370-1odupgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149461/original/image-20161209-31370-1odupgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149461/original/image-20161209-31370-1odupgp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149461/original/image-20161209-31370-1odupgp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149461/original/image-20161209-31370-1odupgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149461/original/image-20161209-31370-1odupgp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149461/original/image-20161209-31370-1odupgp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A group of women in Durban, South Africa, in 2003.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/73416633@N00/297845913/">Sandra Cohen-Rose/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>The different stages of this transition, Popkin says, are related to social and economic factors, such as industrialisation level, the role of women in the labour force and the availability of food-transforming technologies.</p>
<h2>The meat factor</h2>
<p>The rise of the percentage of the population that’s overweight, and changes in diet patterns broadly coincide with the globalisation process. Undoubtedly, globalisation has affected people’s lives in various ways, but has it caused a nutrition transition? </p>
<p>In order to answer this question, <a href="https://halshs.archives-ouvertes.fr/halshs-01400829">we have analysed</a> the impact of globalisation on changing dietary patterns and overweight prevalence using data from 70 high- and middle-income countries from 1970 through 2011.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/149453/original/image-20161209-31402-qn7ut2.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/149453/original/image-20161209-31402-qn7ut2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149453/original/image-20161209-31402-qn7ut2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=239&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149453/original/image-20161209-31402-qn7ut2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=239&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149453/original/image-20161209-31402-qn7ut2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=239&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149453/original/image-20161209-31402-qn7ut2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=300&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149453/original/image-20161209-31402-qn7ut2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=300&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149453/original/image-20161209-31402-qn7ut2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=300&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Has the take-up of globalisation had an impact on obesity?</span>
<span class="attribution"><span class="source">Lisa Oberländer Anne-Célia Disdier, Fabrice Etilé</span>, <span class="license">Author provided</span></span>
</figcaption>
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<p>We found that globalisation has led people to consume more meat products. Interestingly, the social dimensions of globalisation (such as the spread of ideas, information, images and people) are responsible for this effect, rather trade or other economic aspects of globalisation.</p>
<p>For instance, if Turkey caught up to the level of social globalisation prevalent in France, meat consumption in Turkey would increase by about 20%. So our analysis takes into account the effect of rising incomes; otherwise, it could be confounded by the connection between higher incomes making both communication technology and meat products more affordable. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/149468/original/image-20161209-31367-1ycza17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149468/original/image-20161209-31367-1ycza17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149468/original/image-20161209-31367-1ycza17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149468/original/image-20161209-31367-1ycza17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149468/original/image-20161209-31367-1ycza17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149468/original/image-20161209-31367-1ycza17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149468/original/image-20161209-31367-1ycza17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">An increase in meat consumption and animal fats could lead to people becoming overweight.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Psychology_of_eating_meat#/media/File:Man_grocery_shopping.jpg">Bill Branson</a></span>
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<p>But while the study shows that globalisation affects diets, we could not establish a relationship between globalisation and increasing body weight. One explanation for this result could be that we investigated the question from a bird’s-eye perspective, not taking into account specific circumstances of countries. </p>
<p>So while, on average across the world, globalisation does not seem to be the driver of rising obesity, it may nonetheless play a role in specific countries.</p>
<h2>The processed-food impact</h2>
<p>An alternative interpretation of this unclear result is that other factors are responsible for the rising prevalence of overweight people around the world. For example, increasing consumption of processed foods <a href="http://onlinelibrary.wiley.com/doi/10.1111/obr.12107/abstrac">is often associated </a> with rising weight levels. </p>
<p><a href="http://ajcn.nutrition.org/content/early/2015/05/06/ajcn.114.100925.full.pdf+html">A study</a> in the United States showed that Americans derive three quarters of their energy from processed foods, which contain higher levels of saturated fats, sugar, and sodium than fresh foods. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/149470/original/image-20161209-31370-qnc8ky.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149470/original/image-20161209-31370-qnc8ky.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149470/original/image-20161209-31370-qnc8ky.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149470/original/image-20161209-31370-qnc8ky.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149470/original/image-20161209-31370-qnc8ky.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149470/original/image-20161209-31370-qnc8ky.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149470/original/image-20161209-31370-qnc8ky.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Haldirams, one of Indians’ favourite snack chain outlet, offers a wide variety of local processed-food.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/shankaronline/7169259567">Shankar S/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>The increasing availability of processed foods is related to the rapid expansion of the retail industry. Modern logistics technology help retailers centralise procurement and inventory, <a href="http://www.jstor.org/stable/1244885">which drives down costs</a> and allows very competitive pricing. </p>
<p>After saturating Western markets, supermarkets began to spread to developing countries, which had greater growth prospects. Latin America, central Europe and South Africa saw their grocery store boom in the 1990s. Retailers later opened in Asia and are now entering markets in African countries. </p>
<p>An interesting, yet little explored, aspect in the discussion of processed foods is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383750/">the role of multinational companies</a> in offering unhealthy “Western diet”, such as fast food and soft drinks. Multinationals are one of the two market leaders in many emerging countries, including Brazil, India, Mexico, and Russia and they are known for substantial food and beverage advertising. </p>
<p>But it remains unclear whether people gain weight because they adopt a Western diet, or whether they largely preserve their taste for regional cuisines but change the nutritional composition of traditional recipes by adding more meat products, fats, and sugar.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/149873/original/image-20161213-1592-1vxo9ft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149873/original/image-20161213-1592-1vxo9ft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149873/original/image-20161213-1592-1vxo9ft.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149873/original/image-20161213-1592-1vxo9ft.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149873/original/image-20161213-1592-1vxo9ft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149873/original/image-20161213-1592-1vxo9ft.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149873/original/image-20161213-1592-1vxo9ft.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">In Moscow, obesity is on the rise due to Russians’ changing dietary habits.</span>
<span class="attribution"><span class="source">WHO /Sergey Volkov</span></span>
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<h2>Changing food habits: the role of labour markets</h2>
<p>Apart from these supply-side factors, some <a href="http://www.ingentaconnect.com/content/aea/jep/2003/00000017/00000003/art00005">studies</a> on US data also associate overweight prevalence with changes in the labour market, particularly the increased participation of women. </p>
<p>But on the one hand, <a href="http://link.springer.com/article/10.1007/s11150-009-9052-y">working mothers</a> may have less time to prepare meals or to encourage their children to spend active time outside. And on the other, more working hours are likely to boost family income, which can positively influence children’s health through better access to health care, high-quality food, participation in organised sports activities, and higher quality childcare. </p>
<p>Since the decision to work is personal and closely related to individual characters and environment, it is difficult to establish a causal relationship between work status and children’s overweight levels. <a href="http://dx.doi.org/10.1016/j.ehb.2012.04.006">Some studies report</a> a positive effect, but reliable evidence remains scarce. These studies also focus on the role of working women but not on men when there is no evidence indicating a differential impact of working mothers versus working fathers. </p>
<p>People are also increasingly working rotating night shifts. According to a <a href="http://www.ilo.org/wcmsp5/groups/public/@dgreports/@dcomm/@publ/documents/publication/wcms_104895.pdf">systematic review</a> carried out by the International Labor Organization, about one in five of all employees in the European Union (25%) work night shifts, and night work often constitutes an integral part of the shift-work system. </p>
<p>Such schedules presumably render it more difficult to establish regular meal habits and may encourage frequent snacking to maintain concentration at work. Finally, because modern technology has greatly reduced physical demands of many workplaces, individuals must eat fewer calories to avoid weight gain.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/149471/original/image-20161209-31391-1jgfhqc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149471/original/image-20161209-31391-1jgfhqc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149471/original/image-20161209-31391-1jgfhqc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149471/original/image-20161209-31391-1jgfhqc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149471/original/image-20161209-31391-1jgfhqc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149471/original/image-20161209-31391-1jgfhqc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149471/original/image-20161209-31391-1jgfhqc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Eating habits changes and sedentary lifestyles, especially at work, have particularly affected food patterns worldwide.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/motleypixel/4784478824">Roy Niswanger/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>While many globalisation-related explanations for obesity seem plausible, robust empirical evidence establishing a causal link is scarce. This is partly due to the fact that food and eating habits have multiple and often interrelated determinants, which makes it challenging to test the causal impact of a single factor. And it’s further aggravated by the fact that some of the proposed causes of obesity interact and potentially amplify each other. </p>
<p>Despite initial academic evidence then, the main drivers of the global rise in obesity levels remain, to a large extent, a black box. </p>
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<p><em>Created in 2007, the <a href="https://www.axa-research.org">Axa Research Fund</a> supports more than 500 projets around the world conducted by researchers from 51 countries. Discover the work of Fabrice Etile and his team on the <a href="https://www.axa-research.org/fr/projets/fabrice-etile">dedicated site</a>.</em></p><img src="https://counter.theconversation.com/content/70153/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Oberlander a reçu des financements de INRA Métaprgrammes DID'IT et GLOFOODS. </span></em></p><p class="fine-print"><em><span>DISDIER Anne-Célia a reçu des financements de INRA Métaprogrammes DID'IT et GLOFOODS. </span></em></p><p class="fine-print"><em><span>Fabrice ETILE a reçu des financements de INRA Métaprogrammes DID'IT and GLOFOODS, Institut National du Cancer, AXA Research fund . </span></em></p>
Research has yet to reveal why and how obesity rates have surged around the world in the past few decades.
