Thursday, February 16, 2012

Lifestyle Diseases 16: On Smoking and NCDs

Here's another paper from a cardiologist friend, Doc Tony Leachon. After his article, an article from Inquirer columnist Rina David, where she quoted Tony.

Things You didn't know about Smoking and Lifestyle-Related diseases

Anthony C. Leachon, MD

1. Consultant of the Department of Health on Noncommunicable or Lifestyle Diseases
2. Regent, Philippine College of Physicians
3. Cardiologist Internist, Department of Medicine, Manila Doctors Hospital

According to the World Health Organization (WHO), non-communicable diseases (NCDs) or lifestyle diseases are the leading cause of deaths worldwide. In 2008, of the 57 million deaths, 36 million people died due to NCDs. Deaths were attributed to cardiovascular diseases (48%), cancers (21%), chronic respiratory diseases (12%), and diabetes (3%).

1. Lifestyle - related disease is not a disease of affluence.The WHO Global Status Report (GSR) on NCDs for 2011 revealed that poorer countries are more susceptible to NCDs. High-income countries have 13% prevalence, upper-middle-income countries have 25% prevalence, while lower-middle-income countries like the Philippines have 28% prevalence. Low-income countries have 41% prevalence of premature deaths among citizens below 60 years of age. This is three times higher than the proportion of the high-income countries. Death rates from stroke, heart disease, COPD and cancer) is highest among poorer countries in the ASEAN region (Dans et al , Lancet 2010). One reason for greater death rate in the poor is that the poor smoke much for than the rich. The study likewise shows that smoking rates are highest among the poor in the ASEAN region including the Philippines, Malaysia, Vietnam,Laos, and Myanmar while rich countries like Singapore and Brunei have lower NCD death rate.

Prof Antonio Dans of the University of the Philippines College of Medicine said that Southeast Asia is facing the epidemic of chronic non-communicable diseases. Based on 2008 figures, 60% of all deaths in Southeast Asia are attributed to NCDs. Dr. Dans stressed that NCDs are not diseases of affluence but diseases of poverty.

In the Philippines, about 200,000 Filipinos die annually because of NCDs. “This is larger than any epidemic we have ever seen in the country,” said Dr. Dans.

2. Traditionally, NCDs are viewed as the diseases of the elderly, “therefore unavoidable.” However, based on studies, NCDs are now affecting even the productive age group from 15 to 59 years old. “Sixty percent of the disability causes in this age group are NCDs. This situation is greatly affecting the productivity and economy of countries,” said Dr. Dans. He further stressed that this figure is projected to increase to 75 % by 2030 if nothing is done.

While death or disability results to productivity and income losses, it also brings expenditures for medical care on families affected, leading to serious consequences, not only at the household level, but at the national level as well.

3. Based on National Nutrition and Health Survey ( NNHes) 2008, smoking does not just cause cancer and lung diseases, it is also the number one cause of stroke and heart attack ( 50,000 deaths per year). In fact, smoking causes more stroke and heart attack than diabetes, hypertension , obesity and high cholesterol.

“The prevailing risk factors varied among a country’s income groups,” said Dr. Dans. Physical inactivity among women is the prevailing risk factor in high-income countries, while smoking or tobacco use is the prevailing NCD risk factor among middle-income group countries like the Philippines.

4. We are challenging that lifestyle is a choice. “It is not, because we live according to what the environment provides us.” The medical profession has been unsuccessful in improving lifestyle despite decades of trying. Even medical professionals , with all their knowledge , find it hard to live a healthy lifestyle. Lifestyle is shaped by the environment. If food is expensive , people will eat unhealthy cheap food. If tobacco is cheap, people will smoke.

Prof Dans cited the strong connection between poverty and NCDs as an example. “

1. People in the lower socio-economic class have less access to disease prevention. Therefore, they have unhealthy lifestyles and have higher risk factors.

2. They have no access to treatment when they have heart diseases, lung cancer and other NCDs.”

3. Likewise, poor families do not have the money to finance treatments which leads to higher mortality rates.

Dr. Dans proposed several measures to promote healthy lifestyle: 1) legislative advocacy on proper food labeling (emphasizing food health risks and benefits), 2) implementation of sin taxes, and 3) legislation on healthy urbanization or creating infrastructure for healthy lifestyle in school, in workplace and the community.

Rather than begging individuals to live healthy, we should level-up our agenda towards a healthy environment and help promote healthy lifestyle in our society.

We make our goals in life. We define our own successes. We don't get to choose where we start in life ; however, we do get to choose the kind of people we become.

Breaking out of denial

While the Department of Health currently operates on an annual budget of P40 billion, the total annual expenditure for smoking-related illnesses (cancers, lung diseases and cardio-vascular complications, not to mention lower productivity, absenteeism and fires caused by cigarettes) total P400 billion.
Should Congress pass the “sin taxes” law, which would impose higher taxes on cigarettes, among other things, the government would be able to raise an additional P60 billion in revenues, money which could go a long way towards battling smoking-related ailments.
As they say: “You do the math.”
Dr. Tony Leachon, a consultant on non-communicable diseases (NCDs) with the DOH, presents these figures as part of his advocacy to raise awareness about the need to move from a mentality of “treatment and cure” to one of “prevention,” which in the long run is cheaper and more effective.
“We are currently facing an epidemic of NCDs, with six out of every 10 deaths in the country attributable to stroke, cardiac arrest, chronic respiratory disease, Type 2 diabetes and cancer,” Leachon said, speaking at the conclusion of “Moving as One,” a conference billed as “A Global Call to Action for a Public-Private Partnership for Cancer Care and Control.”
NCD’s are also called “lifestyle diseases,” and apart from an unhealthy diet and lack of exercise, Leachon singles out smoking as a culprit. Science has already determined the link between smoking and a number of diseases, but as Leachon points out: “We know it’s bad for our health and yet smokers allow themselves to suffer and die prematurely – this is really absurd.”
The sin taxes would, in theory, impose higher taxes on cigarettes and make them more expensive, putting tobacco out of reach of the young and the poor, the population most vulnerable to NCDs in both the short and long term. Another pending piece of legislation, which would require the use of “graphic” warnings on the health risks of smoking in cigarette packs – already in place in neighboring countries – could also help bring down the number of smokers and prevent more young people from taking up smoking....

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