Saving lives through social action

As recently as the 1920s infectious diseases were still dangerous threats to health, modern medicine, especially the devel­opment of sulfa drugs and antibiotics, has greatly reduced the risk of death from infections. Today the most dangerous diseases are not contagious but chronic disorders. Four types of disease—heart disease, cancer, stroke, and lung disease—account for over 70 percent of all the deaths in the United States. While modern scientific medicine has been able to re­lieve the effects and arrest the progress of these diseases in individual cases, it cannot cure or prevent them. The findings of medical research emphatically suggest that the causes of cancer, emphysema, and circulatory disorders are not just physical but also social. The way we live is strongly affecting how healthy we are.

John Knowles, a physician and past presi­dent of the Rockefeller Foundation, believes that most Americans are born healthy and suf­fer from illness or premature death only be­cause of their own misbehaviour or an unhealthy environment. Prevention of disease, he argues, means giving up some "bad" habits—smoking cigarettes, eating too many fats, drinking too much, exercising too little, driving too fast. Knowles's prescription was borne out by a Cali­fornia study that found that longer life expec­tancy is significantly related to a healthy life style.

For five and a half years 7000 adults followed a few sensible rules:

Three meals a day at regular hours and no snacking;

Breakfast every day;

Moderate exercise two or three times a week;

Adequate sleep (seven or eight hours a night);

No smoking;

Moderate weight;

No alcohol or alcohol in moderation.

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Most of the leading causes of death would be affected by similar changes in the social envi­ronment. Eighty percent of the deaths from cancer and heart disease may be "premature"; that is, they occur in relatively young people and are believed to be preventable. Heart dis­orders and strokes (46 percent of all deaths) are related to diet, cigarette smoking, undetected hypertension, and lack of exercise. Cancer (22 percent of all deaths) is correlated with smok­ing, eating fatty and refined foods, and breath­ing chemically polluted air. Stress, the hallmark of modern urban societies, seems to play an important role in heart disease and strokes. Moreover, the emotional strain of adjusting to loss and change often precedes the onset of other illnesses. The death rate for widows and widowers, for example, is ten times higher in the first year of bereavement than it is for others the same age. In the year following a divorce those who are divorced are twelve times more likely to get sick than married peo­ple.

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There is much evidence to show that social action would prevent many of these deaths. Let us turn to a few recent examples of how changes in social behaviour have affected health.

Smoking. When the surgeon general's report on the link between cigarette smoking and can­cer was released in 1964, 50 percent of the adult population of the United States smoked cigarettes. By 1983, in part because of public education programs and restrictions on ciga­rette advertising, the proportion of adult smok­ers had dropped to about 30 percent. If ciga­rette smoking were stopped entirely, experts estimate that one out of five deaths from cancer would be prevented.

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Accidents. In 1976 Ontario, Canada, made it illegal to drive or ride in a car without wearing a seatbelt. Officials say the use of these safety devices is primarily responsible for the 40 per­cent drop in traffic fatalities between 1975 and 1982, even though there are many more carson the roads. In the United States new legislation and stricter law enforcement to curb drunken driving are credited with reducing 1983 traffic deaths to their lowest level in 20 years. Never­theless, experts warn that these measures tend to become less effective as time goes on, and that only a change in American attitudes toward drinking and driving will prevent greater loss of life in the future. Traffic accidents remain the chief cause of death in the 15-to-25-year-old age group.

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