Lisa Oberlander, PhD student in nutrition and health economics, Paris School of Economics – École d'économie de Paris
DISDIER Anne-Célia, Directrice de recherche en économie, École normale supérieure (ENS) – PSL
Fabrice Etilé, Economist - Paris School of Economics, Directeur de recherche, Inrae
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/66527
2016-10-11T18:03:45Z
2016-10-11T18:03:45Z
Africa needs a fresh approach to ‘lifestyle’ diseases research
<figure><img src="https://images.theconversation.com/files/141232/original/image-20161011-12009-3zzsj1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ghanaian cancer specialists examine a patient’s scan. </span> <span class="attribution"><span class="source">Reuters/Olivier Asselin </span></span></figcaption></figure><p>Non-communicable diseases are often described as lifestyle diseases because they are associated with the excesses of an ageing or privileged population. Not any more. One would be hard pressed today to find someone who has not been touched in some way by these diseases. </p>
<p>The <a href="http://www.who.int/mediacentre/factsheets/fs355/en/">list</a> of these diseases is long, the most notable being cancer, diabetes and cardiovascular disease. Increasingly these non-communicable diseases are a major health threat worldwide: they’re responsible for more than 38 million <a href="http://www.who.int/ncds/en/">deaths</a> annually. Close to 75% occur in low- and middle-income countries.</p>
<p>Their emergence in Africa is a recent development. Rapid changes in lifestyles along with increasing urbanisation are fuelling the <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61349-5/abstract">rise</a>. Evidence suggests that the risk is accelerating in sub-Saharan Africa. However, the non-communicable disease problem is hidden under the infectious disease epidemic. </p>
<p>For low and middle income countries the rapid rise in these diseases is likely to lead to a greater social and economic <a href="https://www.ncbi.nlm.nih.gov/pubmed/16274715">burden</a>. This is because many of these countries are also struggling with communicable diseases, resulting in a <a href="http://www.ecsdev.org/images/V1N2/ekpenyong%20249-270.pdf">dual burden</a> of disease. </p>
<p>This may have implications on <a href="https://www.ncbi.nlm.nih.gov/pubmed/19164428">poverty levels</a> on a macro-level as greater resources are allocated to healthcare. At the household level, high healthcare costs associated with long-term management of non-communicable diseases can drive <a href="http://www.prb.org/pdf15/ncds-africa-policybrief.pdf">families</a> into poverty. </p>
<h2>Limitations of current research</h2>
<p>Current research remains limited to assessing the extent or magnitude and drivers of specific noncommunicable diseases – often also referred to as NCDs – within a given population. The processes and procedures traditionally used to conduct public health research, which are typically applied to infectious diseases, must be modified to meet this challenge. </p>
<p>They should be modified so that they streamline the very nature of non-communicable diseases across all stages of the research process. Early career researchers need to be trained accordingly, with a focus on this emerging challenge. </p>
<p>If this does not happen, the current research practice will continue producing research focused more on the problem than the solution to NCDs. Moreover, the results would not lead to better policy options. </p>
<p>In developed countries, where routine health information systems are strong, NCD research can draw data directly from those sources to produce more robust evidence. </p>
<p>But this is not the case in low and middle income countries, which rely more on survey data. The new approach should be institutionalised at early stages of the research so that more informative data can be generated. The objective of this new approach is not about collecting more data. It’s about more useful data for action.</p>
<h2>Trends in non-communicable diseases</h2>
<p>The growing trend of non-communicable diseases coupled with the need for stronger counter-action in sub-Saharan Africa was the focus of a recent <a href="https://www.rti.org/news/symposium-discusses-increasing-levels-noncommunicable-diseases">symposium</a> in Kenya. It was the first dedicated to research on non-communicable diseases in a country where they account for <a href="http://www.health.go.ke/wp-content/uploads/2016/04/Executive-summary-6-2.pdf">27%</a> of total deaths and 50% of hospital admissions. </p>
<p>There are several reasons why the approach to researching non-communicable diseases must change. </p>
<p>Firstly non-communicable diseases share common risk factors – but there is no one-on-one relationship between the diseases and their risk factors. One risk factor may be related to many. One disease may be related to many risk factors. Alcohol use, for instance, is a risk factor for cardiovascular disease and some types of cancer, as well as diabetes.</p>
<p>Secondly, these diseases develop progressively over a person’s lifespan. People who are exposed to risk factors in childhood or adolescence may develop non-communicable diseases in adulthood or in old age. Research must therefore consider approaches to prevent and manage these diseases over the lifespan. </p>
<p>Equally, patients may require long-term care. So research needs to employ a cohort model that looks at long-term and continuous assessment of care and its outcomes.</p>
<p>Thirdly, non-communicable diseases typically do not occur in isolation. Associated illnesses (co-morbidities) are common. Research should examine co-existing conditions rather than a single disease in isolation.</p>
<p>Lastly, these diseases require a combination of multiple interventions – behavioural as well as clinical. The effectiveness of these in combination should be investigated. </p>
<p>It is also critical that patients are actively involved in their own care. They should be considered partners in the research process as they generate and use evidence. </p>
<h2>Changing the research approach</h2>
<p>Dealing with these challenges requires a thoughtful and deliberate realignment from an epidemiological research approach. Research will need to be contextually relevant to address the complex relationships at the core of prevention, management and response. </p>
<p>There are two other aspects that need to be addressed. One is to stimulate long-term career interest in non-communicable diseases among researchers across Africa. But equally important is the collaboration among research institutions, universities and government ministries to equip early and mid-career researchers with fresh approaches and relevant skill sets. </p>
<p>But widening this scope and approach to research requires innovation, courage and determination as well as a significant investment of financial resources. This should be underpinned by policy level involvement of all stakeholders -— departments of health, national treasuries, agriculture, labour, planning and education.</p><img src="https://counter.theconversation.com/content/66527/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peninah and I would like to acknowledge the contribution made by Shukri Mohammed, APHRC research officer</span></em></p><p class="fine-print"><em><span>Peninah Masibo does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
So-called lifestyle diseases such as cancer and heart disease have been rising in Africa, adding to the already huge burden of disease in poor countries. But the research has not kept pace.
