You … Your Health … Your Community. A Guide to Personal and Communal Health Problems Throughout the World, for VIth Form Students and Teachers

132 Pages·1970·3.06 MB·English

YOU...
YOUR HEALTH...
YOUR COMMUNITY
SONYA LEFF
M.B..B.S., D.C.H., D.P.H.
LONDON
HEINEMANN MEDICAL BOOKS LTD
First published 1970
© Sonya Leff 1970
SBN433 19100 7
Printed in Great Britain by
Spottiswoode, Ballantyne and Co. Ltd.
London and Colchester
List of Tables
Page
I Population distribution paterns . . . . . 5
I Total curent expenditure on health services . . . 9
HI Some major causes of sick absence from work . . . 3 2
IV Death rates from suicide, 1961-1963 . . . . 65
V Number and rates per milion of known narcotic addicts . 75
VI Proportion of children and older people in the total
population . . . . . . . . 1 1 4
VI Population aged 65 years and over, by sex and age . . 1 1 5
vi
List of Figures
Page
1 The geographical distribution of kwashiorkor 21
2 Excess mortality among overweight men and women . 24
3 The race between food and population 25
4 Dr John Snow's map of cholera deaths 36
5 Lung cancer deaths, United Kingdom 1920-1967 41
6 Mortality rate from tuberculosis, 1900-1960 46
7 Deaths from tuberculosis by age groups 47
8 Frequency of cough with phlegm and bronchitic illness 55
9 Suicide, death rate per million, England and Wales 58
10 Motor vehicle accidents, death rate per million, England and
Wales 63
11 Suicide rates by age, males and females 66
12 Addicts known to the Home Office by source of addiction 70
13 Addicts known to the Home Office by age 77
14 Cases of congenital syphilis, ages 0-5 years 83
15 Early infectious syphilis, England Wales . 84
16 Gonorrhoea, England and Wales . . . . 84
17 The growth of world human population . 89
18 National Health Service expenditure allocated to diagnostic
groups . . . . . . . . 110
vii
A cknowledgements
The material in this book has been developed from the experience of
talking to parents, teachers, students and school pupils. I would like to
thank the Health Department of the London Borough of Camden for
having encouraged me to develop this work. I would like also to thank
the many audiences who, by their interest and concern in health topics,
have helped in the development of the presentation of the material.
I am most obliged for permission to quote material from various
publications as detailed in the text. I would like to thank the following:
Professor Brian Abel-Smith, Dr R. D. Catterall, Professor Carlo M.
Cipolla, Dr. J. C. A. Davies, Evans Bros. Ltd, The Food and Agricul-
tural Organization, Geographical Publications Ltd, The Department
of Health and Social Security, The Nuffield Provincial Hospitals
Trust, The Office of Health Economics, Penguin Books Ltd, The
Royal College of Physicians, Mr Michael Schofield, The World
Health Organization.
I owe thanks to several of my friends who kindly read and
commented on certain chapters relevant to their professional interests:
Jayanta Baksi, Harvey Goldstein, Julian Leff, and Robin Weiss,
and particular thanks are due to Barbara Whitlock for reading the whole
manuscript and for making helpful comments throughout.
Vl l l
CHAPTER 1
What is Health?
All of you who pick up this book and start flicking through the pages,
will certainly have experienced at least one occasion of sickness. It may
have been a stomach upset, a cold, a common childhood illness like
measles, or a common minor operation like having your appendix out.
If you were asked to talk for two minutes on the topic 'What is
sickness?' all of you could find plenty to say. But supposing you were
asked to talk for thirty seconds on 'What is health?'; you would find
that it takes less than five seconds to say 'not being ill, feeling well', and
having said that you would probably wonder what on earth you could
say next!
Most of us take our good health for granted. Yet once our activities
are interrupted by even a three day cold, we appreciate at once our
normal state of well-being. Why should we try to understand the many
aspects of feeling really healthy? Should doctors concentrate on
treating disease? Why should doctors concern themselves with people
who feel well?
Traditionally doctors waited until people were ill and came to see
them for advice on how to get well again. Doctors learned about
diseases by recognizing similar conditions in different patients. They
learned to understand the natural pattern of disease and what treat-
ments made a helpful difference to the progress of the illness. Many
people may have the same disease at the same time but in different
parts of the country. That disease may appear from time to time
in different people. When a group of people suddenly gets the
same disease at the same time in the same place, we say that we
have an epidemic. In such a situation the doctor is no longer
treating an individual patient, but is concerned with a whole group
of patients.
