1 October 2003

MANAGING THE HEALTH RISKS

Dinesh C. Sharma*

In today's fast-paced life, our health is under attack from innumerable sources - stress, environmental pollution, unhealthy work conditions, industrial smoke, unsafe water, noise and so on. The average number of visits to the doctor that we make for ourselves or for our children has gone up in the past decade or so despite the fact that health science and the medical field have witnessed revolutionary advances in the same period. In that sense, our health is at greater risk than what it was a decade or two ago.

It is everybody's wish to lead a healthy, longer life and to avoid visits to the doctor or hospitals. In order to do so, it is necessary that we identify risks to our health and then try to manage them. Although there are many definitions of the word "risk", experts of the World Health Organisation (WHO) define it as "a probability of an adverse outcome, or a factor that raises this probability". Going by this definition also, we see that there are countless threats or risks to human health. We all know about risks such as bacteria and the viruses that cause a number of infectious diseases. These risks sometimes cannot be prevented. When health experts talk about risks to human health, they are referring to factors other than viruses and bacteria.

A synthesis of research data and scientific evidence from different countries and regions has helped in defining the major risks to health globally. The WHO has recently published a report based on a massive world wide research exercise. According to this report, ten leading risk factors across the globe are : underweight, unsafe sex, high blood pressure, tobacco consumption, alcohol consumption, unsafe water, sanitation and hygiene, iron deficiency, indoor smoke from solid fuels, high cholesterol and obesity. Together, these factors account for more than one-third of all deaths worldwide!
This means that a relatively small number of risk factors cause a huge number of premature deaths and account for a very large share of the global burden of disease. The risk factors differ for the poor and the rich parts of the world. The top ten risks to health in the so-called rich or developed countries are - tobacco, blood pressure, alcohol, cholesterol, overweight, low fruit and vegetable intake, physical inactivity, illicit drugs, unsafe sex and iron deficiency. This is not to assume that these factors do not apply to people in the poor or developing countries. These factors also very much apply to the rich living in the developing countries. Overweight, obesity, physical inactivity, cholesterol and so on are certainly the risk factors for a lot of urbanites in India.

The risks from blood pressure and cholesterol - strongly linked to heart attacks and strokes- are also closely related to excessive consumption of fatty, sugary and salty foods. They pose greater dangers when combined with tobacco and excessive alcohol consumption. Obesity, a result of unhealthy consumption coupled with physical inactivity, is itself a serious health risk. Overweight and obesity lead to adverse metabolic changes, including increase in blood pressure, unfavorable cholesterol levels and increased resistance to insulin. They raise the risk of coronary heart disease, stroke, diabetes mellitus and even many forms of cancer. Globally, close to a billion people are overweight and 300 million of them are clinically obese.

Most of the risk factors discussed in the world body's report are strongly related to patterns of living and particularly to consumption - it can be a case of either too much or too little. While the poor - facing risks like underweight and unsafe drinking water - are suffering because there is little choice for them, the rich are suffering because they are making wrong choices in terms of consumption and activity. About 1.7 million deaths a year globally are attributed to unsafe water, sanitation and hygiene, mainly through infectious diarrhoea. Nine out of ten such deaths are in children, and virtually all of the deaths are in the developing countries. The WHO report says that while eating fruits and vegetables can help prevent cardiovascular diseases and some cancers, their low intake as part of the diet is responsible for almost three million deaths due to these diseases every year. At the same time, changes in living and working patterns have led to less physical activity and labour. The report finds that physical inactivity causes about 15 per cent of some cancers, diabetes and heart disease.

One must not sit back and wait for the governments and WHO to act. Start identifying risks to your health in your living and working environments. While obesity, physical inactivity and unhealthy food habits are all common risks and must be managed, there are other risks associated with individuals. Many of them are occupational, like low back pain which is a result of wrong seating or working posture. It is an 'ergonomic stressor' and is leading to serious diseases. A lot of respiratory diseases are associated with indoor smoke or dampness at home or at work places. This is in addition to risk from air pollution and particulate matter. Risks from injuries at work or while driving can be reduced by taking appropriate measures like wearing protective gear or seat belts. Unsafe health care practices can lead to serious injuries and exposure to diseases in clinics, nursing homes and hospitals.

So, the time to act is now. The WHO's report has only provided a new, scientific meaning to the age-old adage "prevention is better than cure". (Press Info Features)

*Columnist on science, technology and health-related issued.