Tilahun Haregu, Associate Research Scientist, African Population and Health Research Center
Peninah Masibo, Training Coordinator, African Population and Health Research Center
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/56515
2016-05-23T19:31:47Z
2016-05-23T19:31:47Z
Limited food options take their toll on the health of South Africa’s rural poor
<figure><img src="https://images.theconversation.com/files/123549/original/image-20160523-11010-8biejl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Siphiwe Sibeko/Reuters</span></span></figcaption></figure><p>In the past 20 years, researchers have linked the increase of obesity and chronic diseases like diabetes and hypertension in low- and middle-income countries to urbanisation, changing diets and less active lives. </p>
<p>The spread of big retail food chains and fast food has also had an impact – increasing the availability of processed, high-energy, nutrient-poor foods and making them more affordable than fresh, healthy food. </p>
<p>Though this is <a href="http://www.cpc.unc.edu/projects/nutrans/whatis">accurate</a>, it does not entirely capture the realities of the rural, agrarian poor people and the nutrition challenges they face. </p>
<p>Most South Africans’ food energy needs are adequately met and extreme hunger is a thing of the past. This is thanks, in part, to one of the largest cash-based <a href="http://www.hsrc.ac.za/en/review/hsrc-review-november-2013/social-grants-fiscas">social welfare programmes</a> on the continent. </p>
<p>But the reality is that rural poor people are among the most disempowered among <a href="http://link.springer.com/article/10.1007%2Fs10460-005-6042-4#/page-1">food citizens</a>. Most poor rural South Africans <a href="http://www.up.ac.za/en/coe-fs/news/post_2147313-healthy-diet-remains-unaffordable-for-most-south-africans">cannot afford</a> a healthy, balanced diet with adequate fruits, vegetables and legumes. Where these are not locally produced, supermarkets supply them with hefty price tags that are often higher than city prices. As a result, poor people living in rural areas may suffer from malnutrition.</p>
<p>For children, malnutrition comes as chronic under-nutrition. It translates into <a href="http://data.unicef.org/nutrition/malnutrition.html">stunting</a> or growth faltering. This often occurs simultaneously with obesity. For adults, it means a higher risk of <a href="http://www.hst.org.za/news/more-south-african-adults-now-die-obesity-poverty">obesity</a>.</p>
<p>If the current trajectory continues, the costs of treating obesity-related chronic diseases could be staggering, let alone for a health system that already heaves under the burden of HIV. </p>
<p>And the social and economic <a href="http://thousanddays.org/tdays-content/uploads/Stunting-Costing-and-Financing-Overview-Brief.pdf">costs</a> of childhood stunting due to nutritional deficiencies are even higher, robbing children of quality of life and nations of potential.</p>
<h2>Why rural poor face particular problems</h2>
<p>Industrialised and highly urbanised developed countries have been leading the charge in the <a href="http://www.who.int/nutrition/topics/obesity/en/">global obesity epidemic</a>, but the world’s poorest countries are rapidly catching up.</p>
<p>Researchers refer to this as <a href="http://www.cpc.unc.edu/projects/nutrans/whatis">nutrition transition</a>. This is explained as shifts in food consumption, physical activity levels and increasing urbanisation. </p>
<p>But this does not explain why obesity is also on the rise among rural people. It challenges a common argument around obesity: it is caused by unhealthy lifestyle choices, including inactivity and eating junk food. </p>
<p>Clearly the phenomenon of obesity in poor rural communities has little to do with an addiction to drive-through burgers. But it is no less related to food environments. </p>
<p>Food environments are the ways in which food is produced, distributed and consumed. These are determined largely by <a href="http://www.srfood.org/en/trade-sp-1847639719">global trade</a> policies, national food production and distribution patterns, agriculture and nutrition policies and, increasingly, the unfolding crisis of <a href="http://www.unscn.org/files/Statements/SCN_statement_climate_change_final.pdf">climate change</a>. </p>
<p>And although nutrition transition is linked to changing food preferences, it is also linked to changing rural livelihoods, land and water entitlements, <a href="ftp://ftp.fao.org/docrep/fao/010/i0112e/i0112e00.pdf">agricultural diversity</a> and urbanisation. The dynamics of these push and pull factors are complex.</p>
<h2>The South African case</h2>
<p>Livelihoods and food environments – rather than personal choices – often determine the consumption of healthy or unhealthy food. In South Africa, for example, the particular challenge is that most rural people buy, rather than produce, their own food. This is because the country has an <a href="http://www.plaas.org.za/plaas-publication/agrarian-transformation-smallholder-agriculture-south-africa-diagnosis-bottlenecks">underdeveloped</a> smallholder and subsistence-farmer sector and a weak culture of home food production. As a result their choices are severely limited by income, the retail environment and their capacity to produce their own food. </p>
<p>Producing their own food, in turn, is constrained by the high costs of inputs, land and water shortages, and the lack of support for subsistence and small food producers and marketers.</p>
<p>So instead of vibrant local production and markets, rural people rely mainly on processed foods – refined carbohydrates like maize meal, white sugar, mass-produced vegetable oils and, occasionally, <a href="http://www.who.int/mediacentre/news/statements/2015/processed-meat-cancer/en/">processed animal products</a> – bought largely from big retail chains, because these are the cheapest and most prolific.</p>
<p>Food security in rural South Africa is heavily reliant on cash incomes, which, in turn, are boosted considerably by social grants. But, unlike food prices, these do not increase in response to frequent price hikes. </p>
<p>Rural people are often trapped in cycles of chronic food insecurity. Although they get enough calories, they suffer from hidden hunger. This results in micronutrient deficiencies and obesity due to poor food quality, perpetual anxiety about future food supplies and unstable livelihoods. </p>
<h2>There are answers</h2>
<p>Malnutrition in rural communities cannot be addressed through manufacturing more food and trucking it to rural areas or sending more food charity. What is needed is a systemic approach that considers the underlying causes of hunger and malnutrition and the the whole food system. </p>
<p>Researchers, civil society groups and activists are increasingly highlighting the fact that food systems that primarily generate profits not only fail to deliver adequate nutritious food, but also <a href="http://rajpatel.org/2009/10/27/stuffed-and-starved/">contribute to</a> environmental damage, biodiversity loss and climate change – and a global obesity epidemic.</p>
<p>South Africa produces enough food for local consumption. It also has the natural resources and technology to do this in more sustainable, nutritious and culturally appropriate ways. The key to this is diversification.</p>
<p>The retail sector is critical when most people rely on food purchased with cash. But like ecosystems, when food systems rely too heavily on one component, it makes for weakness and vulnerability. Relying heavily on purchased food from too few sources is making rural people <a href="http://www.economist.com/news/finance-and-economics/21672342-fuel-price-shocks-have-big-influence-price-food-oily-food">vulnerable</a>. </p>
<p>One solution may be to improve small-scale farming and household production. With the right support, <a href="https://www.grain.org/article/entries/4929-hungry-for-land-small-farmers-feed-the-world-with-less-than-a%20quarter-of-all-farmland">small-scale</a>, diverse and ecologically sustainable farming need not be a struggle for survival. </p>
<p>But small producers need access to land, water and inputs, vibrant local markets and protection against <a href="https://www.academia.edu/20879940/Between_Markets_and_Masses_Food_assistance_and_food_banks_in_South_Africa">corporate and charitable dumping</a>. This is but one suggestion. There is much wider scope for innovation in food and agricultural policies.</p>
<p>Addressing current nutrition and health challenges will require improved access to good quality, diverse diets – ending malnutrition is no longer about delivering enough calories to prevent starvation.</p><img src="https://counter.theconversation.com/content/56515/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Angela McIntyre is a PhD candidate at the University of Pretoria Faculty of Natural and Agricultural Sciences and affiliated with the Institute for Food Nutrition and Wellbeing.</span></em></p>
In many rural areas, poor people are suffering from malnutrition, which takes the form of stunting and obesity. To change this, their food environments must change.
