Developing Poor Health

Youth in Qatar (NYTimes)

In most of our discussions around obesity and other diseases associated with “modern life”, we tend to only address the United States and other western industrialized nations. There is another area of the world, however, that is also facing many of these same conditions and ones unique to their settings. Qatar (and other nations of the Middle East) has one of the highest rates of obesity in the world! A nice piece in the NYTimes examines how the privileged lives of native Qataris (less than a quarter of the country’s current population), fed by their nation’s oil wealth over the last several decades – rocketing them to developed nation status decades faster than the general trend has been – are literally making themselves unhealthy. Youth especially, who drive everywhere, eat multiple fast-food, high fat meals a day, and still follow the traditional practice of marrying first cousins, are seeing the devastating effects of speedy development more than anyone.

A couple of interesting aspects of Qatar’s situation jump out. First off, there are obviously cultural differences between Qatar, the Middle East in general, and older industrialized nations that make their circumstances unique. Religious beliefs and practices, social and gender hierarchies, and an environment that can be harsh (and hot!) has perhaps given Qataris less flexibility in their epidemiological changes (or more structure?) One of these elements is the traditional practice of marrying within your family, often a first cousin  known as consanguineous marriage. As many of you may know, reproducing within a small gene pool, like a family, causes any number of genetic disorders and birth defects. (Check out March of Dimes’ recent report on global birth defect trends.) Additionally, Qatar’s fast economic rise has created not only a population of super wealthy but of relatively poor as well. Qatar could be facing a dual-disease burden much like India is currently – India’s economic rise has had a negative health impact on both the newly rich (i.e. rising rates of obesity) and the continually poor (i.e. children dying of malnutrition).

The global health community should take note of Qatar’s story. In the U.S., we can reflect on the health downsides to economic growth (obesity, diabetes, CVD, etc.) and note that some of our health concerns are not isolated within our borders – the US has a malnutrition problem too! For the international development community and international health organizations, seeing some of the side-effects of rapid economic development can perhaps teach the global community what side-effects to be leery of, how similar human populations can be, and how important a role our cultural practices and differences play in our health outcomes.

*Image originally appeared in NYTimes article highlighted in this post.

Reluctant Reality

Many of us have aging parents and grandparents, facing any number of degenerative conditions, as well as family and friends facing the uncertain future that the diagnosis of chronic conditions, including cancers, can bring. Various factors in our society, here in the United States (and is other industrialized countries including the U.K. and Canada), have led to an increase in a variety of cancers, cardiovascular disease (CVD), diabetes, and others. These factors include longer life spans (we are living long enough to get ill in ways we might not have several generations ago), diet and lifestyle choices, and environmental (both “natural” and man-made) variants. With all that said, industrialized countries have growing segments of their populations living with, and inevitably dying from, these conditions. This has created an industry (for lack of a better word) of end-of-life care, including palliative care and hospice.

For those who may not know, palliative care is a method focused on alleviating pain, setting realistic goals, and realizing that for some individuals, quality of life is more important than further treatments. Now a standard option in the majority of U.S. hospitals, palliative care grew out of a backlash towards life and death becoming overly medicalized (some would argue it still is) and the idea that being present at the end of your life (with little physical pain) may be more important to some than being hooked-up to ventilators, feeding tubes, IV’s, etc. Palliative care does not necessarily mean individuals are giving-up or giving-in, it means that they, with the consultation and support of their physicians, have systematically, realistically, and reflectively addressed their health and their lives.

The NYTimes is running a series on the experience of terminal illness with a piece this past Sunday spotlighting a palliative care doctor fighting her own demise from cancer – her intellectual self at odds with her sick self. I have no idea how I would face such a challenge, how long and how hard I would fight. Facing death is a very personal and private struggle, yet one that is experienced by caregivers and loved ones too. Through my recent work on a caregiver narrative, reading Dr. Pardi’s story, and thinking about caregiving, the more I believe that the individual and community experience of facing illness is just as important as the innovations in medicine which strive to keep us living longer – helping us comprehend and face a reluctant reality.

Information Overload

The snow seemed like it would never stop falling here in DC…while getting a work-out in, shoveling, I pondered the information overload the capital area is currently experiencing. News channels have been running non-stop coverage of the storm since noon Friday with no sign that they are going to stop any time soon – how much, really, can be said about a lot of snow?!

With this on my mind, I was perusing the Sunday Washington Post a little early (online of course, there is no-way it’s getting delivered!) and there I found a book review of Medicine in Translation by Dr. Danielle Ofri. The book seems to chronicle the experiences of patients through the eyes of their physician (Dr. Ofri) and the physician’s experience working with a broken health care system and patients from an array of cultural backgrounds. Part of her job, as a physician, is to translate for her patients – to expand their “health literacy” with her knowledge of biomedicine and the system.

As a country, what resources do we have to be health literate? Are we experiencing information overload in an attempt to in fact be more informed? This past week, Oprah did a show on America’s Silent Killer: Diabetes. Diabetes, especially Type II, is a major and growing concern for Americans, there are nearly 80 million people with or on the verge of having it. Questions of cause and treatment aside, is Oprah spreading the word better than nothing?

A Harvard Poll, reported in a NY Times article, finds that the majority of Americans think the H1N1 (swine flu) pandemic is over. They feel there is now no need to get vaccinated and that the whole thing was blown out of proportion. Do they think this because their doctors have told them it’s over or because it is no longer being reported on the news? On international health as well we are inundated with a variety of information – for example, the 2011 Federal budget has several budget cuts for global health programs – but it is often the filtered, bare minimum. Having public discussions about diabetes, health care, and global health is great, but finding the right mixture of information, translation, and literacy is hard. Hopefully, our health information overload isn’t making us illiterate.

*Image is author’s own.