Cut the chocolate: Social dimension of health problems

A dramatic increase in the incidence of certain lifestyle-related diseases, such as cardiovascular disease, some forms of cancer, obesity and osteoporosis has accompanied the progress made by Western-type societies in recent decades. In Crete, for instance, where heart disease and obesity were practically unknown 40 years ago, recent research by the University of Crete demonstrated that childhood obesity has reached worrying levels. Why is this so? The method used until recently to deal with health problems, which involved pinpointing and treating individuals at high risk of contracting diseases, seems to have failed as far as the general population is concerned. One significant reason for this failure is that doctors’ or dietitians’ efforts focus on changing the habits of individuals at high risk, but the new habits, which are imposed in part, run counter to those in force in the individual’s immediate environment (parents and friends) or wider environment (society or country). Income and health Socioeconomic status plays a very important part in lifestyle. Nowadays, there is a new category of poverty to which experts affix the label of relatively low purchasing power. Recent World Health Organization (WHO) data show there are significant differences in the health of the rich and poor in Europe. These differences are partly due to the increase in sedentary lifestyles (and television is the cheapest form of entertainment), but also to dietary habits involving cheap foods which are high in fat and sugar, reduced consumption of fruit and vegetables, as well as increased smoking and alcohol consumption. It is thus wrong to say that obesity is an indication of prosperity. In fact, obesity is more common when educational levels and purchasing power are low. In Greece, unfortunately, the gap between rich and poor seems to be growing, and the recent, indirect redistribution of wealth brought about by the stock market crisis only widened it. Lack of exercise Though a brisk 30-minute walk a day can reduce the likelihood of diseases such as late-onset diabetes and coronary disease, attempts to promote physical exercise have been insufficient. Moreover, in order to maintain normal weight, people who lead a sedentary lifestyle must eat food that is lower in energy than those who exercise. But a low-energy intake harbors dangers because other ingredients, such as vitamins and minerals, which do not provide energy, may be consumed in insufficient quantities. A gradual reduction in physical activity equivalent to 500 calories per day has been observed in almost all adults in Europe. Breast-feeding Another factor known to influence health in childhood and adulthood is breast-feeding. All international health organizations recommend that infants are exclusively breast-fed until the age of about six months, and that breast-feeding should be the chief source of milk for infants up to the age of one year. Exclusive breast-feeding boosts infants’ immune systems and reduces the danger of their becoming obese and developing late-onset diabetes later in life. So it is strange that not only in Greece, but also in Europe in general, breast-feeding is not promoted at a national level. Only 21 percent of mothers in Great Britain and 8 percent in Northern Ireland partially breast-feed their babies after the sixth month. No data is available for all of Greece, Recent research has also shown that infants with low body weight at childbirth are more likely to have small head circumference and thin bodies, and are to develop coronary disease, hypertension or late-onset diabetes later in life, usually during adulthood. Women’s weight before they conceive, the amount of weight gained during pregnancy and dietary balance are all significant factors influencing the weight of infants at childbirth. Clearly, therefore, if public health is to improve, a number of professionals have to work together, including gynecologists, pediatricians, teachers, gym teachers, dietitians, town planners, employers and politicians. It is equally obvious that if people have to see a cardiologist or general practitioner, a whole social system may have been betraying them for years. But our society is structured in such a way at the moment that any changes will need a long-term effort, because of the many different, and often unconsciously conflicting, interests. What employer will help a mother breast-feed by creating the right conditions in the workplace or allowing her extra maternity leave? How much time do parents spend teaching their children what they need to know about a balanced diet (assuming that they themselves know) when they both have to work until late in the evening? How important are home economy classes – which deal in part with nutrition and physical exercise – when the sole purpose of school has become to ensure university entrance? How feasible is it to redesign cities and buildings so as to encourage people to engage in physical activity? About 40 years ago, Finland had the highest rate of heart disease in Europe. The Finnish government decided to embark on a preventive program, and in 1972-92 blood cholesterol levels fell overall by 13 percent while hypertension decreased by 9 percent. This led to a 55-percent decrease in death from coronary disease among men and a 68-percent decrease among women. But 20 years is rather a large time frame for those whose horizon extends only four years, namely the distance between two general elections. Thus in order to get results, a general consensus is needed, not among political parties, but among various social strata. When it comes down to it, everyone wants as long and as healthy a life as possible. *Antonis Zabelas is Assistant Professor of Nutrition and Food Science at Harokopeio University. Don’t you feel there is only a fine line between containment, the resulting infringement of democratic liberties, and the defense of democratic gains?