Angela McIntyre, Doctoral student affiliated with the UP Institute for Food, Nutrition and Wellbeing (IFNuW) and the Centre for the Study of Governance Innovation, University of Pretoria
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/55599
2016-03-04T04:24:38Z
2016-03-04T04:24:38Z
Doctors must be taught how to be better counsellors on lifestyle choices
<figure><img src="https://images.theconversation.com/files/113718/original/image-20160303-9499-sgum6m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Smoking, excessive drinking, not exercising or eating unhealthy foods leads to lifestyle diseases. </span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>People who smoke and drink too much, don’t exercise and eat unhealthily are likely to suffer from non-communicable diseases such as heart disease and diabetes. They are also likely to die early. More than most, they need counselling on how to change their behaviour. This is important because it can ensure that scarce resources in the public health sector are used more cost-effectively.</p>
<p>But, in South Africa, <a href="http://dx.doi.org/10.4102/PHCFM.V7I1.819">counselling</a> about non-communicable diseases and the underlying risk factors has, until recently, been particularly inadequate. Primary care providers are ill equipped to provide more than ad hoc advise on how to adopt a healthy lifestyle.</p>
<p>More than 38 million people die across the world from non-communicable diseases <a href="http://www.who.int/nmh/publications/ncd_report_chapter1.pdf">every year</a>. Four groups of diseases are responsible for 82% of these deaths: cardiovascular diseases, cancers, respiratory diseases and diabetes. </p>
<p>According to the World Health Organisation 40% of deaths in the developed and developing world occur in people who are younger than 70. Of these, 82% are in lower- and middle-income <a href="http://www.who.int/gho/countries/zaf.pdf?ua=1">countries</a>. </p>
<p>In South Africa, non-communicable diseases are among the top ten <a href="http://www.who.int/gho/countries/zaf.pdf?ua=1">leading causes of death</a>. These have been on the increase, driven by risky lifestyle choices. Smoking, drinking excessively, a lack of physical inactivity and an unhealthy diet all contribute to high levels of morbidity and death from these diseases. </p>
<p>Although these can be changed, progress towards prevention has not kept pace with the rising burden of disease. </p>
<p>The effect of non-communicable diseases is felt by the individual as well as their families, communities and the over-burdened health system. </p>
<p><a href="http://www.ichangeforhealth.co.za/healthcare-professionals/">Research</a> has shown that interventions that target people as part of a family unit and a community is more effective. For example, two 40-year-old men – one married and the other single – but both suffering from diabetes need a counselling approach that takes into account their lifestyles. </p>
<h2>Doctors and nurses lack the know-how</h2>
<p>In South Africa, patients are most likely to be counselled by public sector nurses or primary care doctors. Recent <a href="http://dx.doi.org/10.4102/PHCFM.V7I1.819">studies</a> that assessed healthcare providers’ capacity to deliver behaviour change counselling show this service is inadequate in both the public and private sectors. </p>
<p>None of the nurses included in the study and only one-fifth of the doctors had excellent knowledge of the key issues around non-communicable disease risk factors. </p>
<p>Public sector nurses accept the role of providing counselling and about one-fifth believe they are knowledgeable. But they may have an <a href="http://dx.doi.org/10.4102/phcfm.v7i1.731">inflated perception</a> of their knowledge on how to modify a patient’s lifestyle for non-communicable diseases. </p>
<p>Primary care doctors also accept that they must deliver brief counselling and feel it is important. But they doubt their ability to effectively assist patients to change risky behaviours. </p>
<p>Aside from insufficient training, several other factors contribute to their <a href="http://dx.doi.org/10.4102/phcfm.v7i1.731">lack of confidence</a> to deliver counselling.</p>
<p>Many have faced several barriers which have discouraged them. These include: </p>
<ul>
<li><p>a lack of patient education materials;</p></li>
<li><p>time and language constraints;</p></li>
<li><p>poor continuity of care and record-keeping;</p></li>
<li><p>conflicting lifestyle messages; and </p></li>
<li><p>an unsupportive organisational culture. </p></li>
</ul>
<p>There is a need to revise the approach to training doctors to ensure skills can be learnt and transferred to the clinical setting.</p>
<h2>Putting the patient at the centre</h2>
<p>Current training for primary care providers in the Western Cape is not sufficient to achieve competence in clinical practice. Training is limited by time constraints and is not integrated into the curriculum. There is a focus on theory rather than modelling and practice as well as a lack of assessment.</p>
<p>To improve the current training programs, I designed, developed and implemented a best practice training program along with training materials and resources. The program, piloted in the Western Cape, targeted primary care doctors and nurses. </p>
<p>The training programme is based on a conceptual model that combines the 5 A’s: ask, alert, assess, assist and arrange. The training is based on a guiding style derived from motivational interviewing, which differs from the traditional directing style of counselling. This guiding style has been <a href="http://www.files.ithuta.net/eCPD_Healthcare/General/HELPING%20PEOPLE%20CHANGE%20Manual72.pdf">widely used internationally</a>.</p>
<p>The program is designed to target all four risk factors associated with non-communicable diseases.</p>
<p>Traditionally, primary care doctors have been the expert advice giver. They try to convince the patient why, what and how they should change. But in the guiding style, the argument for change is evoked from the patient. Primary care providers are trained to expertly guide the shared decision making process. </p>
<p>This moves the counselling approach from provider-centred to patient-centered. </p>
<p>The program changed primary care doctors’ approach and skills to deliver patient centred counselling, at least in the short term. And it helped them develop the approach of the guiding style, which they were able to retain in <a href="http://bmcfampract.biomedcentral.com/articles/10.1186/s12875-015-0318-6">clinical practice</a>.</p>
<h2>Training is not enough</h2>
<p>Although training enabled primary care doctors to deliver better behaviour change counselling effectively, and increased their confidence, delivering it in a clinical environment remains challenging. Training alone is not enough to ensure that better behaviour change counselling is implemented. </p>
<p>There are still several barriers. These include: </p>
<ul>
<li><p>under-staffing;</p></li>
<li><p>lack of managerial support; and </p></li>
<li><p>poor continuity of care. </p></li>
</ul>
<p>To incorporate better behaviour change counselling into everyday care, a whole systems approach is needed. This requires training primary care doctors to change their counselling behaviour, but also requires change at other levels. </p>
<p>For example, the current organisational culture is not congruent with the patient-centred guiding style of better behaviour change counselling. Asking primary care doctors to embody values of trust, respect and openness in an environment where they are experiencing manipulation, blame and control, is unrealistic. </p>
<p>Incorporating better behaviour change counselling into everyday care does not only require training, but also a change in the underlying supportive culture in primary care settings.</p><img src="https://counter.theconversation.com/content/55599/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zelra Malan receives funding from CDIA (Chronic Diseases Initiative in Africa), and Stellenbosch University.</span></em></p>
Doctors in South Africa have not been doing enough counselling of people who drink, smoke, don’t exercise and eat badly on ways to change their lifestyles.
Zelra Malan, Senior Lecturer, Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/50424
2015-11-24T04:29:35Z
2015-11-24T04:29:35Z
Obesity: why South Africans need to can soft drinks
<figure><img src="https://images.theconversation.com/files/102806/original/image-20151123-18246-1tljisr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">South Africans need to reduce the number of sugar-sweetened beverages they consume.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>If South Africans don’t drastically reduce the number of cool drinks, juices and sugar-sweetened beverages they drink every day, there will be more than nine million obese adults in the country by 2017. </p>
<p>Just three years ago, the country hit the mark of <a href="http://journals.cambridge.org/download.php?file=%2FPHN%2FS1368980015003006a.pdf&code=46bcad3ccceb70d8e4a6c55bf429b91c">eight million</a> obese people, making it the most obese nation on the continent and joining the likes of global heavyweights such as Mexico and the US.</p>
<p>The 2017 projection, captured in our <a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10012163&fileId=S1368980015003006">study</a>, means there will be 1.2 million more obese adults in South Africa. And more than one-quarter of these people will be obese because of the sugar sweetened beverages they drank. </p>
<p>These drinks are not the only reason for the increase in obesity. But because they are high in sugar and contain no essential nutrients, they are a significant contributor. For adults, drinking just one of these beverages a day increases the likelihood of being overweight by almost <a href="http://healthpolicy.ucla.edu/publications/Documents/PDF/stillbubbling-healthimplications-oct2013.pdf">30%</a>. </p>
<p>For children, this risk increases to more than 50%. Other factors that contribute to obesity and overweight are eating fast food or processed food on a regular basis and not exercising.</p>
<p>Across the country, sugar-sweetened beverages result in <a href="http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=26124185">one death every hour</a>.
