MANILA, Philippines--?How young!? This has been the general reaction of people to the news about the death of presidential spokesperson Cerge Remonde at the age of 51.

Many of us have such reminders of our mortality closer to home. Late last year, I lost a cousin, a very successful lawyer, who was only 52. And last weekend, my partner?s stepfather died aged 57.

A hundred years ago, you were considered very fortunate, and very old, if one lived into his 50s. Today, to die in your 60s is still considered premature.

Life expectancy rates dramatically rose in the 20th century with the control of infectious diseases. This happened even before the discovery of antibiotics and came about because of general improvements in nutrition, housing and sanitation. Most of the lives saved were those of children, and that public health revolution is still happening today, boosted by vaccinations, antibiotics and simple oral rehydration medicine for diarrhea. (I just had to mention that last medicine, considered by the British journal The Lancet as the most important medical discovery of the 20th century.)

Because children have been surviving in larger numbers, life expectancy rates soared upwards in most countries over the last few decades. Today, the Filipino?s life expectancy rate is almost 70 years. (Note this is an average. In the National Capital Region the rate is 72, while in Tawi-Tawi it is 53.)

In the meantime though, we forgot about the other end of life?s spectrum. We are not doing enough to help people in their 40s and 50s to live longer, and to live well. For the older age groups, there are still threats from infectious diseases, TB for example, but more lives are now lost to heart diseases, cancers, accidents.

Many of these threats to adults have come about in the period after World War II and are related to lifestyle changes. Remonde?s cardiologist was quite blunt in TV interviews about what killed Remonde, rattling off risk factors: high blood cholesterol, smoking, being overweight. I?m not sure if he mentioned stress, which must have been tremendous given his position as press secretary.

I have written other columns about these problems but let me do a quick summary. The main risk factors are associated with unhealthy foods (and drinks), and while we load up on calories, fats and sugars, we are moving much less, tied down to our desks, moving around in vehicles. The problem is not just a matter of becoming overweight but of our hearts, our lungs and other vital organs becoming dull and lethargic. Exercise has been known to produce many other effects besides burning calories: it boosts the immune system and stimulates the production of many ?feel-good? chemicals in our body, helping us to deal with stress.

Fatalism

I suspect that there?s an element of fatalism involved here. When warned about their bad health, Filipinos will shrug their shoulders and go, ?Kung mamatay, di mamatay,? somewhat loosely similar to the English, ?When it?s time, it?s time. . .? The poor will say they just can?t afford the medicines and health care. The rich will blame genetics, naming relatives who died young.

Let me tackle the genetics argument first. Certainly, medical research in the last 10 years has shown a genetic link to many diseases, but other research, often poorly publicized because their language is overly technical, has shown that genes only spell risks and susceptibility, and that we can overcome many of those risks.

What about poverty? People tend to think that the poor die young because they can?t afford vital medicines. To some extent, that?s true but, as I will explain shortly that there?s more to health care than medicines and doctors. Moreover, studies show that even where health care is accessible, poor patients tend to feel so disempowered about their life that they will not be as motivated to take their medicines and initiate the lifestyle changes.

I have seen that happen all too often, even with the middle class, because serious illnesses are so catastrophic, given the expenses involved. I saw that with my partner?s stepfather. Over the Christmas holidays, battling diabetes, a prostate problem and hypertension while facing the threat of retrenchment in his office, he moved about with little cheer. I felt he had given up the spirit long before his body finally gave way.

In worrying so much about the cost of health care, people forget that a lot can be done to prevent and fight illness, at minimal cost or even resulting in savings, as you find with reduced dietary intake, or walking instead of driving. There has been more research now comparing different interventions for the most common diseases and they keep pointing in one direction: lifestyle changes count much more than medical procedures.

Last October, The Lancet published the results of a research study, the American Diabetes Prevention Program. The program focused on people with pre-diabetes, meaning those with high blood glucose (sugar) levels, but not considered to have diabetes. One group was given a placebo (a pill without any active ingredients). Another took metformin (known to many Filipinos as Glucophage) and another group had motivational counseling to exercise more and go on a healthier diet. The groups were monitored to see how many developed diabetes. The results were dramatic, demonstrating that lifestyle changes were more effective than metformin (and of course, placebo) in preventing the development of diabetes.

National Public Radio was able to highlight the importance of that diabetes study by interviewing twins Tim and Paul Daly. In 1996, Paul was diagnosed as having diabetes II, which is genetic. Doctors told Tim he had a 95 percent chance of developing diabetes. Tim enrolled in the diabetes research program I just described, and was given motivational counseling to help him lose 14 pounds (out of 200). No metformin, no medicines. He has not developed diabetes. (You can read the twins? story on http://www.npr.org/templates/story/story.php?storyId=122104219.)

I want to emphasize that lifestyle changes must include the psychosocial aspects, wonderfully captured in the New Year greeting someone texted me: ?Vive bene, spesso l?amore, di risata molto.? That?s Italian for ?Live well, love much, laugh often.?

Living well means eating (and drinking right), and it need not be an austere diet. The Italian greeting reminded me of the research looking into Mediterranean diets, which seem almost ?too rich? (read ?unhealthy?) at first glance, yet life expectancy rates in the countries around the Mediterranean are high. The research suggests that olive oil and wine help, but even more intriguing is the possibility that these diets are healthy because people in that region take their time with eating, and enjoying good company.

We need to redefine conviviality: When we feast and drink, we should be asking ourselves if we are focusing too much on showing off with the food and drink we serve and pressuring guests to binge. What we need to emphasize more is the laughing and loving that come with those gatherings.

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Email: mtan@inquirer.com.ph