As many of us try to consider and perhaps atone for past bad behavior (sins?) this Yom Kippur I want to point out a review that appeared in the September 5 issue of The New England Medical Journal. It was an article titled “The behavioral and dietary risk factors for noncommunicable diseases”. In other words, what are the worldwide behavioral misdemeanors that cause disease and death from noninfectious causes. There were a lot of graphs and statistics about the “death burden” of disease in men and women and the behavioral factors that caused them. I just want to give you some of the more startling statistics.
Let’s start with smoking… We all know that smoking impacts mortality from cancers, cardiovascular and respiratory diseases. It also effects diabetes and tuberculosis. Exposure of pregnant women and children and nonpregnant adults to second hand has also been found to be associated with infertility, miscarriage, premature delivery, fetal malformation, childhood respiratory diseases and many of the same diseases that are associated with active smoking. There are now more than 1 billion (that’s billion with a B) smokers worldwide and a rising number live in low and middle income countries. The prevalence of smoking has fallen below 20% in Australia and Canada and in areas of the US but has risen among men and women in Central and Eastern Europe, among women in some Western and Southern European countries, and among men in East Asia. An estimated 60% of men in some countries in Eastern Europe and East Asia smoke. Tobacco smoking and exposure to secondhand smoke together are responsible for about 6.3 million annual deaths worldwide and 6.3% of the global burden of disease. (In other words, we should consider that tobacco is one of the most deadly weapons that mankind has developed).
The next deadly sin that was listed in the article was alcohol. Alcohol consumption is responsible for about 2.7 million annual deaths and 3.9% of the global burden of disease. Alcohol is a major contributor to cancers, chronic liver disease, unintentional injuries, alcohol-related violence, neuropsychiatric conditions, and in regions such as Eastern Europe where there is a high prevalence of binge and harmful drinking, cardiovascular diseases. As a matter of fact, alcohol consumption is the leading single because of disease burden in Eastern Europe and is one of the top three risk factors along with high blood pressure and obesity in much of Latin America where it ranks ahead of smoking. In Russia and neighboring countries, men (especially those of low socioeconomic status) consume very large amounts of spirits either regularly or though binge drinking. Alcohol consumption may be responsible for 1/3 to 1/2 of death among young and middle-aged men in Russia!
Sin number three is excess weight and obesity. We know it increases the risk of disease or death from diabetes, heart disease, stroke, cancers, chronic kidney disease and osteoarthritis. It’s estimated that currently, excess weight is responsible for about 3.4 million annual deaths and 3.8% of the global burden of disease. According to the article, the global prevalence of obesity which is defined as a BMI greater than 30, doubled between 1980 and 2008 and is 29.8% among men and 13.8% among women. This is equivalent to more than half a billion obese people worldwide. The United States has had the largest absolute increase in the number of obese people since 1980, followed by China, Brazil, and Mexico. (Please don’t read this while you eat dessert…other than fruit!)
Next let’s go to diet and nutrition. The authors calculated that low dietary intakes of fruits, vegetables, whole grains or nuts and seeds or a high dietary intake of salt are responsible for 1.5% to more than 4% of the global disease burden. We know that Mediterranean diets are healthy, but recent data show that the consumption of animal fats and high calorie foods is increasing in Mediterranean countries such as Greece. There are even more drastic dietary changes in Asia; China is rapidly adopting a western, animal-based diet and has one of the largest worldwide increases in serum cholesterol levels.
I don’t want to leave the reader with the thought of “woe is the world and there’s nothing that can be done.” There are major successes and tobacco control in many high and middle-income countries and the hope is that these can be shifted to lower income nations. Harmful alcohol consumption and cigarette smoking has been curtailed by public policies including taxes as well as limits to age and place of use in many western countries. The governments in Eastern Europe and Latin America have to be pay attention to these successes and follow some of the same policies. There has also been progress in lowering blood pressure and cholesterol levels in high income countries and parts of Latin America. There is obviously much to be done as regarding weight gain and exercise. But once more on the plus side (a non weight comment), we have seen successful efforts in limiting trans fat and salt consumption. World-wide public health policies seem almost philosophical to most of us but each of us can start our own health policy with individual social and political decision-making and better health habits.
On this evening of Yom Kippur, I want to repeat the age old blessing: “May you be inscribed (next year and for many years to come) in the book of life”.