Lifestyle diseases related to obesity, which can result in stroke, blindness, amputations and kidney failure, not only shorten one’s lifespan but also affect their quality of life. These deaths and disabilities place a major financial strain on families and on the already overburdened healthcare system.</p>
<p>If preventive measures are not introduced it is highly likely that people will drink more and more sugar-sweetened drinks over the next few years. </p>
<h2>Tackling the fat problem</h2>
<p>The South African National Department of Health has set a target of reducing the number of people who are obese or overweight by 10% <a href="http://www.hsrc.ac.za/uploads/pageContent/3893/NCDs%20STRAT%20PLAN%20%20CONTENT%208%20april%20proof.pdf">by 2020</a>. Its strategic plan for non-communicable diseases identifies several cost-effective preventive interventions to achieve this.</p>
<p>One of these is a tax on unhealthy products like a sugar tax. This would mean that the <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0105287">cost</a> of cool drinks would increase, making them less affordable.</p>
<p>But in addition to a sugar-sweetened beverage tax, a complete package of interventions is needed for the greatest impact on obesity reduction. Other measures include:</p>
<ul>
<li><p>food advertising regulations; </p></li>
<li><p>easy to understand food labelling; and </p></li>
<li><p>work site and school based interventions. </p></li>
</ul>
<p>The government could also subsidise healthy products. Ideally this should be accompanied by strong education campaigns about the dangers of excessive sugar consumption.</p>
<p>Although the national strategic plan acknowledges the need for a set of interventions including a sugar tax, specific regulations have not yet been passed. </p>
<p>But lessons can be learned from Mexico – one of the most <a href="http://www.oecd.org/health/Obesity-Update-2014.pdf">obese countries</a> on the planet.</p>
<p>For almost a decade, the Mexican soft drink industry spent millions blocking efforts to reduce soda <a href="http://www.theguardian.com/news/2015/nov/03/obese-soda-sugar-tax-mexico">consumption</a>. But impressive public health campaigns and demands for interventions led to a National Prevention and Control Strategy in 2013 and the implementation of a soda tax in January 2014. </p>
<p>By 2015, soda sales had decreased by 10% and people were drinking more <a href="http://www.insp.mx/epppo/blog/preliminares-bebidas-azucaradas.html">water</a>. </p>
<h2>Consumers have little choice</h2>
<p>There is an overwhelming perception that if consumers are educated, they will make good choices. But currently food and beverage choices are shaped by availability, affordability and most importantly relentless marketing. The food and advertising environment in South Africa makes it increasingly difficult to make healthy choices. </p>
<p>Currently, higher-income groups drink more sugar-sweetened beverages. But this is likely to change as the industry has started to target lower-income groups, who are more <a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10012163&fileId=S1368980015003006">vulnerable</a>. </p>
<p>The largest soft drink bottler in the country is clear about its intentions to <a href="http://www.sabmiller.com/docs/default-source/investor-documents/presentations/2014/quarterly-divisional-seminar-south-africa-2014.pdf">aggressively grow</a> its reach within the poorest sector of the population. The growth strategy will be driven by marketing and advertising to connect particular brands with aspirations and passions. This will place an already vulnerable population at even greater risk for obesity-related diseases, and will be exacerbated by existing poor access to quality disease screening and health care. </p>
<p>The impact on children is even worse. One <a href="http://www.cdc.gov/pcd/issues/2015/14_0559.htm">study</a> shows that although many of the leading brands in the country have committed to marketing that promotes healthy choices for <a href="https://www.ifballiance.org/sites/default/files/South_african_marketing_to_children_pledge.pdf">children</a>, half of the sugar-sweetened beverage billboard advertising in Soweto is deliberately close to schools with nearby vendors providing convenient access. </p>
<p>In both the formal and informal convenience stores, locally known as spaza shops, these products are also strategically placed to ensure the most profitable and high-sugar ones are at eye level and easily accessible.</p>
<h2>Levelling the playing field</h2>
<p>Consumers are persuaded to make unhealthy choices through the use of tactical marketing techniques and strategic placement and availability of unhealthy products. </p>
<p>The playing field needs to be levelled with interventions that nudge people to make healthier choices. In the absence of such measures, South Africa is headed towards a future with unprecedented rising healthcare costs, and deaths and disabilities from obesity-related diseases.</p><img src="https://counter.theconversation.com/content/50424/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aviva Tugendhaft receives funding from the Bill and Melinda Gates Foundation and the SA medical research council</span></em></p><p class="fine-print"><em><span>Karen Hofman receives funding from the Bill and Melinda Gates Foundation, SA medical research council. </span></em></p>
With one can of cool drink containing six teaspoons of sugar – your recommended sugar intake for the day – there is a need to reduce the number of sugar-sweetened beverages South Africans consume.
Aviva Tugendhaft, Deputy Director, PRICELESS SA, Wits/MRC Agincourt Rural Health Transitions Unit, Wits School of Public Health, University of the Witwatersrand
Karen Hofman, Program Director, PRICELESS SA, Wits/MRC Agincourt Rural Health Transitions Unit, University of the Witwatersrand
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/47616
2015-09-21T10:00:05Z
2015-09-21T10:00:05Z
Living longer, sicker lives? Make lifestyle changes to remain healthier in old age
<figure><img src="https://images.theconversation.com/files/95374/original/image-20150918-17676-1hyi65o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fighting fit.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-181671983/stock-photo-elderly-person-practicing-a-sport.html?src=hQii59zazhAJcrlSpf4HSQ-2-72">Exercise by Shutterstock</a></span></figcaption></figure><p>Life expectancy across the world is growing, but the number of those extra years in which we’re healthy is not rising at the same rate. This adds to the demographic time-bomb of a greater number of older people suffering from ill-health. Yet, according to the Global Burden of Disease study <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2961340-X/abstract">published in the Lancet</a>, of the top ten health risks most are lifestyle-related and within our power to change.</p>
<p>Between 1990 and 2013, life expectancy in the UK increased by 6.2 years for men to 79.1 years, and by 4.4 years for women to 82.8 years. However, the amount of this gain expected to be lived in good health increased by only 4.7 years for men and 3.3 years for women. </p>
<p>While a similar improving trend was observed in most countries across the globe, in dozens of countries including Belarus, Belize, Gabon, Guyana, Paraguay, Syria and all of southern Sub-Saharan Africa, healthy life expectancy was lower in 2013 than in 1990. Interestingly, this is also the first time that improvements to healthy life expectancy in the developing world (5.4 years for men and 6.4 years for women) are greater than those in the developed world (3.9 years for men and 2.8 years for women).</p>
<h2>Chronic disease and disability</h2>
<p>A surprising fact is that, nowadays, <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960692-4/abstract">fewer than 4% of people are completely free of any health problem</a>, with more people living with chronic and under-reported illnesses. The number of years lived with disability have increased in almost every country, attributable to the growth of chronic diseases such as cardiovascular and respiratory diseases, cancer, back pain, mental health disorders, dementia, road injuries, HIV/AIDS and malaria. This has also increased the demand for care.</p>
<p>A comparison of years of life lost between regions of the UK, <a href="https://stats.oecd.org/glossary/detail.asp?ID=6805">the EU15 group of countries</a>, plus Australia, Canada, Norway and the US, shows that England’s worst affected region – the north-west (with north-east England close behind) – is similar to Scotland, Northern Ireland and the US. The East Midlands is the UK average, equivalent to France, Canada and Germany, while better-off regions such as the south-west, south-east and London are closer to Spain, Australia and Norway.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rates of years of life lost (YLLs) for both sexes combined in the nine English regions, Scotland, Northern Ireland, Wales, the EU15 countries, Australia, Canada, Norway and the US (2013).</span>
<span class="attribution"><a class="source" href="http://dx.doi.org/10.1016/S0140-6736(15)00195-6">Newton et al\The Lancet</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Factors within our control</h2>
<p>We could live longer and healthier if we tackled the main health risks that affect us. Globally, the leading ten risks are smoking, obesity, high blood pressure, diabetes, alcohol use, high cholesterol, kidney disease, low physical activity, diets <a href="https://theconversation.com/top-five-things-you-can-do-to-keep-your-heart-healthy-34950">low in fruits and vegetables</a> and drug use. These are drawn from 79 biological, behavioural, environmental and occupational factors.</p>
<p>The list is similar in the UK, with smoking, high blood pressure, obesity at the top and <a href="https://theconversation.com/top-five-things-you-can-do-to-keep-your-heart-healthy-34950">low physical activity also ranking highly</a>, comparable to <a href="http://www.lancet.com/journals/lancet/article/PIIS0140-6736%2815%2900128-2/abstract">Australasia, Ireland and the US</a>. Among developed countries there is some variation: alcohol use is a bigger problem in Belgium, Denmark, Finland and South Korea, while smoking is less of a problem in Finland, Israel and Singapore, for example.</p>
<p>The same is true <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2900195-6/abstract">within the UK</a>, where Wales scored worse in physical activity but better in blood pressure, or where drug use was a greater problem in the south-west, south-east and the east of England than elsewhere. As the chart below shows, of metabolic (biological), environmental, or behavioural (lifestyle) factors affecting health, it is lifestyle factors that carry the most weight.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=372&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=372&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=372&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=468&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=468&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=468&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Proportion of disability-adjusted life years lost in 2013 attributable to behavioural, environmental and metabolic risks and where they overlap (marked by ∩).</span>
<span class="attribution"><a class="source" href="http://dx.doi.org/10.1016/S0140-6736(15)00128-2">GBD 2013 Risk Factors Collaborators/The Lancet</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>The future</h2>
<p>We are now entering an era when fighting for funding to tackle a single disease in isolation is no longer effective. Health problems <a href="http://pediatrics.aappublications.org/content/88/3/519.abstract">tend to cluster from childhood to adulthood</a> and then <a href="http://spcare.bmj.com/content/5/Suppl_1/A6.1.abstract">around the end of life</a>. They also share both biological and environmental risks. </p>
<p>The main risk factors leading to chronic diseases such as high blood pressure, obesity, smoking and heavy alcohol consumption might result from <a href="http://www.jsad.com/doi/abs/10.15288/jsa.2001.62.773">family problems</a>, <a href="http://bmjopen.bmj.com/content/5/5/e006588.long">social inequality</a> or poverty, beliefs or <a href="http://psycnet.apa.org/journals/hea/21/3/279/">customs</a> of particular subcultures, <a href="http://www.bmj.com/content/350/bmj.h1565.long">selfish business models</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861792/">bullying</a> or violence, <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.82.6.816">poor education (awareness)</a>, depressive mood and even <a href="https://theconversation.com/being-too-hot-or-too-cold-can-worsen-health-conditions-27086">the changeable weather</a>.</p>
<p>Current prevention and interventions programmes and social and health policies aimed at reducing the leading risks might have limited effects. Instead, we should focus on the context and mechanism of actions of these risks. We, therefore, need to restructure human society in each country, with systematic examination and improvements in every aspect of human life including <a href="http://www.healthpolicyjrnl.com/article/S0168-8510%2815%2900221-3/abstract">politics</a>, the occupational (for example, more healthcare and less business; <a href="http://www.theguardian.com/commentisfree/2013/sep/18/shorter-working-week-fairer-economy">shorter working hours</a> with lower unemployment rates), the built environment (including <a href="http://www.ingentaconnect.com/content/hsp/jbsav/2015/00000004/00000001/art00012">housing and neighbourhoods renewal</a>, <a href="http://onlinelibrary.wiley.com/doi/10.1002/wps.20191/epdf">the transport system</a>, etc), <a href="http://link.springer.com/article/10.1007%2Fs10964-010-9584-8">consistent culture, education and parenting</a>, <a href="http://www.tandfonline.com/doi/full/10.3109/11038128.2015.1085596">hobbies</a> and so on. This is the grand challenge that faces us in the next decade.</p><img src="https://counter.theconversation.com/content/47616/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ivy Shiue (Scthiue) does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
A global health and disease study shows we’re living longer, but spending more years in poor health. But there are some things within our power to change.
