We all want to be in good health but…

By Dr R Neerunjun Gopee

The cyclonic weather has come to play spoilsport with an International Conference on Diabetes, Obesity and Associated Diseases organised by the Ministry of Health and Wellness jointly with Diabetes Foundation Mauritius and World Community for Prevention of Diabetes Foundation Spain at the Balaclava Intercontinental Resort over three days, with the inaugural session held on Monday 21st January 2024.

From Ministry of Health to Ministry of Health & Quality of Life to the current appellation Ministry of Health & Wellness: the change in nomenclature has sought to emphasise the importance of being in good health, which one would presume is everybody’s wish. Unfortunately, not everybody is willing to make the little effort that is constantly required to achieve that goal, and hence the need to keep reminding them of the consequences of failure to look after themselves properly, which are the subject of such conferences. Along with diabetes and obesity, they comprise the cluster of diseases known as the non-communicable diseases or NCDs. The experts present at the present conference will share with each other and with the local health professionals the latest developments in the various aspects of these diseases covering prevention and treatment, but how did Mauritians come to be major sufferers from these ailments which have such a high toll of morbidity and mortality?

A brief consideration of the evolution of the health situation in Mauritius will throw some light on this. Basically, the change has been from communicable to predominantly non-communicable diseases.

Communicable diseases are caused by microbes such as viruses (influenza), bacteria (tuberculosis or TB), parasites (malaria), and potentially cure is possible. They are also known as infectious or transmissible diseases because they can be transmitted from person to person by direct (e.g. touching) or indirect contact (e.g. influenza/TB through the air, gastroenteritis through water). Specific microbes cause specific diseases (e.g. influenza viruses will cause ONLY influenza not TB). They can usually be prevented by good personal hygiene and adequate sanitation; treated by antibiotics targeted at specific microbe (e.g. antimalarial medicine cannot treat pneumonia) and can be completely cured or eradicated (e.g. smallpox, malaria).

Non-communicable diseases (NCDs) are caused by multiple factors, thus leading to different diseases for which generally cure is not possible, only control. Further, unlike communicable diseases, they are not transmitted from person to person. They began to surface around the 1980s, in developed countries, caused by a combination of genetic and environmental factors allied to personal lifestyle i.e. there is a common set of multiple factors hence the term multifactorial used in connection with the causation of NCDs.

These common factors are, for example: lack of physical exercise; poor nutritional habits; overweight and obesity; substance abuse: drugs, alcohol, tobacco; chronic exposure to environmental pollutants: pesticides, air pollution, vehicle exhaust smoke; high cholesterol. Collectively, these are the risk factors for NCDs to which one may add another significant one – stress.

The interaction of gene, environment and lifestyle leads to the NCDs: diseases of the heart, hypertension, asthma, cancer, road accidents, mental health problems, renal disease, strokes, etc.

In the early 1980s, our Annual Health Statistics Reports showed that communicable diseases were diminishing but diseases that were later to be called NCDs were increasing.

WHO assistance was sought to assess the situation. Professor Paul Zimmet of the International Diabetes Institute Melbourne, Australia (a WHO Collaborating Centre) was delegated to assess the situation, and he recommended the first formal NCD Survey (1987) conducted by local and WHO team led by him with Prof Alberti (UK) and Prof Tuomelihto (Finland), and confirmed that Mauritius had made the epidemiological transition – a shift in the pattern of disease of whole populations – from communicable disease to NCDs.

The following was the Response of MOH:

• NCD Unit set up (late Dr H Gareeboo and Dr P Chitson)
• Core Measures (together known as Public Health Interventions): Legislation (hike in price of tobacco, regulation of saturated fats in cooking oils, salt in imported food items), health education and promotion, screening campaigns, ongoing studies of risk factors.
• NCD Surveys repeated 5-yearly, last one 2021, showing that trends of disease and risks maintained, and would have worsened without the interventions. Importantly, the objective of such surveys of whole populations is an epidemiological exercise to reveal trends, not necessarily to produce exact figures, though precise validated data are provided. They alert clinicians to expect rising numbers of NCDs and to prepare to handle them for treatment.
• Meanwhile, new knowledge about many NCDs, diabetes (DM) in particular, and new techniques of treatment confirm high prevalence of DM, a disease in itself and an aggravating risk factor for the other NCDs. Hence emphasis on its control, for which same measures as above would apply to other NCDs as well.
• To standardize the approach for control, a National Service Framework for Diabetes (NSFD) was elaborated with the help of Prof Owens of the UK and fine-tuned by Prof Paul Zimmet and team. This led to interventions being scaled up, and new ones added. Mobile clinics were provided for targeted screening.
• Updated tobacco and alcohol legislation; banning of soft drinks in educational institutions;setting up of health clubs, health tracks, NCD clinics, etc.
• Preparation of plans of Action (Physical Activity, Nutrition, Cancer Control).
• Holding of IAC (International Diabetes Committee) meeting August 2007.
• International Conference on Cardiovascular Diseases 2008.
• International Conference on ‘Diabetes and Associated Diseases’ November 2009, and the current one being held, with notably Obesity added as it has become a major concern worldwide, but also interestingly effective surgicaltechniques to treat it have been developed in recent years.

Fortunately, there have been some notable differences since the last survey, as the Conference Handbook notes: ‘Overall, improvement in terms of public awareness and status of NCDs and their risk factors have been observed. This is likely due to the implementation of various screening and preventive activities over the last 15 years. However, NCDs remain a major public health problem in Mauritius.’

All the studies have repeatedly shown that the mainstay of promotion of good health and prevention of NCDs are: proper nutrition and adequate physical activity – starting from childhood. Parental responsibility for their children’s health is therefore paramount, as is individual responsibility in the case of adults. MOH and health professionals can only go so far through advising and providing the proper information. The rest is up to parents and individuals. We are therefore warned…

Mauritius Times ePaper Friday 19 January 2024