Is Public Healthcare Sick? (Part1)

By Dr. Eric Ulloa  In almost every country, including the so-called industrialized or developed ones, there is an epidemic of serious health maladies. 

Diabetes, obesity, and cancer as the leading causes of death and morbidity.

Public health measures have successfully curtailed diseases like cholera, malaria, gastroenteritis, childhood respiratory infections, and infectious diseases in general, but today they are not the main causes of illness or death, except in the most underdeveloped regions of the world.

While public health workers have rightfully celebrated their hard-won success in eradicating diseases like poliomyelitis and smallpox, there has been a silent recognition and sometimes, an ‘accomplice’ type of accommodation among professionals about what is also happening.
Between the years 1990 and 2000 there was a true epidemic of deaths, but not of avian influenza, H1N1 or any infectious disease, but of chronic disease like cardiovascular diseases (including heart attacks, strokes and diabetes), and cancer. In these cases, the assassins are not bacteria, parasites, or viral attacks.
We, are making ourselves sick{jathumbnail off}
Our unhealthy dietary habits, lack of exercise, and lack of self-control are the real culprits. “Yet, we blame others and bad luck, when we commit Hari Kiri…,”
The Lancet, published an editorial in March of 2004, titled the “Catatrosphic failures of public health”, which changed much of the focus of the public health debate to patient responsibility .
Let’s see the statistics of our own country, Panama. The primary causes of death are cardiovascular diseases, followed by cancer, and then accidents, suicide, and homicide. It is no different from countries like the United States or El Salvador.
We, our parents, and government are all responsible for the increase of these conditions.
The proliferation of fast food outlets and processed foods worldwide, has replaced to our detriment, the eating of fresh fruits and grains, fish and poultry, healthy foods that our grandparents knew instinctively were good for them. But of course, they weren’t exposed to CNN.
It has been shown that obesity is the precursor of metabolic syndrome, diabetes, many cardiovascular problems, and cancer. In the year 2000, it was estimated that 60% of the population 20-years or older in the United States was overweight or obese. It was estimated also that about 15% of the children were overweight.
It is well known that the amount of time our children spend watching TV or playing video games also contributes to obesity.
I remember my childhood when we used to play basketball or baseball with our neighbors. Today the neighborhoods are more commercial, with less parks and areas to play or ride bicycles.
But also the government has a large role that it is not playhing. Remember, in our country there is a Ministry of Education edict that makes physical education an optional requirement.
But diseases like HIV infections are still prevalent. The control has been placed on distributing condoms, or in some countries facilitating the “next day pill” instead of true sexual educations programs promoting self-control before our children get involved in sex activities. Many movies and TV programs promote promiscuity, the use of drugs, and violence.
The increase in traffic accidents is also an epidemic. It is not only that there are more cars circulating in thecountry. We seem to be less tolerant of both other drivers and pedestrians. Remember the recent incident of the teacher that fired a gun at another driver because he did not let him pass?
The use of alcohol and drugs might have something to do with this, as well.There is complete lack of driver courtesy: people dislike traffic lights; they grumble that they cannot make an illegal U-turn, or that they can’t blow through a pedestrian crosswalk or signal, scattering people like pins in a bowling alley.
There is also a lack of police enforcement of some traffic violations and sometimes it is the police car that breaks the law!
Smoking has been known to be detrimental to health for more than 40 years, but it was not until the last few years that the habit has trended downward.
Yet, I don’t think it was public health education that cut the smoking habit for many; instead, taxes boosting the price of cigarettes succeeded where doctors’ urgings and common sense failed.
So what can we do to stem the tide of unnecessary deaths?
I will try to provide some of the answers in my next column.
*Dr Ulloa is a practicing internal specialist and an advisor to the Ministry of Health.