Ivy Shiue (Scthiue), Senior research associate, Northumbria University, Newcastle
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/46598
2015-08-26T04:25:27Z
2015-08-26T04:25:27Z
Balancing the health budget: chronic disease investment pays big dividends
<figure><img src="https://images.theconversation.com/files/92895/original/image-20150825-17783-gb0601.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Older people are more likely to drop out of the workforce for good when they're sick than young people.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-187813430/stock-photo-very-old-woman-typing-on-keyboard-and-using-mouse.html?src=UPB5qB4-ERCBdQOkmUKM8w-2-65">Bacho/Shutterstock</a></span></figcaption></figure><p>Australians may be living longer but lifestyle-related chronic diseases are now the leading cause of illness, death and disability. <a href="http://www.aihw.gov.au/chronic-diseases/">Nearly 40% of Australians</a> aged 45 and over have two or more chronic diseases, such as arthritis, asthma, back problems, cancer, <a href="https://theconversation.com/explainer-what-is-chronic-obstructive-pulmonary-disease-25539">chronic obstructive pulmonary disease</a> (COPD), heart disease, diabetes and mental health conditions.</p>
<p>Health expenditure in Australia accounts for about <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129548869">10% of GDP</a> and the cost of health care continues to rise faster than inflation. Treasurer Joe Hockey has left the door open for a GST on health, while states premiers have flagged increasing the GST to 15% or Medicare levy to 2% to cover the rising cost of health. </p>
<p>But so far the debate about reining in health costs has largely overlooked the economic benefits of implementing policies to reduce chronic diseases. This can be done via education programs to lower risk factors such as smoking and weight gain, and by early detection and treatment programs. </p>
<p>To illustrate the impact of improved health on the <a href="http://www.natsem.com.au/storage/LBrown_IMA%20paper.pdf">broader economy</a>, researchers at Victoria University’s Centre of Policy Studies translated the results of a <a href="http://www.nejm.org/doi/full/10.1056/NEJM200105033441801">Finnish study</a> of the effects on health of a large-scale diabetes educational program into Australian conditions. </p>
<p>The Finnish program involved one-to-one counselling and group sessions covering nutrition, physical activity and weight management. Scaled up to Australian conditions, close to a million people would be involved, at a cost of about A$0.5 billion. </p>
<p>If such a program produced comparable lifestyle effects to those in Finland, the gain to GDP would be A$4.5 billion a year, which amounts to 0.3% of GDP. Compared with efficiency gains available from policies in areas such as taxes and trade, this is a huge gain.</p>
<p>Why are the potential gains so large?</p>
<p>Economic models of potential savings capture two key connections between the economy and chronic disease. </p>
<p>The first is obvious: treating chronic disease is expensive. It pushes our taxes higher and reduces our ability to enjoy other forms of public and private consumption, such as good roads, public transport, education and housing.</p>
<p>The second key connection is less obvious but critically important: chronic disease reduces our ability to work. People with poor health – especially in the 49-plus age group – participate at significantly lower rates in the work force than people with good health. </p>
<p>Data from the <a href="https://www.melbourneinstitute.com/labour/research-topics/microsimulation/papers/health_status.html">Household, Income and Labour Dynamics in Australia</a> (HILDA) survey show that the fraction of potential workers in each age group that are employed declines sharply with poor health: </p>
<iframe src="https://datawrapper.dwcdn.net/5EWu1/1/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="500"></iframe>
<p>Chronic diseases such as diabetes are a major factor in poor health which is, in turn, a significant contributor to reduced labour supply and employment. </p>
<p>But where should we direct funding for prevention and intervention? </p>
<p>We <a href="http://www.sciencedirect.com/science/article/pii/S0264999314005045">modelled</a> two comparable health programs aimed at improving health status transitions. One program reduces the number of older people who move to poor health. The other reduces the number of younger people who move to poor health.</p>
<p>The economic modelling figures give a resounding victory for improving health transitions for the older group. The gains to GDP and employment are ten times larger for the program that improves transitions for older people than for the one that improves transitions for younger people (see chart below). </p>
<iframe src="https://datawrapper.dwcdn.net/ekKC2/1/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="500"></iframe>
<p>There are two reasons. The first can be seen from the first chart: employment of older people is considerably more sensitive to their health status than employment of younger people. </p>
<p>The second depends on the dynamics of health transitions. Once members of the older group fall into poor health, often associated with chronic disease, they tend to stay there with low labour force participation. By contrast, young people tend to suffer more temporary episodes of poor health, bouncing back to good health quickly.</p>
<p>So what does all this mean? </p>
<p>We should think of health as not only an area of social policy but also a major component of economic policy. The potential contribution of good health policy to the economy far outweighs the contributions of most other micro-economic reforms. </p>
<p>Finally, we should not just think of health policies in terms of costs. Costs are important, but health influences the economy in a far more profound way through labour supply. Improving peoples’ health enables them to contribute more to the economy by staying employed. This is especially true for people over 50. Keeping this group healthy is largely a matter of reducing their incidence of chronic disease.</p><img src="https://counter.theconversation.com/content/46598/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maureen Rimmer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Economic modelling shows that policies to reduce chronic diseases can have large economic benefits –A$4.5 billion a year for diabetes alone – by reducing health costs and boosting the workforce.
