LIVING CONDITIONS ON THE PLANET HAS CHANGED STRONGLY: climatic shifts, migration, new technologies – all this and much more affects, directly or indirectly, human health. Now the WHO and the UN are seriously concerned about the so-called invisible epidemic – and this is not about exotic infections. Experts say that non-communicable chronic diseases, including diabetes mellitus and cardiovascular, oncological, and respiratory diseases, are turning into an epidemic. Together with the WHO representative in Russia, Dr. Melita Vuinovich, we tried to understand the forecasts and what can be done to protect our health.
The prevalence of noncommunicable diseases is growing all over the world, and, according to the WHO expert, Russia is no exception. Every year around the world 41 million people die from non-communicable diseases – this is 71% of all deaths; in our country, these diseases are the main cause of death and disability. Until a few decades ago, it was believed that chronic diseases were a “burden of the rich”: they were characteristic of countries where people could afford to move a little, overeat and spend money on cigarettes and alcohol. But the situation has changed: already more than 80% of deaths from chronic diseases account for to low- and middle-income countries, where people used to die mainly from causes of malnutrition and infectious diseases. Local health systems are failing: in many countries they were built with an emphasis on fighting infections, and there are simply no funds for lifelong treatment of chronic diseases.
An important global trend is the relocation of people from rural areas to cities. Now more than fifty percent of the world’s population lives in cities, and by 2050 this figure will be two-thirds. The fastest growing urbanization is in Africa and Asia; in Japan and Russia it is even expected that the pace of urbanization will slow down in the coming decades. In countries with weak economies, cities are growing rapidly, and people do not have access to good medical care, and sanitation also leaves much to be desired. In addition, moving to a city is a change in lifestyle: urban people eat more high-calorie food, move less, smoke more and breathe polluted air. Aggressive marketing by tobacco, food and alcohol companies only contributes to the spread of unhealthy habits.
Large studies are usually carried out in America, Europe, including Russia, Japan – and scientists note that outside these countries, chronic diseases behave somewhat differently. For example, type 2 diabetes is usually associated with older age and obesity – but in low- and middle-income countries, it is increasingly being diagnosed in slim and younger people . There was a theory that children born to women who were starving or malnourished are especially sensitive to overeating throughout their lives – their cells “remember” about the hunger suffered by the mother, so the endocrine system simply cannot cope with a large amount of glucose.
Of course, global population aging also plays a role. For most of history, the proportion of elderly people did not exceed 5%, but now it has reached 15%, and by the middle of the century it will be about 25%. This trend is most pronounced in Japan and European countries, but gradually demographics are changing around the world. This means that there will be more and more chronic diseases and new types of them may appear. The picture is grim, but still about 80% of cases of diabetes and cardiovascular diseases are preventable, as well as a third of cancers, and the risk factors for many of them are the same: smoking, alcohol abuse, unhealthy diet and lack of physical activity.
One of the measures recommended by WHO and other international organizations is global tobacco cessation. According to the calculations of scientists, smoking by 2030 will kill 8 million people a year. Many countries are acting decisively: Finland is going to completely phase out tobacco by 2040, Scotland by 2034, and New Zealand by 2025.
Melita Vujnovich says that Russia joined the WHO Framework Convention on Tobacco Control ten years ago. A national tobacco control law was developed (and passed in 2013). It is now forbidden to smoke in bars, restaurants, in stadiums, at the entrance to the subway, on trains, hotels, in schools, universities, hospitals. The sale of cigarettes to minors, sale in kiosks and stalls or near educational institutions is prohibited , and now a gradual increase in tobacco prices has begun. According to the Global Tobacco Use Survey (GATS), the measures were quite effective: from 2009 to 2016, the prevalence of smoking in the country decreased by 21.5%, including by 16% among men and 34% among women.
The benefits and harms of alcohol
Alcohol abuse is a risk factor of particular importance for our country, measures are being taken gradually – and, according to a WHO expert, they are working. Today, they include limiting the time and place of sale of alcohol, reducing the amount of alcohol advertising in the media, and toughening the punishment for drunk driving. As a result, from 2006 to 2016, Russians began to drink significantly less – from 17.1 liters of alcohol per person per year to 11.1 liters.
Scientists have long debated whether drinking alcohol in small doses is good for the body. Drinking alcohol in moderation has been shown to reduce the risk of myocardial infarction – but drinking large amounts of alcohol increases mortality. Alcohol abuse is associated with the risk of certain cancers (cancer of the esophagus, liver, intestines, breast), as well as death from injury and violence. People who drink alcohol are advised by doctors to stick to moderate use – and non-drinkers are advised not to start doing it “for the sake of health.”
Sugar, salt and fat
Melita Vujnovic emphasizes that only medical workers cannot fight non-communicable diseases – interaction with food production and the media is important here. In some countries (for example, Hungary) there are measures aimed at the production of products with a lower sugar content: according to WHO recommendations, an adult should receive less than 10% of the total calories from sugar, and ideally less than 5%. Another problem is excess sodium, which comes from not only salt but also processed foods such as bread, biscuits or cheese sticks. To reduce the risk of hypertension and heart disease, it is recommended that you eat no more than 5 grams of salt per day. You can limit yourself on your own – or, as in Portugal, you can increase taxes on ready-made salty snacks like chips and crackers. The WHO also recommends replacing trans fats with polyunsaturated fats – this is a very effective preventive measure. Denmark, Switzerland, Austria and several other countries have already introduced legal bans on trans fats.
When the global fight against chronic disease was just beginning, the largest food corporations said they were ready to change the composition of products, use responsible marketing and promote healthy lifestyles – but it turned out to be more difficult. Critics point out that many food companies are really trying to promote a healthy lifestyle, but they are shifting the emphasis – for example, they are focusing on the importance of physical activity. At the same time, it is known that the main risk factor for obesity is not physical inactivity, but an excess of calories in food.
Living a healthy lifestyle is both simple and difficult, scientists are looking for other prevention methods that could be applied to most people, including in low-income countries. We are talking about “polypil” – a universal tablet containing several types of medicines for the treatment and prevention of cardiovascular diseases. A similar drug could be prescribed to all people at risk (for example, everyone who is obese, high blood glucose, high blood pressure); the cost of such treatment should ideally be much lower than the cost of the combination of individual drugs.
Another pharmacological prevention method is vaccination. Despite the fact that cancers are non-communicable, some tumors (including cervical cancer) are caused by HPV infection, and liver cancer can be a consequence of hepatitis virus infection. Although vaccines against HIV and malaria do not yet exist, vaccines can protect against many other risks. And infectious diseases cannot be written off as defeated yet.
This year, the WHO has included “X disease” in the list of infections in need of priority study. This means that the emergence of new dangerous infections is possible, the causative agents of which are not yet familiar to science. There are millions of unknown viruses, half of which can be dangerous. Recent stories with the Ebola and Zika viruses show that known pathogens can suddenly change their behavior: the Zika virus has been known since 1947, and the Ebola virus has been known since 1976.
It is believed that global warming will also continue to affect our health: there will be droughts and floods, hurricanes and storms on Earth. This will lead to migration and possible conflicts – which means there will be more injuries, the spread of infections will increase, and the psyche may suffer due to increased stress. Humanity is able to cope with many global threats – but this requires that international organizations, scientists, governments, representatives of different industries and ordinary people act together and remember that we are all dependent on each other. And despite the unhealthy tendencies imposed by advertising, each of us can lead an active lifestyle, eat healthy foods and avoid bad habits.