Imagine a sudden outbreak of food poisoning at school. The doctor
cannot treat each person in isolation, but must look after everybody
who is a member of the school community. To halt the infection, the
doctor must look at all the people who are ill and ask what was the
common source of infection. He must find the source and stop new
infection of other members of the school. Instead of treating one
person, the doctor is watching a group of sick people and is preventing
the spread of the illness.
Once doctors had learned the techniques of preventing the spread of
1
2 You, Your Health, Your Community
disease, they asked, why not prevent the outbreak of a disease . . .
eradicate it altogether!
One of the exciting adventures in modern medicine is the battle
against smallpox. In 1796 an English doctor, Edward Jenner, intro-
duced vaccination to protect people against smallpox. This disease is
caused by a virus that thrives in human beings and is spread from
person to person. It is a very dangerous disease. Today, three quarters of
the world's cases of smallpox occur in India, Indonesia and Pakistan.
The smallpox virus in Asia is very deadly and kills four out of every ten
victims. If enough people in a community are protected against
smallpox by vaccination, the virus can no longer be spread from person
to person and the disease dies out. This state has been achieved in
England and elsewhere. If we could vaccinate enough people all over
the world we could wipe out this killer altogether. In fact we are
planning to do just this!
After the second world war, the United Nations Organisation was
formed to protect our state of peace and to promote good international
relationships. In 1948 the World Health Organization (W.H.O) was
founded as an agency of the United Nations. W.H.O. studies sickness on
a world scale and plans international programmes to conquer disease.
One of the first diseases that W.H.O. decided to tackle was malaria. The
anti-malaria programme is meeting with certain difficulties, but by
1965 eradication schemes had been started in 80 per cent of the
malarious areas of the world, in which 1,200 million people live. Today
W.H.O. is fighting smallpox. In twenty-one of the twenty-nine countries
where smallpox is rife, vaccination teams are probing jungle areas,
travelling rural lands in the tropics, seeking out nomadic peoples in
desert areas in a world-wide effort to eradicate this scourge. It is a truly
international campaign. The United States is providing help to nineteen
African countries; the Soviet Union has donated 75 million doses of
vaccine for distribution; Holland, Yugoslavia and Switzerland have also
donated supplies. Today when you walk around the streets of Bombay
or of New Delhi, it is common enough to see the faces of adults pitted
with smallpox scars, but the children bear a single vaccination mark on
their arms. If plans are fulfilled according to schedule, we should be
free of this killer by 1977.
But the doctors who met together in Geneva in 1948 to decide the
aims of W.H.O. were not content to think only in terms of wiping out
disease. They were equally concerned with the struggle to increase our
standards of health. They stated that health was not only the absence
of disease or infirmity, but also a state of physical, mental and social
well-being.
When your school doctor meets you at your routine medical check,
he must consider your physical health. He wants to know if you are
What is Health? 3
prone to certain diseases. He also wants to know that you are coping
physically with the daily school routine and with sports events. He
must check that you see and hear sufficiently well to join in all the
learning and social activities. He must make some assessment of your
mental and emotional development. If your teacher has noted that, for
no obvious reason, your work attainment is not matching your
expected potential, then the school doctor may be consulted. If you
have taken the initiative in approaching your teacher about certain
personal emotional difficulties, again your school doctor may be asked
to help and advise.
Today teachers try, not only to prepare people for examinations,
but also to meet the demands of growing independence. Schools today
try to prepare people for the social relationships that they will make in
the work and study situations that they will meet on leaving school.
Your school doctor may be invited to talk to classes about difficulties
in making good social adjustments. He can help in individual cases. He
can make arrangements to investigate inadequate housing conditions,
and can arrange extra help in homes where either of the parents may
suffer from ill-health.
The doctor who works in a hospital treats the illnesses that he meets
in his daily activities. The nature of his work is determined by the
problems that his patients present. The doctors who look after our
well-being must anticipate the pitfalls awaiting us, and try to strengthen
the weak links in our daily activities that may undermine our health.
How do such doctors decide which problems need the highest
priority? There are many clues to help decide this. Let us consider the
top killers. We keep a central register of all causes of death which are
entered on death certificates. By law such a certificate must be made
out for every person that dies. Sometimes the doctor can be very sure
of the cause of death. At other times he must rely on his judgment in a
less obvious situation. From these certificates we can see not only
which illnesses are most common today, but by comparing different
years we can see which diseases are losing or gaining importance. We
can compare the common killers of an industrial country with those of
a rural under-developed land. Comparisons between advanced countries
also show interesting differences.
