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April 2010
Lifestyle Medicine
A solution to Modern Medical Maladies
Prof Adrian Kennedy

On this World Health Day (April 7th), lifestyle diseases send us urgent and unavoidable warning signals.
 

To understand this topic better, we need to start with the evolution of disease itself. Looking back, we see three major phases in the causation of disease.

  1. In early history and right upto the 15th century, violence and injury was the major cause of death. The average lifespan then was around 30 years.
  2. When man began to live in communities to protect himself from the dangers of marauding armies, the close interaction between humans, domestic animals and consequently with insects, infectious diseases like malaria, typhoid, plague, etc. became major killers. This was remedied in the 18th century with the creation of antibiotics, drugs and medication. The overall lifespan increased to 50 years then.
  3. Modern times are marked with automation, globalisation and abundance. This brings is to the current phase of modern degenerative lifestyle related ‘diseases of prosperity’.
Lifestyle Factors
The World Health Organisation (WHO) mentions that the major killers in the world today accounting for more than 80 percent deaths worldwide are lifestyle diseases like heart attack, brain stroke (60 percent) and cancer (20 percent). Where medication and hospitalisation are concerned, the 80 percent disease factor includes hypertension, diabetes, depression, asthma, obesity, arthritis, lung, liver and kidney disease etc, all of which are lifestyle related.

Lifestyle Factor (in India) Percentages
Physically unfit 70.00 Physically inactive 66.00 Low fruit & vegetable intake 66.00 Obesity 61.00 Sexually promiscuous behaviour 48.00 Stressful personalities 37.00 High fat intake 26.00 High sugar intake 23.00 Social drinkers 19.00 Smokers 17.33 Major problems 15.00 Automobile accident 14.00

Lifestyle in relation to health is defined as the diseases we get due to the way we live. It encompasses such factors as the food we eat, our levels of physical activity, mental stress and tension, and our social habits of alcohol and smoking. It also includes our safety adherences in relation to automobiles and sexuality.

Chronic Diseases
The result of our modern lifestyles is a spate of chronic diseases caused by inappropriate living. Chronic diseases are different from infectious diseases requiring acute care, in the sense that acute care usually requires hospitalisation, is of a finite period, and seven to 10 days of treatment results in a cure. Chronic ailments usually require lifelong medication and care, do not require hospitalisation, but at the same time reduce human productivity.

Ailment (in India) P ercentage High blood lipids 57.49 Digestive ailments 39.00 High blood pressure 32.87 Daily medication 31.00 Musculoskeletal problems 30.00 Diabetes 17.49 Neuro related disorders 16.00 Hospitalisation 11.00 Respiratory ailments 06.00
The hierarchy model of healthcare indicates that underdeveloped countries usually suffer from infectious ailments, developing counties have both infectious ailments and chronic diseases, and developed countries usually abound with chronic diseases only. India being a developing county has both problems.

Ageing and Longevity
The advent of modern medicine has certainly contributed to longevity, which is over 75 years in most countries. The problem is that with ageing and longevity, coupled with modern lifestyles, comes an increased disease burden. The extended period of life, post-retirement, is medically the most expensive.

In India today, we have a young population, meaning that the number of people below 40 years exceeds those above that age. Moreover, with improved medicare and increased longevity, the burden of chronic diseases in India will increase.

Today, the USA spends trillions of dollars to cover its healthcare costs, and along with Canada and Europe, will not earn enough to cover its medicare costs, by 2050! This means that future years with ever increasing ageing populations, most countries’ medical expenditure will exceed their income, unless something is done now.

6 Solutions
The WHO, in its document Healthcare 2015, has suggested the following solutions.
  • Healthcare systems must expand their current focus of acute care, to encompass the management of chronic diseases and most importantly, to promote the prevention of illness.
  • Consumer attitudes and behaviour must change. Individuals must assume personal responsibility of their own health and lifestyles.
  • The society’s attitude to lifestyle will need to change. Unhealthy lifestyles of obesity and inactivity should become as unacceptable as smoking or driving under the influence of alcohol.
  • Location of preventive care must shift out of hospitals and clinics. They should be provided in retail stores, pharmacies, at work and at home. Equipment should be easily usable as home kits. Computer based lifestyle solutions must be provided.
  • Today, the doctor is the centre of healthcare delivery, and the emphasis is on acute care and life saving. Preventive care should therefore be taken care of by health professionals including nurses, physician’s assistants, dieticians, physiotherapists, fitness professionals and psychologists.
  • Complementary medicine (diet, exercise, stress management) and alternative therapies (ayurveda, homoeopathy, acupuncture etc) should be widely utilised in view of their proven efficacy from several WHO sponsored studies. The objective should be to create an interactive system of Complementary, Alternative and Modern medicine (CAM) to manage chronic diseases.

Prof Adrian Kennedy is Managing Director, Wellness Rx, International guru on health, wellness and lifestyle medicine and guest faculty for Harvard Medical School, USA

    
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