Thursday, Jun. 10, 2010

Irony in Progress

Many people marvel that the developing world still suffers from infectious diseases, such as tuberculosis, malaria and cholera, that haven't been rampant in the U.S. for decades. I am more stunned that in those same parts of the world, the largely noninfectious ills — cardiovascular disease, chronic respiratory disease, cancer and diabetes — still kill more people than AIDS, malaria and tuberculosis combined. We are showing progress in major metrics like infant mortality and life expectancy. But I am chagrined by the irony that any progress will be short-lived if diseases of the developed world reach pandemic proportions in the developing one.

One of the trade-offs of globalization is that as we become more and more connected, countries and cultures inherit one another's baggage. The factors most responsible for our health woes in the West are the terrible triad of poor diet, too little exercise and tobacco use. Traditionally, these culprits haven't been issues in the less-industrialized world. But as the good parts of Western culture, like its lifesaving antibiotics, seep into the farthest reaches of the rainforests and savannas, so do its cigarettes, video games and fast food.

Better trade in food and the reduction of economic obstacles means cultures that used to grow fresh vegetables and chase after unprocessed meats now have every problematic Western food item at their disposal just as we do. Processed, nonperishable foods filled with fat, sugar and calories are responsible for more than a billion overweight people worldwide, and the reach of these foods is growing. In Latin America, the Caribbean, the Middle East and northern Africa, the overweight portion of the population exceeds 30%. We are only in the acknowledgment phase of breaking our addiction to these problem foods in the U.S.; countries seeing warehouses full of megabrands for the first time are largely unaware of the dangers.

Lifestyles in the developing world have become more sedentary too. The Internet is a profound mainspring of human progress, eliminating traditional geopolitical barriers like oceans and bad governments and leveling the playing field between the haves and the have-nots in ways we never could have dreamed. But it also means more people are sitting down at computers rather than walking and biking to work. Once on the job, those who would have gotten exercise, say, working in agriculture are now employed in manufacturing and data-processing. From a quality-of-life perspective, this is wonderful. From the perspective of a heart surgeon, it's catastrophic.

Worst of all is the unconscionable increase in the sales and marketing of tobacco products in developing countries. According to the World Health Organization, at least a billion people worldwide are smokers, and more than 80% of them are from developing countries. I have spent a lifetime opening people's chests and seeing with my own eyes the damage tobacco does to hearts and lungs. As a physician, I also signed up for the responsibility of telling family members that their spouses and parents won't be around very long because of tobacco-ravaged organs. To see tobacco use in the developing world rise virtually unchecked is incredibly distressing. Smoking has declined in the U.S. largely because of the laundry list of steps imposed to make it difficult to pursue the addiction, like forcing people to leave restaurants to smoke and raising the price of cigarettes. But if you make it easy for people to smoke, they will. Awareness and antismoking campaigns that incentivize cessation and isolate tobacco users are necessary.

What else do the members of the terrible triad have in common? They are all completely within one's control. They all involve personal decisionmaking, and that means all of them are avoidable. The developed world's main export should be wellness, not chronic disease. Industrialized countries have a responsibility to make sure that when we send our miracle drugs, vaccines and super science around the globe to people who lack basic health care, we also send the miracle cure of prevention through education, lifestyle enhancement and healthy socialization. Real health is possible only when the entire sum of causes and effects is taken into account. If we defeat tuberculosis, malaria and cholera but the next deadly threat is our inability to get a handle on what we eat, our progress amounts to nothing.

Mehmet Oz is vice chairman and professor of surgery at Columbia University, a best-selling author and the host of the nationally syndicated television talk show The Dr. Oz Show