Cell 2 Soul: The Humane Health Care Blog

Fat Planet

Study Finds: More Than 10 Percent of World’s Population Is Obese

More than 10 percent of the world’s population is now obese, a marked rise over the last 30 years that is leading to widespread health problems and millions of premature deaths, according to a new study, the most comprehensive research done on the subject.

Published Monday in The New England Journal of Medicine, the study showed that the problem had swept the globe, including regions that have historically had food shortages, like Africa.

The study defined obese as a body mass index of 30 or higher and overweight as a B.M.I. from 25 to 29. By those measures, nearly 604 million adults worldwide are obese and 108 million children, the authors reported. Obesity rates among children are rising faster in many countries than among adults.

No country in the globe has reduced overweight or obesity levels. This is astounding given the huge health and economic costs linked with overweight and obesity.”

The study largely did not go deeply into the causes of obesity, but the authors said the growing accessibility of inexpensive, nutrient-poor packaged foods was probably a major factor and the general slowdown in physical activity was probably not.

Here is a BMI calculator if you want to see where you fall.

Just so you don’t feel too bad if your BMI is hovering at 30 or above, there is the Obesity Paradox hypothesis which holds that obesity (and high cholesterol) may, counterintuitively, be protective and associated with greater survival in certain groups of people, such as very elderly individuals or those with certain chronic diseases. It further postulates that normal to low body mass index or normal values of cholesterol may be detrimental and associated with higher mortality in asymptomatic people.

Hans Rosling: 'Edutainer' par excellence

Hans Rosling, a Swedish physician became a pop-star statistician by converting dry numbers into dynamic graphics that challenged preconceptions about global health and gloomy prospects for population growth. He died on February 7^th at 68 of pancreatic cancer.

The topic of Global Health and Social Determinants of Health has interested us greatly.  It is covered in detail in Michael Marmot’s dense book, The Health Gap (that few will wade into).  Rosling’s work makes this information palatable and easily understandable.

See:  NY Times Obituary

Rosling, his wife and daughter founded Gapminder, an independent Swedish foundation with no political, religious or economic affiliations in 2007. Gapminder is a fact tank, not a think tank. It fights devastating misconceptions about global development.

See Hans Rosling:  How To Be Ignorant About the World (TED 2014) 19 minutes.

Many more instructive videos are linked on Gapfinder.org.

Patients Prove Profitable

When is it ethical to design a health care system that caters to those who can pay? 

An old Yiddish proverb runs:  "If the rich could pay the poor to die for them, the poor would make a very good living."

Khawar Mann, OBE, a venture capitalist with the Abraaj investment group, travels around Africa scoping out hospitals to buy that seem likely to provide good returns on investments.

Private health care has been an interesting model in the U.S. which lags behind all other developed nations in outcomes.  So why is the American system now envisioned as a viable model for Africa?  Will this not just serve to widen the "health" gap between the rich and poor?

Mr. Mann says: "“Nairobi is a sweet spot for us. There is a big population that is growing. You have emerging middle incomes. And there is a massive need for health care.” (for those who can afford to pay in cash).

This in-depth NY Times article gives one much to mull over.

How Ideas Spread in Medicine

A current article in the New Yorker, while long, is fascinating and will appeal to students, physicians, and anyoine interesrted in the spread of ideas and global health.

Annals of Medicine: New Yorker, July 23, 2013
Slow Ideas: Some innovations spread fast. How do you speed the ones that don’t?
by Atul Gawande

Keywords:    health; medicine; innovation; surgeons; nurses; childbirth; babies; Bangldesh; cholera; oral rehydration

"Why do some innovations spread so swiftly and others so slowly? Consider the very different trajectories of surgical anesthesia and antiseptics, both of which were discovered in the nineteenth century.

The first public demonstration of anesthesia was in Boston in1846.  The idea spread like a contagion, travelling through letters, meetings, and periodicals. By mid-December, surgeons were administering ether to patients in Paris and London. By February, anesthesia had been used in almost all the capitals of Europe, and by June in most regions of the world.  Within seven years, virtually every hospital in America and Britain had adopted the new discovery.

Sepsis—infection—was the other great scourge of surgery. It was the single biggest killer of surgical patients, claiming as many as half of those who underwent major operations. Infection was so prevalent that suppuration—the discharge of pus from a surgical wound—was thought to be a necessary part of healing.

In the eighteen-sixties, the Edinburgh surgeon Joseph Lister read a paper by Louis Pasteur laying out his evidence that spoiling and fermentation were the consequence of microorganisms. Lister became convinced that the same process accounted for wound sepsis. During the next few years, he perfected ways to use carbolic acid for cleansing hands and wounds and destroying any germs that might enter the operating field. The result was strikingly lower rates of sepsis and death. You would have thought that, when he published his observations in a groundbreaking series of reports in The Lancet, in 1867, his antiseptic method would have spread as rapidly as anesthesia.

Far from it.  It was a generation before Lister’s recommendations became routine and the next steps were taken toward the modern standard of asepsis—that is, entirely excluding germs from the surgical field, using heat-sterilized instruments and surgical teams clad in sterile gowns and gloves."

A major thrust of this important article deals with how oral rehydration therapy for diarrheal diseases is only slowly spreading in the countries where it is most needed.  “In the nineteen-sixties, scientists discovered that sugar helps the gut absorb fluid. Two American researchers, David Nalin and Richard Cash, were in Dhaka during a cholera outbreak. They decided to test the scientific findings, giving victims an oral rehydration solution containing sugar as well as salt.”  This cut the death rate from 30% to ~ 3%.  But 40 years later it is only just starting to be taught on a large scale.”  It gives one hope – but this simple, inexpensive therapy is just not sticky enough.  Progress has been slow

Gawande’s article has much more of interest is an important read for anyone interested in global health, public health, and the spread of medical innovations. 

See attached: Download Slow Ideas Gawande