Maureen Rimmer, Professor, Centre of Policy Studies, Victoria University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/2859
2011-08-16T04:34:58Z
2011-08-16T04:34:58Z
Dying to watch something good on TV? You might be
<figure><img src="https://images.theconversation.com/files/2954/original/521176003_6aa2715836_z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Each hour of television shortens the viewer's life by between eight and 25 minutes.</span> <span class="attribution"><span class="source">Jack Brodus</span></span></figcaption></figure><p>Watching television for an average of six hours a day could shorten life expectancy by almost five years, according to a <a href="http://bjsm.bmj.com/content/early/2011/08/01/bjsm.2011.085662.abstract?sid=c06d02cd-20db-4225-9c02-77ba96b6e0c7">study</a> we published today in the British Journal of Sports Medicine.</p>
<p>What’s more, our research found the impact of sedentary behaviour linked to television viewing rivals that of other major risk factors.</p>
<p>In the 1950s, <a href="http://en.wikipedia.org/wiki/Jerry_Morris">Professor Jerry Morris</a> reported that <a href="http://www.lancet.com/journals/lancet/article/PIIS0140-6736%2853%2991495-0/fulltext">conductors on London’s double-decker buses had a lower risk of coronary heart disease than the drivers of those buses</a>, who sat all day.</p>
<p>As the conductors ran up and down the stairs at work, the inference from the observation was that physical exercise was good for health.</p>
<p>Much research followed but surprisingly, it took more than 50 years to discover what might have been obvious from the start: the reverse is also true – too much sitting is bad for health.</p>
<h2>Australian study</h2>
<p>We used previously published <a href="http://circ.ahajournals.org/content/121/3/384.long">data on the impact of television viewing on death</a> from analyses of the <a href="http://www.bakeridi.edu.au/ausdiab/">Australian Diabetes, Obesity and Lifestyle Study (AusDiab)</a> and national population and mortality figures to ascertain the degree of risk posed by television viewing.</p>
<p>We wanted to answer questions such as how much higher would the life expectancy of Australians be if they watched no television at all, and how does the effect of television viewing compare with other major risk factors, such as a lack of exercise, smoking and obesity. </p>
<p>The results are striking: our study indicates that if Australian men never watched television, they could expect to live nearly two years longer than they do now. For women, the figure was one and a half years.</p>
<p>Six hours of television a day amounts to almost five years of lost life. That means every single hour of television viewed after the age of 25 reduces life by 22 minutes.</p>
<p>And because Australians are exposed to an average of about two hours of television a day, the associated disease burden may be bigger than that of a lack of exercise, being overweight or obese, or even smoking. </p>
<p>So it appears that many Australians are hastened to their death by their television sets.</p>
<h2>How could this be?</h2>
<p>Television viewing is a marker for time spent passively sitting. </p>
<p>It’s likely that other sedentary activities such as sitting in front of a computer carry an equivalent risk. But it’s much more difficult to measure these compared with asking people how much television they watched in recent memory. </p>
<p>Theoretically, viewing time also comes with exposure to advertising for unhealthy foods, so perhaps people who watch a lot of television have other habits that kill them. </p>
<p>Our study adjusted for a long list of these including age, gender, leisure-time exercise, waist circumference, smoking, education, total energy intake, alcohol intake, diet quality, hypertension, total cholesterol, medication use, previously reported cardiovascular disease, and glucose tolerance status, among others. </p>
<p>Statistical correction for such factors is never perfect because they can only be measured with limited accuracy, but much of their effect was removed by our adjustment. </p>
<p>And the effects of dietary factors and physical activity are estimated in exactly the same way, so if our results are biased, then much of our knowledge about risk factors for chronic disease is also called into question.</p>
<p>Because it is self-reported, measurement of television viewing is imperfect, and this could in theory have led to an underestimation of its effect on mortality.</p>
<p>And what if we’ve got it all the wrong way around? Perhaps people who are in bad shape and close to death watch more television? </p>
<p>We can’t rule that possibility out although we did exclude persons with a known history of cardiovascular disease.</p>
<h2>Other studies</h2>
<p>An optimist might think it is all simply due to chance but that’s unlikely. Since the AusDiab paper came out in 2010, two other studies on the same topic have reached similar conclusions. </p>
<p><a href="http://ije.oxfordjournals.org/content/40/1/150.abstract">A study in England</a> found a 4% risk of mortality for every hour of television (but the participants in that study were a bit older and relative risks tend to go down with age because people increasingly die of unrelated causes).</p>
<p>And <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=21232666">Scottish data</a> showed a 7% increase in mortality.</p>
<p>A recent <a href="http://jama.ama-assn.org/content/305/23/2448.abstract">meta-analysis of thee three studies</a> in the Journal of the American Medical Association reports a weighted average effect of 6%, with a range of 3% to 9%.</p>
<p>That means each hour of television shortens the viewer’s life by at least eight minutes and as much as 25 minutes.</p>
<p>In all, it seems likely that television viewing does increase the risk of chronic disease and death. Future research can lead to better estimates of the extent of that risk.</p>
<h2>What this means for you?</h2>
<p>Watching television is a form of sedentary behaviour - the absence of physical activity, as it were. </p>
<p>Until recently, physical activity was measured only with questionnaires. Such surveys are reasonable at picking up deliberate physical exercise, but bad at measuring light physical activity. </p>
<p>This led to recommendations for exercise, and talk of a level of physical activity so low that it confers no health benefit.</p>
<p>These days, pedometers and accelerometers can measure almost every step, and it seems increasingly likely that every step counts.</p>
<p>Health recommendations for children include limiting viewing time. Our study suggests that adults would do well to follow the same advice.</p><img src="https://counter.theconversation.com/content/2859/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lennert Veerman receives funding from the NHMRC and the ARC.</span></em></p>
Watching television for an average of six hours a day could shorten life expectancy by almost five years, according to a study we published today in the British Journal of Sports Medicine. What’s more…
Lennert Veerman, Senior Research Fellow, School of Population Health, The University of Queensland
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/2351
2011-07-18T20:59:19Z
2011-07-18T20:59:19Z
Giving what it takes: healthy priorities emerge from independent review of aid
<figure><img src="https://images.theconversation.com/files/2361/original/5501010868_820cea0b4d_o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The US has been in the lead of changing the rhetoric and practice of how the developing world gives aid.</span> <span class="attribution"><span class="source">cea b d o/Flickr</span></span></figcaption></figure><p>Ever since the global financial crisis, “value for money” has become the slogan of choice for international aid. </p>
<p><a href="http://www.state.gov/s/dmr/qddr/">The Americans have been in the lead, changing the rhetoric and practice of how they give aid</a>. Efficiency and impact, accountability and transparency, and a view towards sustainability are what the modern aid agency should deliver. </p>
<p>Similarly, the Conservative-led British Government insists its development assistance will become more “business-like”. <a href="http://www.dfid.gov.uk/Media-Room/News-Stories/2011/The-future-of-UK-aid/">It announced changes to how and to whom they give money through their bilateral and multilateral programs in March.</a> </p>
<p>In the same vein, Foreign Minister Kevin Rudd recently released the report from the <a href="http://www.aidreview.gov.au/index.html">independent review of aid effectiveness</a>. It’s a <a href="http://www.aidreview.gov.au/report/index.html">weighty piece of work, wide ranging, well researched, and thoughtful</a>. We should note and celebrate the productive bipartisan support aid enjoys. </p>
<p>And just like the other reviews, it focuses on the “how” of our international giving far more than the “what”.</p>
<h2>Impact on health funding </h2>
<p>The focus on process improvement means all of the implications for health are not entirely clear, although the report is generally supportive and positive. </p>
<p>In particular, the review cites the primacy of reducing poverty as the goal of Australian aid. This has clear implications for health as anyone who is truly poor – the working definition being those billion plus people who live on less than $1.25 a day – is too poor to afford health care. </p>
<p>Good health is recognized as the fundamental basis for a good and productive life that enables one to contribute to a socially and economically vibrant community. </p>
<p>Part of the review’s recommendation is that a pillar of our aid program aims at creating “opportunities for all”. Strong emphasis on helping those with disabilities remains unchanged, in a continuation of previous strategies</p>
<p>In 2010-11, health aid comprised 14% of Australia’s aid budget, amounting to approximately $550 million. Health programs and priorities will benefit from our growing aid budget. </p>
<p>The review particularly recognizes the new breed of public-private partnerships that are the major new financing mechanisms for the world’s health menaces. </p>
<p>This should translate into boosts for the <a href="http://www.gavialliance.org/">GAVI Alliance</a>, which immunizes children in the poorest countries (Australia significantly increased our support in June), and the <a href="http://www.theglobalfund.org/en/">Global Fund to Fight AIDS, Tuberculosis and Malaria</a>. </p>
<p>Medical research is also noted as an area for funding expansion, building on Australia’s long history and considerable expertise. And providing resources and drive to eliminate malaria from the Asia-Pacific is named as a desirable goal. </p>
<p>These are very good things. Aid, and health aid in particular, are important and effective global manifestations of the “fair go” that we cherish as a nation. </p>
<p>At the same time, a few things are missing from the list of suggested “whats”. </p>
<h2>Using Australia’s aid to anticipate future risks</h2>
<p><a href="http://www.ausaid.gov.au/">AusAID</a> is increasingly working towards the need to adjust priorities to reflect the world’s changing burdens of disease. </p>
<p>In particular, it’s trying to address the <a href="http://theconversation.com/how-to-combat-the-deadly-epidemic-of-lifestyle-disease-973">growing salience of lifestyle or non-communicable diseases (NCDs)</a> that result from smoking, excessive alcohol, lack of exercise, and unhealthy diets. </p>
