Silent epidemic

At its annual meeting last July, the National Academy of Science and Technology (NAST)—the country’s highest government scientific advisory group—declared an epidemic that claims the lives of some 300,000 Filipinos a year.

NAST was referring to a “crisis of lifestyle-related, noncommunicable diseases” including strokes, heart attacks, cancer, chronic lung diseases and many more ailments.

It was an important wake-up call. We fear infectious diseases much more than noncommunicable diseases (NCDs), in part because so much media attention is skewed toward those infections, especially when they are new and mysterious. Entire societies have panicked over some infectious diseases: When HIV/AIDS first emerged, all kinds of strategies were proposed to isolate those who were infected. And in response to Ebola, health workers went around dressed like astronauts.

With Ebola, what we’re seeing is not an epidemic but outbreaks, several of which have occurred since the 1970s. The latest is still ongoing and has claimed some 11,000 lives—a large number, but certainly much smaller than the number of lives claimed by other diseases, especially NCDs.

Meanwhile, people die by the thousands each day in the silent epidemic of NCDs—silent at least to most of society, but not for the patients and their families.

Old and young

We are aware of the strokes and heart attacks because these are often dramatic, standard staple for telenovelas, usually to show an elderly person dogged by problems—poverty, or, for some aristocratic patriarch or matriarch, family intrigue—suddenly gripping his or her chest and dying in agony.

The reality is more grim. Strokes and heart attacks, which we used to associate with the affluent, claim victims from all social strata and from among the elderly and the young. We have all heard about deaths of fairly young people after a stroke or heart attack, and we wonder why we have such cases.

Few lay people are aware of the widespread prevalence of “metabolic disease,” a cluster of conditions—increased blood pressure, high blood sugar levels, excess body fat around the waist and abnormal cholesterol levels—that increase risks for diabetes, heart disease, stroke, even kidney disease. These conditions involve a lifetime of treatment that is so expensive that I’ve even heard wealthy family members complaining about the costs.

Yet I observe that even medical schools continue to offer their guests sodas—implicated as a major culprit in metabolic disease—when I’m invited to speak.

NAST explains that NCDs are caused by “smoking, consumption of unhealthy food, and inadequate physical inactivity.” It prefers “NCDs” to the lay people’s term “lifestyle diseases” because the latter tends to reduce the problem to a matter of individual choice and obscures the fact that the choices are made in certain contexts and environments.

“People consume unhealthy food because unhealthy food is cheaper, advertisements surround us, and food establishments allow no choice,” NAST notes. I want to emphasize that last phrase: So-called lifestyle choices in many cases are a matter of “no choice.”

Just recently while buying medicines for my mother at a drugstore, I looked at a snack food that was labeled “low fat.” When I was reading the list of ingredients—15 of them, including all kinds of coloring agents—the woman next to me couldn’t resist and complained that the “low fat” label was a come-on, obscuring the many unhealthy ingredients, including high salt. She sighed and explained that she had to be extra careful because she had a son, 18 years old, with hypertension and obesity problems. She and I agreed that it has become difficult to go grocery shopping if you want to stick to healthy foods.

Habits and addictions

Smoking provides another case study to show our lack of choices. When you see a person in the slums smoking away, we tend to shake our heads and say, “Look at him. His children are probably hungry but he’s spending the meager household budget on cigarettes.”

We forget that he may have picked up the habit in an earlier era when TV was full of cigarette advertisements that used models projecting an image of health and wealth. Today, we ban tobacco ads but the cigarette producers have many other marketing gimmicks, including posters that inundate sari-sari stores and convenience outlets.

All around them, young people still imitate adults who smoke. In front of a Mercury drugstore I once spotted a security guard smoking away. Next to him were some urban poor boys playing. Think of the psychological imprinting here, with these kids looking up to security guards as alpha males.

I look forward to security-guard agencies strictly enforcing no-smoking rules for those on duty. But I would still worry about the kids’ community and home environments. If Tatay and, increasingly, Nanay, smoke, they may order the kids to buy cigarettes for them. Stella Quimbo, a health economist and professor at the University of the Philippines Diliman, recounted at a recent NAST forum that in a research project, it was found that when parents send their kids to buy the cigarettes, they sometimes tell the kids to light one at the store!

We don’t end there. Even if Tatay or Nanay doesn’t smoke, the kids are going to see their teachers smoking in schools.

NAST talks more about the illusion of lifestyle choices: “People don’t engage in sufficient physical activity because there is little access to open space, and no opportunities for nonmotorized transport.”

That’s why I smile when I hear fitness advocates urging people to exercise. One time I heard a proposal to teach yoga in urban poor communities, to lessen stress.

It is encouraging, however, to see local governments sponsoring fitness activities—usually aerobics and other dance activities—in town plazas. In malls, too—my most recent two encounters were in Quezon City’s Fisher Mall and Davao’s Abreeza—you have groups sponsoring fitness activities. The one at Fisher Mall was organized by a Rotary Club chapter and draws dozens of people—mostly women and a few elderly, so we do need to get the men out there.

But we also need health education campaigns to emphasize that you don’t need to do aerobics for exercise. Even brisk walking is exercise, and NAST is correct to point out we need more “nonmotorized transport.” While we push the national and local governments to provide more bike lanes, we should get large universities to also do so, and provide bikes as well for students, faculty and staff.

DPWH for healthcare?

NAST wants to make control of NCDs a multisectoral endeavor, and is calling for a national commission under the Office of the President. It emphasizes that you can’t leave NCDs to the Department of Health. So many other government agencies need to be brought in to fight the epidemic.

NAST mentions the need to tackle the designs of urban and rural infrastructure so there are enough spaces for healthy physical activity. We’re talking about the Department of Public Works and Highways getting involved in healthcare. And why not, indeed? We try to solve our traffic congestion problems by building more flyovers and roads, reducing spaces for pedestrians. In a few years, I hope, the government will recognize the value of biking; but by then, it will have realized that there are no spaces left to carve out bike lanes.

We need a multisectoral commission that can not only deal with the existing overwhelming problems but also project years ahead, and provide long-term, multisectoral—including civil society and organizations like the Rotary Club—solutions to this NCD epidemic that will offer, I hope, real lifestyle choices.

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