Your health is in your hands

Esteban S. Poni and Carlos Poni

The World Health Organization has identified globally 10 risk factors to human health: (1) unsafe water, lack of sanitation and hygiene; (2) indoor smoke from solid fuels; (3) high blood pressure; (4) high cholesterol; (5) tobacco consumption; (6) underweight (emaciation); (7) obesity; (8) alcohol consumption; (9) unsafe sex; and (10) iron deficiency. Together, these account for more than one-third of all deaths worldwide (see Table 1).

Unsafe water, sanitation, and hygiene (mainly through infectious diarrhea) cause 1.7 million deaths a year worldwide. Nine out of 10 deaths occur in children, mostly in developing countries.

Half the world's population (3.1 billion people) is affected by indoor air pollution due to cooking and heating fuel, leading to lower respiratory infections and chronic obstructive pulmonary diseases.

High blood pressure and cholesterol are related to excessive consumption of fatty, sugary, and salty foods. They become even more lethal when combined with tobacco and excessive alcohol consumption. Overall, high blood pressure causes 7 million deaths a year and cholesterol more than 4 million deaths.

Deaths from tobacco use in the year 2000 stood at 5 million people around the world–a jump of one million over the incidence in 1990. Smokers have death rates two to three times higher than non-smokers.

More than one billion adults worldwide are overweight and between 300 and 500 million are clinically obese. Half a million die annually in North America and Western Europe from obesity-related diseases. In industrialized regions like North America, Europe, and the Asia Pacific, at least one-third of all diseases are caused by tobacco, alcohol, high blood pressure, cholesterol, and obesity. More than three-quarters of cardiovascular diseases–the world's leading cause of death–are connected to tobacco use, high blood pressure, and/or high cholesterol/obesity.

Worldwide, alcohol caused 1.8 million deaths in the year 2001, or 4 percent of the global disease burden; the proportion peaked in the Americas and Europe. Alcohol was the cause of 20 to 30 percent of esophageal cancers, liver diseases, epilepsy, motor vehicle accidents, homicides, and other intentional injuries worldwide.

At least 27 percent of children (<5 yrs old) worldwide are underweight. This condition caused an estimated 3.4 million deaths in 2000, including about 1.8 million in Africa and 1.2 million in Asia. It was a contributing factor for 60 percent of all child deaths in developing countries.

Iron deficiency is the most prevalent nutritional deficiency in the world, affecting an estimated two billion people, and causing almost a million deaths a year. Young children and their mothers are the most commonly and severely affected. Vitamin A deficiency is the leading cause of acquired blindness in children. Iodine deficiency is probably the single most preventable cause of mental retardation and brain damage. Severe zinc deficiency causes short stature and impaired immune function and is a significant cause of respiratory infections, malaria, and diarrhea.

Globally, about 2.9 million deaths are attributable to unsafe sex. Most of these deaths occur in Africa. In addition, during 2001 more than 99 percent of HIV infections prevalent in Africa were attributable to the same behavior. Elsewhere, the proportion of HIV/AIDS deaths attributable to unsafe sex ranged from 13 percent in East Asia and the Pacific to 94 percent in Central America. Less than 30 years after its appearance, HIV/AIDS is the world's fourth single biggest cause of death (see Table 2). Currently 28 million (70 percent) of the 40 million people with HIV reside in Africa, but the infection is spreading rapidly elsewhere, as well. Life expectancy in sub-Saharan Africa is estimated at 47 years; without AIDS it would be 62.

What you can do to reduce and eliminate risks

Take a proactive stand for life. Those who do not take a proactive stand against the major risk factors to human health often become victims to disease and early death. “Eat, drink and be merry, for tomorrow you shall die” is not a motto for the ones who want to resist illness and enjoy healthful living. When faced with real threat to health, the passive presumption that nothing can be done will do more harm than good. Arguing for a pro-active stand means taking a possitive step against what contributes to the risk factors to human health. These risks must not be ignored.