<p>As it increases its emphasis on results and their transparency, the Australian Government can increase its use of available evidence to choose where to invest, and this should lead to more investment in NCDs and mental health - as we are doing domestically.</p>
<p>This doesn’t have to be expensive. Sharing our domestic experience as <a href="https://theconversation.com/topics/plain-packaging">Health Minister Nicola Roxon goes up against Big Tobacco</a>, for instance, will help poorer, less legally powerful countries as they try to protect their populaces. </p>
<p>While malaria and humanitarian disasters are mentioned, the growing risks of dengue and our regional vulnerability to emerging pandemics are not. </p>
<p>We have a clear interest to work with our neighbors to strengthen our collective systems against infectious diseases. </p>
<p>The review does well not to just provide a laundry list. Instead, it gives a vision for a way of a better way of managing aid.</p>
<p>It vital to note that this vision poses a sizable implementation challenge as a reform agenda across the whole of government and for key agencies. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/2360/original/aapone-20090428000175333325-switzerland-health-flu-world-who-original.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/2360/original/aapone-20090428000175333325-switzerland-health-flu-world-who-original.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=421&fit=crop&dpr=1 600w, https://images.theconversation.com/files/2360/original/aapone-20090428000175333325-switzerland-health-flu-world-who-original.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=421&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/2360/original/aapone-20090428000175333325-switzerland-health-flu-world-who-original.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=421&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/2360/original/aapone-20090428000175333325-switzerland-health-flu-world-who-original.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=530&fit=crop&dpr=1 754w, https://images.theconversation.com/files/2360/original/aapone-20090428000175333325-switzerland-health-flu-world-who-original.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=530&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/2360/original/aapone-20090428000175333325-switzerland-health-flu-world-who-original.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=530&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Australia could help break habit of drip-feeding the WHO earmarked, self-serving funds.</span>
<span class="attribution"><span class="source">AAP</span></span>
</figcaption>
</figure>
<h2>A few other considerations</h2>
<p>There are a few things that should be re-examined as the review is implemented. First and foremost is the recommendation that if we increase our support to the <a href="http://www.who.int/en/">World Health Organization (WHO)</a>, we should only do so through what’s called “earmarked” funding. </p>
<p>The WHO is the lead global agency for health. But historically it has been neutered by its member governments, who call for action but don’t necessarily fund the required activities.</p>
<p>What’s more many wealthy nations play the agency like a marionette through an unpredictable, self-serving dripping of earmarked funds. </p>
<p>This places the WHO at the mercy of politics and bureaucracy – a self-reinforcing cycle paid for by donors. </p>
<p>Rather than rely on earmarked funding to get the WHO to do the most important things and do them well, Australia could drive fundamental governance reform to break the post-World War II mindset of government-driven stranglehold. </p>
<p>We could work toward shaping a global health agency structured and equipped to respond to the health needs of the twenty-first century. </p>
<p>This would be more in keeping with our overriding commitments to better coordinate aid with other donors. </p>
<p>It falls on us as voters and tax payers – as the review correctly points out – to keep watch and to demand the best from our development assistance, whether in the pursuit of health, nutrition, education or any other basic right.</p><img src="https://counter.theconversation.com/content/2351/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate Taylor previously ran the Global Health Initiative at the World Economic Forum and worked as the Vice President for Global Vaccine Policy and Public Health Partnerships for GlaxoSmithKline.</span></em></p><p class="fine-print"><em><span>Rob Moodie was the CEO of VicHealth from 1998-2007 and chaired the National Preventative Health Taskforce and is currently serving an advisor to the WHO on NCDs.</span></em></p>
Ever since the global financial crisis, “value for money” has become the slogan of choice for international aid. The Americans have been in the lead, changing the rhetoric and practice of how they give…
Kate Taylor, Visiting Fellow at Nossal Institute for Global Health, The University of Melbourne
Rob Moodie, Professor of Public Health, The University of Melbourne
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/1474
2011-07-05T04:09:23Z
2011-07-05T04:09:23Z
Explainer: Diabetes and obesity – the biggest epidemic in human history
<figure><img src="https://images.theconversation.com/files/2090/original/Psammomys_obesus_Tino_Strauss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Psammomys obesus or the Israeli sand rat provides an insight into how the thrifty gene hypothesis may work. </span> <span class="attribution"><span class="source">Tino Strauss</span></span></figcaption></figure><p>In the last few decades, the number of people with diabetes has more than doubled globally, making the combination of type 2 diabetes and obesity (known as diabesity) the largest epidemic the world has yet faced. </p>
<p>The most recent global predictions suggest that currently there are 285 million people with diabetes worldwide; in Australia alone, there’s been a 300% increase in the number of people with diabetes over the last 30 years. </p>
<p>Recognising the gravity of the situation, the United Nations General Assembly unanimously passed a resolution declaring diabetes an international public health issue on December 21, 2006. </p>
<p>This is only the second disease after HIV/AIDS to attain such an important status. </p>
<p>Diabetes is a chronic disease, which, through complications, can impact seriously on the quality of life of individuals and their families through premature illness and death. </p>
<p>Because it affects people who are still in the workforce, it has a major impact on both individual and national productivity. </p>
<p>So, how is it that a relatively uncommon disease in past times now poses a magnitude of global threat to societies akin to climate change? </p>
<h2>The thrifty gene hypothesis</h2>
<p>To explain this, the late James Neel, a renowned American geneticist proposed the “thrifty gene” hypothesis. </p>
<p>He suggested the gene or genes for type 2 diabetes – formerly known as adult-onset diabetes – conveyed a survival advantage to early hunter-gatherer and agricultural societies.</p>
<p>This is because such societies were subject to periods of nutritional hardship: “feast or famine” scenarios. </p>
<p>Neel proposed the thrifty gene prompted fat deposits in the body during periods when food was abundant, providing the basis for survival during periods of food shortage. </p>
<p>But the modern, sedentary lifestyle with its over nutrition and continuous “feasting” means the gene has become a disadvantage. </p>
<p>It now inclines people to develop obesity and diabetes. </p>
<h2>Lessons from the Pacific</h2>
<p>The Pacific island of Nauru is now in the news for political reasons. But, in 1975, I was discovering that it had the highest rate of diabetes of any nation in the world. </p>
<p>Nauruans present an extreme case of how type 2 diabetes can rapidly reach epidemic proportions and illustrate the role thrifty genes may play.</p>
<p>The same epidemic is now emerging in other developing countries and indigenous communities such as our own Aboriginal and Torres Strait Islander peoples.</p>
<p>The high diabetes rate in the Nauruans was attributed to the change from a more traditional diet and way of life to a modern one – we used the term “Coca-colonisation” to describe it. </p>
<p>There’s very limited food produced on the island so nearly all the food was imported western products – and most of it had dubious nutritional value.</p>
<p>Despite its appeal, the thrifty gene hypothesis is somewhat controversial because it’s difficult to prove in human populations unless an environment similar to that of the Nauruans is reproduced and the population studied for 30 to 40 years. </p>
<p>However, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2477729/">the theory finds support</a> in an excellent animal model of obesity and type 2 diabetes in the Israeli sand rat. </p>
<p>This desert-dwelling, burrowing rodent is native to desert regions of the Middle East, where it exists on a diet of saltbush. </p>
<p>In their native environment, Psammomys obesus remain healthy with no evidence of diabetes or obesity. </p>
<p>But when they can access a relatively high-energy diet, a substantial proportion of the rodents develop mild to moderate obesity and severe type 2 diabetes within a few months.</p>
<p>Put them back into a desert environment, and within a few months, they lose their obesity and the diabetes is reversed.</p>
<h2>A new theory</h2>
<p>Another theory now gaining considerable momentum emphasises the importance of events during gestation: the focus here is on the intra-uterine environment. </p>
<p>This theory suggests that the intra-uterine environment, and in particular, maternal diet, influences the risk of developing type 2 diabetes. </p>
<p>The classic study that lends support to this theory relates to the Dutch Winter Hunger. </p>
<p>People who were conceived during the “Hunger Winter” of 1944-45 in the Netherlands have been found to have higher rates of type 2 diabetes and heart disease compared with those born when food was more readily available.</p>
<p>Their diabetes and heart disease have been attributed to the starvation diet experienced by their mothers during pregnancy. </p>
<p>There is growing evidence that exposure of the foetus in the uterus to poor maternal nutrition, tobacco use and alcohol will increase the risk of diabetes, obesity
and heart disease in adult life. </p>
<p>This scenario may explain the very high rates we see now, particularly in our indigenous population and other indigenous groups globally, and the spectacular rise of diabetes in countries such as India and China.</p>
<p>This theory highlights the need for a “whole-of-life” approach to the prevention of type 2 diabetes and heart disease. </p>
<p>Tackling diabetes and obesity is likely to be one of the
most important challenges for the Australian public health community in the 21st century.</p>
<p>It is a huge challenge for the global community and it is a battle that we can and must win.</p><img src="https://counter.theconversation.com/content/1474/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Zimmet does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
In the last few decades, the number of people with diabetes has more than doubled globally, making the combination of type 2 diabetes and obesity (known as diabesity) the largest epidemic the world has…
Paul Zimmet, Professor (Hon) at Monash University, Baker Heart and Diabetes Institute
Licensed as Creative Commons – attribution, no derivatives.