Globalisation, changing lifestyles and public heath issues

Mohammad Tareq Hasan Since the beginning of the 21st century, the world is experiencing a demographic and epidemiological transition in the form of increasing incidences of chronic andor non-communicable diseases. The change has been regarded as a major challenge for the healthcare system of the developing countries. Chronic diseases have long been equated with the developed countries while it was believed that people from the developing countries suffer more from infectious diseases. However, the reality is quite different and obvious from World Health Organisation (WHO) data that as 80 per cent of the chronic disease deaths occur in low and middle income countries. Furthermore, while in the next ten years mortality from infectious diseases, maternal and perinatal conditions and nutritional deficiencies combined are expected to decline by 3.0 per cent, mortality from chronic diseases, such as cancer, heart disease, diabetes, etc., are projected to increase by 17 per cent globally. A WHO report estimated that 44 per cent of all deaths in 2002 were accounted for chronic disease in Bangladesh. The increasing trend of chronic diseases have been regarded as a resultant of changing lifestyles related to food intake, less physical activity and growing tobacco use and air pollution. All these processes are inexorably linked with the process of globalization. The socio-economic impacts of the epidemiological transition and increased rate of chronic disease are enormous as morbidity resulting from chronic diseases is much higher than mortality. Consequently, a large number of people become partially or fully disabled. Thus, the quality of life of an individual is profoundly reduced and individuals become incompetent or incapable of contributing as a full productive member of the society. The process of epidemiological transition is believed to be taking place faster because of globalization and associated changes in the culture, that is, patterns of behaviour. The forces of globalization over the last few decades have not only made our markets and economies more interdependent but also virtually linked population of Bangladesh with people all over the world through easy modes of cultural exchange, such as internet, movies, tourism, education, etc. All these processes, together changed people's perception, attitude and behaviour while the open markets cater to our new forms of needs -- importing and selling variety of western products, for instance, fast-food brands like Kentucky Fried Chicken (KFC), Pizza Hut, A&W, etc. Besides, local brands of fast-foods are also being popularized through rigorous marketing, promotion and advertising. The growth and popularization of fast foods are causing abundant intake of high fat foods. In this respect, people's perception regarding being 'smart' plays a critical role. For an example, now-a-days a person is regarded smart if he she chooses burger over home-made foods. These junk foods cause people not to eat a proper balanced diet; instead, people consume large amounts of fat and calories. Furthermore, with the sharing of information and ideas across countries our concept of 'beauty' has also got a new westernized dimension. People, especially women, are being portrayed and represented in media as beautiful if they are slim and slender in general. Therefore, social and cultural influences, coupled with peer pressure, affect the minds of the young people to become thin, slim, skinny and beautiful. Consequently, young people (mostly women) starve without considering the possible grave consequences of indiscriminate starvation. Thus, people are suffering either from under-nutrition (anorexia) or over-nutrition (obesity). Being inconsiderate about how to get the proper vitamins and nutrition, people do not find a middle ground between the two extremes. Besides, as people do not realize and ignore or even overlook the health implications that over- or under-eating can cause for a person, many people suffer from severe health problems during older age such as heart disease, diabetes and high blood pressure (people with obesity) and fatigue, mal- nutrition and emotional problems (people with anorexia). Additionally, the process of globalization urge the people to get richer faster and the entrepreneurial class by any means want to get extra benefits. This which pushes the general people to a position where all faces the daily danger of consuming contaminated foods. In Bangladesh, every food item is being adulterated in one way or another. This has become an open secret now-a-days. However, the official drive is very much limited in scale and intermittent against food adulteration. Thus, everyone in the country remain exposed to slow poisoning and as we consume more and more contaminated and adulterated food, we become more and more vulnerable to all types of diseases including chronic diseases. Another impact of globalization is the proliferation of computers, televisions, video games and other various forms of electronic entertainment. All these are making people devoid of physical activity. Advancement of technology means less physical work is needed and electronic means of entertainment lead children and