Financial Daily from THE HINDU group of publications
Wednesday, Apr 07, 2004
Road to human health: Take a U turn
At the individual and family level, good health and long life have been a fundamental aspiration in every culture. The dictum "health is wealth" is universal. Perhaps, one can restate with equal validity that "population health is the ultimate wealth of a nation".
In a rapidly globalising world developed and developing countries have been changing at breakneck speed in search of boundless economic prosperity. This has been causing unprecedented social and cultural changes increasing urbanisation, environmental damages, crippling job market, jobless economic growth, and acceleration of income inequities among other things.
Though the consequences of globalisation have been well documented, the increasing threat to health from it has not been comprehended yet. Health is a complex matter: It depends upon physical, biological, environmental, economic, social and behavioural factors, among other things.
In 1977, Dr George Engel, a professor of medicine at the University of Rochester, proposed a "bio-psycho-social model" of health. According to this model, disease and health outcomes occur within a complex interaction of biological, psychological and social factors. This is a modification to the mainstream system of Western medicine, mostly anchored in the biomedical model. Dr Engel, in fact, provides an eclectic, "systems theory" approach for comprehending the interconnected determinants of health.
Surprisingly, back in 5 BC, Hippocrates, a Greek physician and the founder of scientific medicine, was the first to envisage the impact of social environments on health and disease. He also foresaw the importance of diet and nutrition, and environmental conditions in achieving good health. In fact, Ayurveda (6 BC) the science of life envisioned the importance of maintaining a balance between the microcosmic body and the macrocosmic world.
Also, traditional Chinese medicine highlighted the notion that internal harmony is essential, and changes in a person's mental, physical and emotional wellbeing would affect health. The World Health Organisation (WHO) aptly defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." In fact, this comprehensive definition reflects the time-honoured views of health.
A groundbreaking Ottawa Charter for Health Promotion culminated from the WHO's First International Conference on Health Promotion held in Ottawa in 1986. This Charter made the most imaginative recommendations "to put health on the agenda of policymakers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health." Furthermore, in 1997 the Jakarta Declaration on Heath Promotion into the 21st Century underscored the fact that social security, stable ecosystem, shelter, income, sustainable resource use, social justice and income equity, among other things, are the major determinants of health.
Despite a profusion of proclamations and valuable recommendations originating from the international conferences on health promotion, health agendas of most countries continue to be narrow focussed, with least emphasis on disease prevention and health promotion.
The dominant western medicine has been eclipsing time-honoured traditional medicine, and has left no room for other determinants of heath. Now, there is increasing realisation that modern medicine is just one factor in the complex equation of advancing human health, and many determinants fall outside the sector.
Bluntly put, one cannot rely on western medicine alone to solve the emerging health problems. In the altar of global market efficiency, we have tossed ecologically sustainable, equitable, and welfare-enhancing policies to the background. A sweeping globalisation has been increasingly constraining the governments in most countries in carrying out much needed "healthy economic and social policies".
Consequently, the road leading to human health and welfare has become increasingly hazardous in our so-called globalizing world bustling with mind-boggling accelerated economic activities. Far too long, countries have been ignoring the far-reaching negative externalities of all sorts, with varying time lags, arising from their myopic market-driven economic growth.
Though modern medicine has improved, there has been an onslaught of new and re-emerging infectious diseases. Whilst winning the war against communicable diseases remains a mirage, particularly in developing countries, non-communicable diseases, directly linked to lifestyle and behavioural factors, are increasing at an alarming rate.
According to the 1998 World Health Report, "The war against ill-health in the 21st century will have to be fought simultaneously on two fronts, infectious disease and chronic non-communicable diseases."
In the 1990s, 50 per cent of mortality from the 10 leading causes of death was attributed to lifestyle factors. WHO estimates that chronic diseases of modern lifestyle will cause more than 70 per cent of deaths by 2020. In fact, lifestyle-related non-communicable diseases (such as cardiovascular diseases, diabetes, and certain forms of cancers) are preventable.
The common risk factors include high cholesterol, high blood pressure, obesity, tobacco addiction and excessive alcohol consumption. These are mainly the result of exposure over many years, to unhealthy diets, physical inactivity, and stresses of modern life. Now, developing countries have been exposed to these risk factors at an alarming rate.
It is shocking that diabetes, a gateway disease, has been increasing at a fast rate in developing countries.
Consequently, they have been saddled with an increasing burden of chronic non-communicable diseases. The private healthcare costs have skyrocketed, and the public healthcare system has been far from satisfactory in dealing with the crisis. Health inequities are becoming rampant.
The impending crisis in the healthcare system cannot be averted by just spending more on disease care. Since most health determinants fall outside the health sector, the biomedical model cannot be relied upon solely to deal with the health crisis. In a recent conference, Dr Brian Smedley, at the Institute of Medicine in the US, noted that "we are also increasingly coming to understand that breakthroughs in medical genetics are not going to result in the overall population health improvements that has been the goal of public health for decades".
He emphasised that the greatest improvements in the nation's health will result from a better understanding of social factors that influence the health. It is worth mentioning that the Parliament of Sweden approved the Swedish Government's Public Health Service (Lines of Development) Bill in 1985.
While discussing the health issues, it observed: "The health risks in contemporary society take the form of, for instance, work, traffic and living environments that are physically and socially deficient, unemployment and the threat of unemployment, abuse of alcohol and narcotics, consumption of tobacco, unsuitable dietary habits, as well as psychological and social strains associated with our relationships and the lack of relationships with our fellow beings."
These risk factors contribute to the most common diseases, such as cardiovascular disorders, mental ill health, tumours and allergies, as well as accidents, as noted in the Bill. Now, there has been increasing evidence that the road leading to the so-called modern economic prosperity leads to chronic non-communicable diseases. This dramatically undermines the quality of life. It is time the route is changed. It is imperative that the health risk factors are eliminated by appropriate economic and social measures.
A broad-based health promotion strategy, as opposed to the conventional disease care strategy rooted in biomedical model, embracing the integration of various social and biological sciences, is required.
Research on health and human development must concentrate on the dynamic interaction between biological, environmental, psychological, social and economic factors that ultimately affect health and illness.
A shift in the development path is absolutely essential for improving the health of the population the ultimate wealth of the nation.
(The author is Emeritus Professor of Economics, University of Prince Edward Island, Charlottetown, Canada)
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