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Sunday, September 19, 1999
Doctors Worry Unhealthy Trends Will Persist
By Jackie Jadrnak
Journal Staff Writer
Envision the next century of health care and you might fantasize a glowing future of cancer cures, replaceable body parts, easy corrections of genetic flaws and maybe even a medical fountain of youth.
Or maybe your view of the future harbors darker prophecies: rampant euthanasia of the elderly and infirm, mobs of clones from millionaire madmen, and institutionalized discrimination against people based on their genetic code.
The view from some New Mexico doctors whose jobs focus on population health, however, is more down-to-earth. Their concerns center less on the unknown and more on already visible trends that spell trouble for the future. And many of their prescriptions go far beyond a new drug or medical procedure.
Consider income inequality. Some recent studies have shown that those with lower incomes are more likely to suffer disease complications and premature death, said Dr. Howard Waitzkin, professor and director of the division of community medicine at the University of New Mexico.
So one of the best ways to improve New Mexico's position in health rankings, he said, is to address poverty.
"If these (income disparities) are not addressed, conditions will continue to deteriorate," Waitzkin said. "In some New Mexico counties, mortality is similar to some Third World countries."
While poverty can influence certain lifestyle factors, such as diet or smoking, it also can correspond to more exposure to toxins. Some studies also have suggested doctors give less intensive treatments to women and racial minorities who tend to be over-represented in lower income categories, and some researchers have theorized that racial minority and poverty can lead to greater stress.
The next century's view of health has to look beyond the medical care system, said Dr. Norton Kalishman, medical director for the state Department of Health. You have to look at working conditions on the job, levels of violence in the home and community, exposures to toxic and hazardous materials, and even simple changes in a community that stem from economics or urban planning, he said.
"They take a market out of a community and put in fast food. That affects people's health," Kalishman said.
The future of health care should involve partnerships with communities and grass-roots activism, he said. "We see communities pulling themselves together, getting drug dealers off the streets," he said. "It comes from community activism and community involvement."
Health is becoming a class issue, said Dr. David Keller, director of infectious disease epidemiology with the state Department of Health. "If you have the means, you can exercise and eat the right food," he said.
"It blows my mind how many people consider a hamburger, french fries and soda a normal meal, that it's OK to have it for lunch every day of the week. ... One of the messages of the next century is that people's health lies in our own hands," Keller said.
The population increasingly is becoming more obese and more sedentary, he said. "Native Americans and Hispanics have an especially high risk for diabetes," he said. "Combine that predilection with an increasingly sedentary lifestyle, and you have a recipe for disaster."
Dr. David Coultas, professor of internal medicine and director of UNM's Center for Population Health, said he's worried about increasing tobacco use among youths. "Chronic diseases that result will manifest in 20 to 40 years from now," he said.
High rates of hepatitis C in New Mexico will lead to more cirrhosis and liver cancer down the road, he said.
More attention will be paid to the health of entire populations, with private doctors linking closely with public health, Coultas predicted.
And more attention has to be paid to social supports such as day care, elder care or home meals programs, Coultas said. "While technology has a role (in health care), we can't continue to develop that at the exclusion of other factors."
And closer attention has to be paid to what's in food and water, Keller said. "Food-borne infections will probably get worse before they're going to get better."
Also, "There's a lot of research on residual drugs in the drinking water," Keller said. "In the Rio Grande downstream from Albuquerque, I'm sure you'll find a lot of Prozac, Viagra in the water. It has to have an effect."
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