Assume a responsible attitude to life. “I don't have it,” “I won't get it,” “I can take care of myself” are often the expressions of not the strong, but the irresponsible. When it comes to lifestyle habits like the use of alcohol, tobacco, or drugs, or when the temptation is irresponsible sex, the really responsible person will say No. Only the person irresponsible to oneself or one's family would say such things, as “I can quit it when I want to” or “I fell a victim to an irresistible attraction.” Instead, stand tall and firm. Be responsible. Take every precautions against these health risks, and don't fall a prey to any of them.

Do something positive. Don't assume a nihilist attitude that nothing can be done about the present condition. Great things can happen with small beginnings. Take, for example, the high risk of poor sanitation or lack of clean water. An entire community can be affected by this. Do something. Write to the local government. Organize self-help campaigns. A community so organized can clean up its neighborhood, provide basic sanitation, and be an example of healthy enviornment to others.

Do not put off what can be done today. Procrastination is the devil's great tool. Suppose the doctor has told you to quit drinking as your liver is damaged. You must take a stand for your health's sake. Don't justify your behavior: “Tonight is the big party, I want to have some fun one last time. I'll stop tomorrow.” That may never happen. If you are a victim of one of these risks of health, take action immediately.

Don't be apathetic. Apathy (i.e., a kind of exclusion through indifference in spite of indubitable evidence) leads a person to self-delusion. Such an individual knows that eating a low-fat diet, high in vegetables, fruits, and fibers, helps to decrease the risk of cardiovascular disease, but he still continues eating greasy foods with few vegetables, fruits or fibers. The result of such apathy is self-delusion, and eventually the person falls victim to ill health.

Interventions to increase wellness in your life

Interventions may be defined broadly as any preventive, curative, or rehabilitative activity where the primary intent is to improve health. Here are some tips for a better style of life:3

Improve your mental health

• Be realistic. Unrealistic people spend time and energy trying to force the world into their ideal picture. Realistic people modify their beliefs if sufficient evidence exists contradicting their viewpoint.
• Behave like an adult. Know who you are, what you are capable of, what roles you can play, and your place among your peers. Assess your strengths and weaknesses without relying on the opinions of others.
• Develop spiritually. Find beliefs and values that give meaning and purpose to your life as well as transcendent perspectives.
• If you consider suicide or have a history of hallucinations, progressive memory loss, delusions, or incoherent speech, seek professional help. Don't feel embarrassed. Mental illness is an illness like many others, and can be treated.

Make responsible choices about substance use

• Stop or decrease caffeine consumption. Caffeine produces physical dependence via physical tolerance–a need for more caffeine for the same level of alertness.
• Stop nicotine and alcohol use. These are highly addictive and dangerous drugs.
• Do not use or self-prescribe any medicine or drug without medical consent or prescription.

Make wise decisions about food and drinks

• Adults should eat a minimum of two servings of fruit per day and three servings of vegetables. (A child's diet requires professional advice, but in general, children after a year can eat “table-food” if the food is healthy and balanced.) Reduce deep-fried food, packaged cookies, crackers, processed snacks, and sweets.
• Reduce or stop regular (non-diet) soda consumption, which is the leading sugar ingestion source.
• Reduce white flour consumption. Unless labeled “whole wheat,” the floor is processed (the bran and the germ are removed).
• Reduce the intake of saturated fat (usually present in meat, butter, cheese, palm, and coconut products). This intervention reduces LDL, a bad cholesterol that increases the risk of heart disease.
• Choose moderate amounts of olive, canola, avocado, peanut butter (without added fat), and nuts (including peanuts, almonds, and pistachios).
• Consume products abundant in omega-3 fatty acids (an oil with a set of cardiovascular protective effects). Sources of omega-3 fatty acids include tofu and dark-green leafy vegetables.
• Eat foods rich in minerals. Iron (found in fortified grain products, dark green vegetables, and dried fruits) helps to treat ferropenic anemia, the most prevalent anemia in the world. Calcium (present in milk, yogurt, tofu, fortified orange juice, bread, and green leafy vegetables) helps to ensure adequate bone mass and reduce some muscle cramps during pregnancy. Always get calcium from foods. Only take supplements under medical advice. Zinc is found in whole grains, nuts, legumes, and soy foods. Iodine sources include iodized salt. Vitamin A sources include whole milk; egg yolk, fortified margarines, carotenoids from plants, green vegetables, and yellow fruits and vegetables.
• Consider the advantages of a vegetarian diet. Include a wide variety of plant foods minimally processed and unrefined. A well planned lacto-ovo-vegetarian diet can satisfy all the needs of a balanced nutritional diet. However, it is necessary to keep in mind two special considerations. First, people in a transitional diet need to reduce the ingestion of meat, poultry, and fish while progressively increasing the consumption of a balanced mix of vegetables and fruits. (The biblical book of Leviticus, chapter 11, can help you choose the most appropriate animal sources of food in this transition.) Second, vegetarians who want to exclude eggs and milk products from their diet will benefit from periodical medical consultations in order to ensure that the vegetarian diet remains balanced.4
• Get adequate vitamin D through 5-15 minutes of exposure to the sun every day. Fortified milk and margarine also help to keep a balance in the vitamin D and calcium metabolism.

