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Ending poverty a path to wellness

Now that the children are back in school, perhaps more of us have time to consider the big questions, like “What can I as a parent do to make sure my child lives a long and healthy life?”

Though I haven’t heard exactly that question from parents who bring their kids in for well-child check-ups, many are expressing some approximation of this age-old concern. Fortunately, a massive study reported in two major medical journals has recently arrived to help answer the question. They discuss the “global burden of disease (GBD),” a concept that takes in both conditions that lead to death and those that lead to disability. The sheer volume of number crunching is mind-boggling; the articles summarize a vast amount of data, and I will summarize it further for you.

The papers, reported in the Journal of the American Medical Association and in the New England Journal of Medicine, present both encouraging and discouraging data, and give us some of our marching orders for improvement of the health of the U.S. population.

Here’s some of the good news: Overall, the burden of disease decreased a bit from 1990 to 2010, despite population growth and an aging populace. The burden from certain disorders has decreased markedly: HIV, for example, has seen a remarkable 61 percent decrease in GBD over those two decades, due to more effective anti-viral treatment, early detection programs and prevention of disease transmission – for example, from infected mother to her newborn.

Considering diseases susceptible to medical care, lower respiratory infections, largely pneumonia and influenza, cause 13 percent less GBD, and conditions having to do with prematurity – for example death and chronic disease due to immature lungs and cerebral palsy – are down a gratifying 25 percent.

But there’s bad news as well: though some of us (not I) are fond of saying that the U.S. has the best medical care in the world, we are slipping in terms of our relative position among developed countries on global burden of disease. In 1990, the U.S. ranked 18th of 34 economically developed countries in indicators of mortality and GBD; by 2010, we had slipped to 27th. (Who was first? Japan in both years.)

In the U.S., we’re seeing an increase in GBD due to both alcohol (26 percent) and other drug use disorders (85 percent!). And we’re seeing major increases in death and/or disability due to diseases seen primarily in the aged, such as Alzheimer’s disease (up 156 percent!) and osteoarthritis (up 56 percent). Diabetes is up a frightening 58 percent and the greatest effects of the diabetes-associated obesity epidemic appear to be ahead of us.

If you’re still with me despite those mind-numbing statistics, I’ll finally get around to answering my hypothetical parent question: What can we do about all that? The papers list a group of what I would call “intermediate causes” associated with disability and GBD. Top on their carefully researched list are dietary risks, linked especially to heart disease, but also to cancer, diabetes and other conditions. Dietary factors are also vital regarding the third on the list, high weight for height (body mass index) and fifth on the list (high blood sugar). Second is tobacco smoking; fourth is high blood pressure; sixth to ninth are physical inactivity, alcohol use, high cholesterol and drug use.

To deal with these intermediate causes, we need to improve the diet – increasing the quality while decreasing the quantity (of calories). All too often I hear parents speaking of their inability to get their children to eat good meals – all they want are pizza and soda. Parents should set good examples in what they eat and what they buy. Salt consumption has been associated with high blood pressure and fat consumption with high cholesterol; do we really need to purchase all those chips and fried Snickers bars? We need to promote healthy physical activity for the whole body (and not just our video-game thumbs!).

We need to prevent tobacco, alcohol and drug use. Again, setting examples and setting expectations are important. Children who say their parents have spoken with them about these substances have been shown to abuse tobacco, alcohol and other drugs less than children who haven’t heard what their parents expect of them.

I have used the term “intermediate causes” because I believe we also need to affect the root causes behind them. Chief among them is poverty – poverty is highly associated with interpersonal violence, substance abuse and poor nutrition. Poverty is not ennobling, as some would claim; it is a dangerous precursor to disease, disability and death. If we could prevent childhood poverty and its intermediate and long-term consequences, we would go a long way toward improving the U.S.’s position on the world scale.

Lance Chilton, M.D., is a pediatrician at the Young Children’s Health Center in Albuquerque, associated with the University of New Mexico. Send questions to lancekathy@gmail.com.

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