This week: On the Age of Gender Equality

SDG 5: Achieve gender equality and empower all women and girls

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“We need to empower women. Give women a voice in the decision-making process. Give women a political voice where they can champion, for their own welfare. And, of course, for us. United Nations – organizations, agencies – we need to do our part.” – Margaret Chan

Have a great Monday!

– Christiana

 

The Basics: Causes of Death

In the past I have written about how non-communicable i.e. non-infectious diseases make up four of the five global causes of mortality. I have also written about how this is, on the whole, a good thing. This article, although based on strong epidemiological data, is heavy laden in opinion.

The objective of this article is to provide a basic outline of the major causes of death. Everyone dies. And on more than a few occasions, I have heard the comments that all, in their own way, suggest that reducing mortality from specific disease causes is merely an exercise in pushing mortality from one disease cause to another; largely based on funding and location.

I wholly disagree with this sentiment.

It is my opinion that a major objective of improving global health is, beyond widening quality healthcare access for all, increasing the number of healthy life years lived by individuals and populations. In this regard, it is preferable to die of a stroke at older age than the next major influenza outbreak within the next five years, or tuberculosis, or pneumonia, or a lower respiratory tract infection. Moreover, the risk factors for most non-communicable diseases are generally modifiable.

The global reduction in childhood illnesses has been huge, although there is still much work to be done, particularly in Sub-Saharan Africa. Case in point: Diarrheal diseases are no longer amongst the top 5 causes of death. (Can you believe that easily treatable, diarrheal diseases were, until recently, amongst the top 5 causes of death?)

I’m glad we no longer live in that world. And whilst cancers, diabetes and cardiovascular diseases are a major force to be reckoned with within the next 15 years of the SDG era, and likely beyond, based on current trends, we are all projected to live longer. And to me, that says ‘improvement’. Even HIV positive individuals, adherently monitored on Antiretroviral Treatment, are living longer: according to some studies, as long or even up to two years longer than average life expectancy.

Most recent estimates place the top 10 global causes of death as follows:

  1. Ischaemic Heart Disease
  2. Stroke
  3. COPD
  4. Lower Respiratory Tract Infections
  5. Trachea, Bronchus and Lung Cancers
  6. HIV/AIDS
  7. Diarrhoeal Diseases
  8. Diabetes Mellitus
  9. Road Injury
  10. Hypertensive Heart Disease

This is important. It is not important to memorize this list, per se, as they are constantly changing. But it is important; as understanding disease profiles and trends is invaluable to understanding the current, global health landscape.

In future articles I discuss the major problem this poses to health systems, economic development and economic stability for individuals and communities, particularly in low and middle-income settings.

For now, have a stellar Thursday!

Reflection: On Sitting, Standing and Sedentary behavior

(a.k.a. Thoughts on my personal apathy and our collective ‘laziness’)

This is a reflective piece. And as such, it will be more personal than most of my writing. But true to form, it’s based on some pretty solid (albeit somewhat terrifying) science. You have been warned.

I’ll be honest. I’ve read the studies. There is a growing body of evidence that independent of diet and exercise, sedentary behaviour, being generally inactive, in itself, is a pertinent health risk.

Studies have found that independently, consecutive hours of sitting, at a desk, for example, is a major risk factor for disease. This means that regardless of whether you ride your bike to work, eat raw vegan everything (with kale), and hit the gym for an hour, daily; spending 5-6 hours at work, sitting in a chair, is a risk factor for a number of illnesses. In particular, cardiovascular diseases.

Think about this: it is easy to understand that a pack-a-day smoker who still manages to do daily, vigorous exercise and keep a healthy diet is still at risk of smoking-related illness, regardless of how admirably healthy the rest of their lifestyle may be. Similarly, ‘sitting’ has been dubbed by many as “the smoking of our generation.” (Lol: Fear-mongering alert. I should probably be taking this more seriously.)

‘Sedentary Behaviour’, as it is called, is measured in METs, a measure of metabolic activity. Light activity measures roughly 2.5 METs, standing 2.9 METs. The threshold for sedentary activity is 1.5METs or less.

Thus, all across the world’s trendiest work spaces from London’s Islington to Silicon Valley, employers are installing standing desks: keeping employees on their feet. Literally. And, I must admit, yours truly, too, has converted to using a (makeshift) standing desk, from time to time. Not necessarily because of the health benefits, but because it makes me feel like the kind of forward thinking, conscientious individual I would like to view myself as.

To be completely honest, thus far, I’m pretty apathetic towards changing my personal activity levels.

Unfortunately, it is this kind of apathy at personal and community levels that fueled the continued use of asbestos, even after the risks were well understood. It’s this kind of apathy that persists in the debates for environmental conservation and reform. And, it is likely this kind of apathy that continues to drive global overweight and obesity levels at the unprecedented rates of recent years.

