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Thursday, June 3, 2004

1-2 punch to modern health

LONDON -- In the "bad old days," tuberculosis and epidemics of infectious diseases were the main killers. In advanced societies today, the No. 1 killers are cardiovascular problems and various forms of cancer. Some of these diseases can be traced to hereditary causes, but lifestyle and environment are major factors. Although we probably cannot eliminate these factors entirely, we can certainly reduce their effects if we are willing to take serious measures to control the substances that cause us so much harm.

Most advanced societies have been forced by popular pressure to ensure that the worst types of pollution caused by dust, smoke, chemicals and industrial wastes are reduced, but the situation in China and in developing countries shows that much more still needs to be done.

However, tobacco, the biggest killer, is still allowed to thrive in many societies. In 1604 King James I of England colorfully described smoking tobacco as "a custom loathsome to the eye, hateful to the brain, dangerous to the lungs, and in the black, stinking fume thereof, nearest resembling the horrible Stygian smoke of the pit that is bottomless."

Medical evidence that smoking causes cancer (especially of the lung) and exacerbates heart disease and the effects of diabetes is incontrovertible, although smokers often attempt to argue that the case is not proven.

The tobacco companies and growers who earn large profits from tobacco sales have strong lobbies and deep pockets to fight cases brought against them. The tax derived from sales of tobacco products is a valuable source of revenue, reducing government willingness to take measures to curb the use of tobacco. Tobacco users argue that they have a natural right to smoke if they wish and that this right should not be curbed by the "nanny" state.

Tobacco users, though, rarely give adequate consideration to the rights of nonsmokers. They frequently dismiss without justification the dangers to health caused by "passive smoking" and the fact that tobacco smoke is offensive to many. They also object strongly when it is suggested that smokers should be forced to pay for the medical and surgical treatment that may well be needed to treat their addiction to tobacco and extend their lives.

Some 25 years ago in Washington, Americans used to think nothing of lighting up between courses at meals. The situation in North America today has changed beyond recognition as rules against smoking in public places and restaurants are strictly enforced to the relief of nonsmokers.

In Britain the situation has also improved. A disastrous fire in an underground station some years ago ensured that smoking is now forbidden on public transport, and most offices are "smoke-free" zones. There has been a significant decline in the number of smokers, especially among men. On the other hand, the number of young women smoking seems to have grown, and visitors to the city of London comment on the numbers of young women escaping their offices for a few minutes to smoke.

There are also still too many teenagers smoking, partly as a result of peer pressure to disobey rules. Health education on the dangers from smoking needs to be stepped up. Many British nonsmokers would like to see Britain follow the Irish example of banning smoking in all restaurants, pubs and public places. India apparently has also adopted a similar policy.

In other European countries, including France, Germany and Italy, many people seem addicted to smoking and their societies have much to learn about the health effects of smoking.

Japan has recently moved some way toward limiting smoking in public places, but Japan Tobacco was until recently a public monopoly and the price of cigarettes in Japan is still far too cheap.

Attention in Britain is now focused on the dangers arising from obesity. The problem is not yet of North American proportions, but it is alleged that 25 percent of men and 20 percent of women in Britain are now obese. Obesity increases the dangers of heart disease, diabetes and certain forms of cancer. The main causes seem to be an increase in the consumption of junk food and inadequate exercise.

A recent parliamentary report blames the government and the food industry for the growth in obesity. The Department of Transport is blamed for not doing enough to promote facilities for pedestrians and cyclists while succumbing to pressure from motoring organizations representing car users. The Ministry of Education is accused of selling off school playing fields and not doing enough to ensure adequate facilities for physical education and games. Young people in Britain have become crazy about football (soccer and rugby), but too often as spectating "couch potatoes."

The food industry is indicted for promoting junk food and fizzy sugar drinks to school children and not doing enough to cut down on sugar, fats and salt in prepared foods. The industry, stung by the current popularity of the Atkins low-carbohydrate diet, has begun to respond, but it is trying to protect a huge market and will need to do considerably more if it is to stave off increased regulation.

Japan seems less affected so far by the problem of obesity, but as the Japanese diet becomes increasingly Westernized (burgers and doughnuts) the problem will grow. Interestingly, Japanese cuisine has become highly popular in Britain. The Wagamama chain of noodle shops has attracted large numbers of customers, and sushi of a kind can be bought from sandwich bars and supermarkets. Japanese cuisine is seen as healthy in a different way from the Mediterranean diet with its emphasis on tomatoes and olive oil combined with red wine.

A modicum of red wine is now accepted as beneficial to the heart (to say nothing of its other encouraging properties), and wine consumption has been rising in Britain while beer consumption has been declining. But Britain has to do more to tackle the problems of alcoholism associated with the binge-drinking culture -- including violence and vandalism -- that has grown up around the country, especially among young people. Limited consumption of alcohol, as long as it is not combined with driving, is harmless and possibly beneficial.

Many Japanese seem to be unable, for reasons of their physical metabolism, to consume safely as much alcohol as Westerners. This has disadvantages as well as advantages. Overconsumption of alcohol is another danger to health, but it is not a new threat as a study of ancient history shows.

Hugh Cortazzi, a former British career diplomat, served as ambassador to Japan from 1980 to 1984.

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