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

throughout.

CHAPTER 1

What is Health?

Publisher Summary

This chapter discusses why an individual should try to understand the many beneficial aspects of feeling healthy. With improved housing, better standards of nutrition, clean piped water supplies, and sewage disposal, the standards of environmental health have vastly improved and conquered diseases caused by the spread of germs. Problems that have become prominent in modern society include diseases that are aggravated by atmospheric pollution, overeating, mental and physical stagnation, cigarette smoking, and poor design of the urban environment. Pulmonary and heart disease, mental illness, rheumatoid arthritis, and accidents at work are common disorders. The minor disorders that family physicians most commonly see are colds and chest infections, stomach upsets, skin troubles, and minor mental upsets. Long-term disabilities include chronic bronchitis, prolonged mental illness, anemia, and high blood pressure. The acute serious diseases that are dealt with in the chapter include pneumonia and acute bronchitis.

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 treatments 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 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, introduced 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 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 cancer, 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 environmental health and conquered the diseases caused by germs spread 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 undermining 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 community, 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 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