The industrial revolution came and went. World over, fewer people are toiling on their feet in rigorous, manual labour and vocations. Increasingly, we are employed in occupations that are not conducive to high levels of activity. And this is increasingly true across the board – from high to low income nations.

More of us are sitting at a desk – (perhaps typing out a blog post) – slouched over our laptop or generally writing, receiving and rewriting e-mails; some place where the only opportunity for mobility is a trip to the photocopier or the restroom.

Despite my personal apathy, it was fairly easy to bring myself to write on the topic of sedentarism. The reason for this is clear; and it is demonstrative of one of the fundamental problems in health psychology as it pertains to global health.

On a personal level, such changes in lifestyle and habit seem almost unattainable. The mere concept that something as mundane (or even virtuous) as ‘sitting’ may be as bad for our health as researchers are saying is rather hard to digest. Nonetheless, for those of us like you and I who take an interest in public health, we do realize that at a population level this is, or could be, a problem; the gravity of which may be larger than we care to admit.

Another barrier to change is the opportunity cost of change. How will I reorganize my life to minimize sedentary time? And is it really worth it? Are we really that convinced? How conclusive is the data anyway? (Oh my goodness I will be freaking miserable.)

Our increased levels of sedentary time, though often reflective of positive outcomes in economic growth and technological development, indeed pose a major global health risk. Whilst there is still some debate as to the molecular biological forces driving unfavorable health outcomes, the correlational studies have shown clear association.

Unfortunately, hoping that tens of millions of at risk individuals the world over will read this blog post or even be exposed to the studies that I have referred to is a pretty long shot.

Dealing with non-communicable diseases is hard. We continue to see this with obesity. Sufficiently informing the public of health risks in order to facilitate behavioural change, without jeopardizing economic growth, and fostering the development of health positive behaviours on a population level, is a hard task. Moreover, getting people to care may prove to be even harder.

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(Source: americaninfographic.com)

So here are more of my signature, health-related, fictional allegories: How do you tell the self-employed, Burmese fabric maker, who has always seen purchasing an automated vehicle as a sign of financial success and stability for her family, that she is better off riding a bicycle? This is essentially an exercise in changing entire cultural views.

How do you convince the Togolese steel worker who, whilst forming part of the working class perhaps, aspires to one day make enough money that his family can eat meat with their dinner every night. How do you create the kind of paradigm shift that shapes, informs and changes culture sufficiently that at a population level, in discrete and distinct communities world over, people understand that this form of improvement in circumstance, and possibly subsequently, eating behavior, may pose a risk to his family? Not necessarily only for him, but for his children; who are now less likely to work on the steel mill and more likely to reach a level of education that secures them the kind of higher paying but less physically demanding occupation that demands protracted periods of relative sedentarism.

ACTION

I believe that the answer is multiple-fold. The broadening frontiers of prosperity need to expand with health ideologies and beahviours that are conducive to long, healthy life – wherever life is lived. Whilst the threat of communicable diseases still exists, advancements in health and access to healthcare mean that the majority of these are steadily on the decrease. Indeed, in many regions, health services are dealing with the dual burdens of both communicable and non-communicable diseases. In my opinion, the threat of disease associated with inactivity is real; and with mean life expectancy rising globally, it is relevant in high, middle and low-income nations.

The Sustainable Development goals make great provision for non-communicable diseases. However, unlike its predecessor, the document is fairly (deliberately) vague about which NCDs are of particular concern. This is an opportunity. From a global health standpoint, will the risk of continued and increased sedentary behavior require mass action? Is the funding available? If YES to the former but NO to the latter, can funding be garnered? If this health risk is deemed worthy of global concern, this will require agreement. Global agreement. Acknowledging the existence of the problem and the need for action. (Sounds like an AA meeting already)

Secondly, once consensus is reached there will be a need for widespread community-based education that is appropriate to the social context. What we are suggesting are major shifts in lifestyle. One-size fits all approaches in any capacity are likely to be a waste of time and resources.

Ultimately, on a personal level, you (and your rear) will choose. The decisions that you make on a daily basis have an irrefutable impact on your health, health outcomes and life expectancy.

On a public health level, however, there is a need for the expertise of allied health professionals and health psychologists, who can aid in implementation of high quality policies and programs; and, vitally, community-based health workers, who genuinely understand culture and community, and work on effecting change without overwhelming populations (nor producing the same kind of apathy this knowledge elicited in me).

Have a stellar Friday!

Christiana

 

Read more:

“Are workplace interventions to reduce sitting effective? A systematic review” – W.J Brown et al, 2010

“Too Much Sitting: The Population-Health Science of Sedentary Behavior” – N. Owen et al, 2010