Other important lifestyle choices

• Become physically fit through exercise. Fitness is adaptation to the demands of stress. You can exert yourself with moderate-to-vigorous exercise without becoming overly tired. Regular exercise can improve your cardio-respiratory function and increase your metabolism. Exercise increases blood flow to the brain and the production of neurotransmitters. It decreases risk of osteoporosis, improves immune system function, prevents injuries and low-back pain, and improves feelings of wellness and the life span.
• Maintain a normal weight. Your expected normal weight can be calculated by the Body Mass Index (BMI). BMI=Weight in kilograms divided by Height2 in meters (i.e., BMI=Wt/Ht2). In general, a BMI value between 18.5 and 24.9 is the normal range and should be your goal. (A BMI greater than 25 suggests overweight, while a BMI less than 18 suggests underweight or malnutrition.)
• Reduce your cancer risks. Avoid smoking, a leading cause of lung cancer. To prevent colon cancer, exercise regularly, eat a high fiber diet, and maintain within a normal weight. Men over 50 should have regular rectal tests to detect possible prostate problems. Women should have appropriate tests and screening for breast and cervical cancers. Avoid excessive exposure to radiation from the sun, tanning lamps, and tanning-salon beds, as these tend to cause skin cancer. For additional information about cancer prevention and treatment, visit http://www.cancer.org and http://www.yourcancerrisk.harvard.edu.
• Visit your doctor. Talk honestly to him or her about any physical concern. The following websites can help with a physical program of exercise: http://orthoinfo.aaos.org; http://www.acefitness.org; http://www.justmove.org; http://www.hc-sc.gc/ca/hppb/paguide; http://www,cdc.gov/nccdphp/dnpa.

Protect yourself from sexually transmitted diseases ( STDs)

• If you are not or have never been sexually active, or have a mutually monogamous relationship with an uninfected spouse, you are at minimal risk for STDs including HIV infection.
• The best prevention against STDs is sexual abstinence before marriage and faithfulness in marriage.

• Use your power as a citizen to request and demand action from your local authorities regarding public health. The most basic public health action is to keep a clean community. Demand efficient clean water services, waste disposal, sewage, solid waste/garbage, and food inspection.
• Take personal steps in preventing pollution. Set an example. Become a community leader. Defend the environment.

By being informed on these important matters and making wise lifestyle choices you will be able to significantly reduce your health risks and increase your well-being.

Esteban S. Poni-Ravagli (M.D., Universidad Central de Venezuela; Loma Linda University) is a physician with specialties in internal medicine and pediatrics involved in clinical research and scientific publications. His email: este3808@hotmail.com. Carlos A. Poni-Escobar has completed his premedical studies and is a teaching assistant at Loma Linda University School of Medicine in Loma Linda, California, U.S.A.

REFERENCES

1. The World Health Report 2002 and 2003. In www.who.int/whr/2002/overview.

2. E. Poni, “Taking charge of your health,” Dialogue 16(2004) 1: 8-10.

3. P. M. Insel and W.T. Roth, in Core Concepts in Health, Stanford University, 2004.

4. If you are a strict vegetarian, your doctor may recommend vitamin supplements to avoid vitamin B12 deficiency. However, cereals, soy beverages, and yeast can provide vitamin B12 to your body, thus delaying or decreasing the need for frequent medical interventions.