For National Academy of Science and Technology (NAST) Academician Antonio Miguel L. Dans, no amount of health education or counselling can make people change their lifestyles to prevent non-communicable diseases (NCD) such as cancer, heart disease, stroke, COPD, and dementia.

Instead, Dr. Dans, a cardiologist and University of the Philippines College of Medicine professor, proposes making changes in the environment in order to make a person change his lifestyle and health status. Environment refers not only to things around people but also to policies that impact their lives.

His suggestion came up during a NAST-sponsored round table discussion (RTD) at the Hyatt Hotel in Manila last August 19, 2014. NAST is an advisory body of the Department of Science and Technology (DOST).

“We eat unhealthy because unhealthy food is cheaper. For a cheaper price, you can get a burger while salads are more expensive. We don’t exercise because there is no place to exercise. If you jog (on the street)… you’ll die – you’ll get run over by cars, you’ll get cancer,” he elaborated during the RTD titled “Health Beyond Health Care: Changing Mindsets for the Control of NCDs.”

Fun Runs, on the other hand, are good but when the running event is finished, there is nothing where people can run safely, comfortably, and regularly for the rest of the year. “Go to UP. You’ll see how people are thirsty to exercise. They just don’t have a place to do it,” he emphasized.

Instead, Dr. Dans said instituting environmental changes, such as imposing sin taxes on cigarettes and alcohol, is one strategy outside healthcare which can lead to a healthier population.

The enactment of the Sin Tax Bill in December 2012 led to a six percent reduction in the Philippines’ smoking population. Specifically, the number of smokers among the 10-19 age bracket dropped by 25 percent, and those in the 70 and above age group had a 34 percent drop. The number of smokers among the poor likewise decreased considerably.

“We are contemplating (on proposing) sin tax on sugar and salt, hoping that it will be as effective as that on tobacco,” he added.

Other environmental changes suggested by Dr. Dans include the banning of unhealthy foods and creating more P.E. activities in schools, building gym facilities and stand desks in workplaces, and creating more bike lanes, parks and sidewalks with “walkability” qualities such as cleanliness, adequate lighting, and safety.

“We’re not saying that it (health education) does not work,” remarked Dr. Jaime C. Montoya, executive director of DOST’s Philippine Council for Health Research and Development during the open forum. “But maybe … we should determine the tipping point. Is it legislation? Or maybe it is in community initiatives,” he said.

NCDs: a global outlook
Cancer, heart disease, stroke, COPD, dementia, renal disease, osteoarthritis, asthma, cataracts, osteoporosis, and diabetes are among the range of NCDs which caused 34.5 million deaths out of a total 52 million deaths in 2010.

Unhealthy lifestyles as well as aging, an issue that is becoming more difficult to manage, are among the factors leading to the onset of NCDs which are long-term and costly.

Citing a study by Dr. Sha Ebrahim et al. published in the Cochrane Database of Systematic Reviews in 2011 that involved 55 clinical trials and 163,471 patients, Dr. Dans revealed that counselling and education aimed at behavioral or lifestyle changes neither affected longevity nor prevented NCDs.

Dr. Dans explained that health education is not effective in the battle against NCDs for reasons that risk factors in populations are widespread and long standing, there is no threat perception or no immediate danger, and there are market forces promoting them.
“We need strong policies, legislations, and fiscal interventions which will impact large populations,” he said. (S&T Media Service)