An expert in disease prevention believes ageing populations and the rise of so-called Western diseases will cause serious problems, writes CLAIRE O'CONNELL
LIFE, IT’S SOMETIMES said, is a terminal condition. But for too many people around the world it ends prematurely due to causes that are potentially preventable – key among them being infectious diseases, a lack of clean drinking water and sanitation, and ailments such as cancer, heart disease and diabetes that were once considered “Western” but are rising alarmingly in developing regions.
Writing more reports isn’t likely to help, but co-ordinating aid efforts could, according to an expert on disease prevention who spoke recently at Dublin City University.
“Death is inevitable,” says Prof Peter Boyle, who directs the International Prevention Research Institute in Lyon, France. “But premature death, death before the age of 70 – at least half of those deaths are avoidable in the sense they can be postponed for many years until after the age of 70 within the current knowledge that we have.”
And looking at the numbers, things could get worse: Boyle has statistics and charts at his fingertips to show how the globe is gathering more people – another two billion or so are expected in the coming decades and middle-age bulges already swell in the age profiles of countries as populations live for longer.
With all those extra people on the planet comes a responsibility to feed and nourish them, provide them with drinking water and sanitation and as individuals live longer their risk of developing health complications increases, Boyle explains.
“Two-thirds of the people who have ever lived to the age 65 are alive today,” he says. “That is a sobering thought – these are the ones who are at high risk of chronic disease that you have to continue to treat for years and years.”
But when it comes to premature death, one of the prime causes boils down to the very basics: lack of access to clean water and sanitation, notes Boyle.
“Over 9 per cent of the global burden of disease could be prevented by improving drinking water and sanitation,” he says, describing how more than a billion people have no clean water, and 2.6 billion do not have access to sanitation.
“If you don’t have water, you are going to die. About two million children under the age of five every year die from diarrhoea – they get the diarrhoea because of drinking dirty water and there’s no clean water to rehydrate them afterwards. It’s a vicious circle.”
The big increases in the global population are going to come in what are now lower income countries, he adds. “While the issues of water and sanitation and nutrition are paramount for our global society, they are now likely to be exacerbated by the impact of climate change. It is a huge challenge for global public health.”
And as communicable diseases, including HIV/Aids, continue to ravage populations and families in poorly resourced regions, there’s another time bomb ticking. The diseases we would previously have labelled as “Western” – heart disease, cancer and diabetes – are rising at an unexpectedly rapid rate in developing and emerging countries, explains Boyle.
“There’s a tsunami of chronic disease coming as the population increases and the population ages more,” he says, citing the rise in cheap cigarettes and junk food in low-resource settings, plus people moving to cities and so reducing their physical activity.
“These western diseases – cancer, diabetes, cardiovascular disease – are increasing in these populations at a rate which is much, much quicker than anyone anticipated, and their health systems at the present time cannot in the majority of cases cope with the current situation, let alone what is going to happen.
“The successes in treating communicable diseases like HIV/Aids in lower resource countries will actually increase the burden of chronic disease since it will contribute to more people living longer.”
In Africa, patients commonly present late with cancer, in part due to the stigma surrounding the disease, according to Boyle, a former director of the International Agency for Research on Cancer.
“In Africa, the stigma associated with cancer is an order of magnitude worse than it even was 40 years ago in our community, so the first thing we have got to break down is the stigma, so that people will not be ashamed or frightened to consult with the medical profession at an early stage.”
And while cancer will be a huge problem in Africa in coming years, diabetes and its associated problems of blindness, kidney failure and diabetic foot damage will be an even greater issue, Boyle suggests.
“In Africa, you cannot have the five or six serious sub-specialties that you need to treat a disease like diabetes and its sequelae, because you don’t have the medical staff or the nursing staff or the infrastructure support,” he says.
“A in Ireland can virtually have a normal life expectancy if it is well managed. But it’s a death sentence in the current situation in most of the low-resource countries, particularly the African countries.”
Meanwhile smoking – which can push up the risk of various cancers, heart disease and diabetes – has been subject to bans in several European countries and US states, but can continue to be promoted unfettered in many lower-resource regions, notes Boyle.
“If you go to one of the low-income or lower middle-income countries at the present time, you will see smoking like you saw in Ireland 30 or 40 years ago,” he says.
In the face of the present and looming health catastrophes, what doesn’t work is more paperwork and administration, according to Boyle, who argues that instead we need more co-ordinated efforts on the ground.
“What we have been doing too long is forming committees, making declarations, writing reports – it’s obvious that is a broken model,” he says.
“What we need now I believe is co-ordinated international action. We have examples like Oxfam and Feed the Children which are doing fabulous work and it’s all action, but there’s a need for co-ordination. It’s not going to cost much money or take a lot of people, yet the impact could be enormous if you could co-ordinate the work of these charities and harness the tremendous goodwill that exists in the general population in the high-income countries.
“Governments must take a lead. We are living in challenging times as far as public health goes but the irony is that we know enough to prevent the majority of the killer diseases, especially in middle age.”