One hundred years ago in England we would have found typhoid,
paratyphoid, tuberculosis, scarlet fever, dysentery and cholera listed
amongst the top killers. Today we find that heart attacks, strokes,
pneumonia, bronchitis, lung cancer, stomach ulcers and stomach can-
cer, accidents and suicide top our list. In other words, with improved
housing, better standards of nutrition, clean piped water supplies and
sewage disposal, we have vastly improved our standards of environ-
mental health and conquered the diseases caused by germs spread
4 You, Your Health, Your Community
through air, milk, water and waste. Other problems have now taken
prominence and these include diseases which are aggravated by modern
living standards . . . by atmospheric pollution, by over-eating, by mental
and by physical stagnation, by cigarette smoking and by poor design of
our urban environment.
You may say, that is all very well, but we all have to die of
something sometime. That is true. But what concerns us most is
premature death in younger people from accidents and suicide, or in
men at the height of their working careers from heart attacks and lung
cancer. Some illnesses make their worst effects by chronically under-
mining a person's health. We can look for these illnesses by asking
which disorders cause people to lose most time from work?
Every time someone is off work for more than three consecutive
days, his doctor must sign a sickness certificate stating the cause of
absence. From these we see that chest and heart disease, mental illness,
rheumatoid arthritis and accidents at work are the common disorders.
If we want a clue to the troubles of both our working and our
non-working population, we can look at the family doctor's case-load.
The minor disorders that the doctor most commonly sees are colds and
chest infections, stomach uspsets, skin troubles and minor mental
upsets. The longer term disabilities that occupy his time include chronic
bronchitis, prolonged mental illness, anaemia and high blood pressure.
The acute serious diseases that he deals with include pneumonia and
acute bronchitis. He would see about six new patients with heart
attacks every year and six with newly diagnosed cancers.
But much of the family doctor's work, and of the work of school
doctors and of doctors who work in mother and child welfare centres,
is concerned with the problems of broken homes, of lonely old people,
of families living in poverty, of unmarried mothers and mothers who
are divorced or widowed, of alcoholics and drug addicts, of younger
people on probation and of older people in prison, and with the
problems of all the other families who for one reason or another are not
coping and who seek the advice of medical workers. When we say
health is the absence of disease or disorder, we mean not only the
absence of physical complaints, but also the absence of mental ill-health
and of social disorder. The more carefully we study all the causes of
ill-health in our community, the better we are able to protect people
from such pitfalls and to promote the highest standards of health.
Let us compare the problems of a country like England with the
problems of a poorly developed community in Africa, Asia or Latin
America. For every thousand children born into an advanced com-
munity, 975 will reach their first birthday and the overwhelming
majority of these children will reach their fifteenth birthday. In a
poorly developed community only 750 babies would survive the first
What is Health? 5
year, and only half of the original thousand would be alive at age
fifteen years. Table I shows the life expectancy and the population
distribution in such communities. In the advanced community a large
proportion of the total population is of working age. In the poorly
developed community, half of the population consists of children under
the age of fifteen years. Moreover the working population consists of
both men and women. In advanced communities adult women are
playing an increasingly active role outside the family. In poorer
communities, where an adult woman lives only to her mid-thirties, most
of her energy is spent in childbirth and child rearing.
TABLE I. Population distribution patterns
Typical of a
Typical of an Poorly-developed
Advanced Community Community
Percentage Population
(i) Age less than 15 years 25 50
(ii) Age 15-64 years 63 48
(iii) Age over 65 years 12 2
Life expectancy at
birth (years)
average: for both sexes 70 35
We know that the chief problems in the under-developed countries
arise from poverty, dirt, ignorance and want. Throughout the world,
one in four hospital patients is ill because of infected water! We also
know that the battle against such problems must be fought by teaching
people about diet, hygiene, immunization, and child care . . . in other
words, repeat what was done in this country at the beginning of this
century. But if we carefully study the problems of an advanced
industrial country we shall see that health education is as much a
weapon against the diseases of an affluent society as against the diseases
of poverty.
In the following chapters we shall look at some of the influences
affecting our physical, mental and social well-being, at home, school
and at work. We cannot know all the answers to contemporary
problems, but at least we are beginning to ask some of the relevant
questions!