World’s 4th leading killer

By Rufus Adedoyin

It is a known fact that chronic diseases (CDs) are the leading cause of mortality worldwide. While efforts are directed to reduce the prevalence of chronic diseases in advanced nations, prevention of CDs and other chronic non-communicable diseases (NCDs) are rarely on the public health agenda in Africa. Priority has been on infectious diseases.

Th e World Health Organization’s African Regional Offi ce documented that chronic non-communicable diseases are on the increase and already represent a signifi cant burden on public health services. The epidemiologic transition to chronic disease is said to be happening at a much faster rate in sub-Saharan Africa than ever witnessed in other regions of the world. Nigeria, being the Africa’s most populous country with over 170 million people, probably has the highest prevalence of chronic diseases in Africa. Inactivity or a sedentary lifestyle, poorly functioning digestive system, poor dietary habits, tobacco consumption, amongst others, are the common risk factors for cardiovascular diseases and other chronic disease.

Two public health revolutions, called epidemiologic revolutions as analysed by Terris (2001) have been discussed extensively in the literature. Th e fi rst began more than a century ago and addressed communicable diseases. Th e second public health revolution concerned noncommunicable diseases. It was heralded by the launch of Healthy People in 1979 in which the concept of health promotion was juxtaposed with disease prevention. Physical inactivity is one of the leading problems in international health watch. It is reported by WHO to be the fourth leading cause of death with most of those deaths in low and middle income countries. Hundreds of millions of people are living inactive lifestyles and therefore putting themselves at risk for numerous chronic diseases. According to Sallis (2011) changes in technology are making profound alterations to people’s activity patterns where mechanization and computerization at work over many years have dramatically reduced occupational physical activity. In the same vein automobiles have become the dominant form of transportation in most countries, severely reducing active modes of transportation. Adoption of this western lifestyle coupled with increase rate of smoking, poor diet, high salt intake have contributed signifi cantly to the reasons for increase in the prevalence of CVD in Sub-Saharan Africa. A few cases of sudden death resulting from heart attacks among the students and staff of the Obafemi Awolowo University (OAU) over some decades ago stimulated a study I conducted with my colleagues in 2006.

We randomly recruited 600 participants which comprised students and staff of the university and assessed their level of cardiovascular disease risk. None of the participants was found to be in the high risk stage of cardiovascular disease, however, majority (80%) were in the low risk zone. When the study was repeated 7 years later in 2013 within the OAU community, we recorded (4.1%) of people to be in the high-risk stage. Even though the percentage appears to be small, but the proportion showed that over 6,000 people are at the high risk of CVD within the campus. Percentage of the low risk had dropped to 61.1%. Stress (77%), inactivity (55%) and poor diet (36%) in that order were the strong factors attributed to the increase in the risk of CVD in the OAU community (Adedoyin et al 2006&2013) Table 2.

Th e fi ndings of this study have potential implications. A routine assessment of cardiovascular risk and blood pressure measurement could help to detect persons that are at the risk of cardiovascular disease. Thus, preventive measures should be put in place to reduce the morbidity and mortality rates. WHO estimates that 2 million deaths per year can be attributed to physical inactivity, making physical inactivity one of the leading global health challenges. Physical inactivity is a risk factor for three of the four leading chronic diseases such as cardiovascular disease, type 2 diabetes and cancers. Physical activity is defi ned as “bodily movement produced by skeletal muscles that requires energy expenditure” and produces health benefi ts, while exercise is a type of physical activity, defi ned as “a planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness.”

Physical inactivity denotes a level of activity less than that needed to maintain good health. The health benefits of physical activity include improvements is longevity, CVD risk factors, diabetes, obesity, osteoporosis, and mental health. Although CVD is reported to be evident in middle age, its onset starts from youth. In United States emphasis has been placed on achieving national objectives for improving eating and physical activity behaviors of adolescents to prevent chronic diseases. Th is is because the proportion of children and adolescents who are overweight has increased. Adolescence appears to be the most important period of risk for predicting adult obesity.

Adolescent obesity increases the long-term risk of adult morbidity and mortality, independent of adult obesity status and over 70% of obese youth become obese adults. Recommendation for physical activity in the adolescents consists of moderate to vigorous intensity movement through organized sports, play, walking, and cycling for at least sixty minutes daily. However, only about 30% of this age group meets the 60-minute exercise per day guideline. Studies have shown that walking to school is associated with higher overall physical activity.

In Nigeria proliferation of tokunbo cars (fairly used imported cars) and operation of Okada (motor bikes) for commercial purpose has reduced walking and biking as mode of transportation. Several organisations have identified environmental and policy interventions as the most promising strategies for creating population-wide improvements in eating, physical activity, and weight. Ecological models of behavior predict that the most effective interventions should work on multiple levels to change in psychological, social, policy, and physical environmental factors. Behavioural and social factors including environments can promote unhealthy food choices and discourage physical activity.

I wish to reiterate that heart disease and stroke are among the most widespread and costliest health problems facing the nation today, accounting for huge cost in health care expenditures and lost productivity annually. At individual level, families who experience heart disease or stroke not only have to deal with medical bills but also lost wages and the real potential of a decreased standard of living.

Prof. Adedoyin wrote from Obafemi Awolowo University, Ile-Ife, Osun state

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