adolescents in spending more and more of their time in front of the TV, computers and playing video games rather involving in activities demanding more physical engagement. Consequently, more and more children, adolescents and young people with every passing day suffer obesity and other forms of chronic diseases. Further, sleeping late in the night has become a regular feature for the young generation of the country. This has become a practice as people started to remain busy with Internet and social networking sites, movies, video games, etc. The consequences of this tendency are alarming as young people are being devoid of regularity and time maintenance. Thus, work efficiency is also decreased. Besides, health consequences are also grave as more and more people has started to suffer from eye problem (computer vision syndrome) due to over-exposure to ultra violet rays as they spent hours before the screen of the computer. Furthermore, disconnection between body time and working hour can result in restlessness, sleep disruption, and shorter sleep duration which may lead to heart attack, suicide and accidents. Tobacco use is another contributory factor of increasing chronic diseases. While tobacco use is declining in most of the developed countries, tobacco companies are increasingly targeting the developing world for their products. Though tobacco companies do no strive for direct advertisement now-a-days due to legal reasons, they tend to do and patronize public activities, thereby, promoting and reaching a far greater number of people with their brand names. Further, smoking is being popularized as in the media especially in films or cinemas. Smoking is represented as a bench-mark for smartness which influence young people and adolescents and lure them into tobacco. Recently, in the metro cities of Bangladesh, a new culture is flourishing in the form of 'Sesha' bar where people, irrespective of age and sex, consume tobacco. This form of tobacco intake is being popularized and getting social acceptance gradually among the mass people. Furthermore, though the government of Bangladesh has banned smoking in public, the practice of smoking in the public places still continues and a greater number of people are under threat of passive smoking. Moreover, one of major environmental problems for the dwellers of the cities in Bangladesh is the air pollution from vehicular exhausts. Additionally, innumerable small and large industries are also acting as smoke emitters. As, the people of the cities are inhaling polluted air, toxic gases and other forms of inorganic particles, they are becoming ill of headache, heart and respiratory disease, asthma and cancer. The changes in the food habit and trend of lessening physical activity are much visible among the urban middle class and above people. However, we must not forget the fact the poor segments of the population are also prone to the effects of adulterate foods, contaminated air, and tobacco use. In Bangladesh, as in other developing countries, the poor are more vulnerable as the process of globalization has further worsened their poverty and thus, they are forced to eat more stale and adulterate food. In other words, balanced diet is increasingly becoming a rarity. Consequently, chronic malnutrition makes them increasingly vulnerable to chronic diseases. Furthermore, illiteracy, and lack of access to information on chronic disease and their risk factors add to their vulnerability and it is estimated that one-out of ten people from the poorer segments of the society, suffers from disparate forms of liver diseases due to adulterate foods. Albeit the aggravating situation posed by the changing lifestyle of the people in the form of increasing rate of chronic diseases, we find little concentrated efforts to address the threatening situation. For example, though a huge portion of the population in Bangladesh is suffering from diabetes, it mostly remains ignored while planning is made about health care services at the district or sub-district level. As chronic diseases have emerged major health hazards for the people of Bangladesh, massive information, education and communication campaign should be driven forward to make mass people aware of the possible grave outcomes of continuing the lifestyles that have become a regularity. In this aspect of creating general awareness, mass media like television, newspapers, internet and radio can be powerful tools. Though diverse programmes emphasizing different health issues are going on different TV channels, unfortunately these can not help exert the desired influence on people as these are aired on non-pick time when people remain busy with daily livelihood activities. Therefore, to increase awareness of people, media outlets like radio, television, newspapers etc., may offer no-cost or low cost slots for public health announcements. Thus, people can be made knowledgeable about the lifestyle that could act as measures for prevention of chronic diseases as well as ways to deal with such prolonged diseases as 80 per cent of chronic diseases can be avoided through changing food habit, increasing physical activity and stopping tobacco use. The writer is an anthropologist and can be reached at e-mail: tareqhasan99@yahoo.com