Originally published in The Ottawa Citizen November 25, 2003
Original Title: The unromantic past

The history of medicine is fascinating. Today we have the means to combat vicious infectious childhood diseases. New cancer therapies and cancer vaccine research hold tremendous promise. Technological advances have improved our society’s ability to produce food in record amounts.

Indeed, I firmly believe that to understand the importance of advances in medial treatments and overall improvement in public health, it is vital to understand history. What was it like living in an era without many of the options we today accept as commonplace?

This is more than just an academic exercise. Many well-meaning people make health decisions without the benefit of the full picture. This is not a criticism; it reflects our society’s general state of health. Many have not experienced full-fledged epidemics that kill hundreds of thousands of people. We naturally assume our children will be healthy and free of any serious disease. Unlike parents 100 years ago, we do not matter-of-factly account for at least one of our children dying from an infectious disease before their fifth birthday.

Although I understand the reticence of some to vaccinate their children, get a flu shot, or use a prescription medication for life, the alternatives if one looks to the past are stark and real.

In 1900 the ten leading causes of death as an approximate percentage of all deaths (in parentheses) were:

1. Pneumonia (12)
2. Tuberculosis (11)
3. Diarrhea/Enteritis (9)
4. Heart Disease (7.5)
5. Stroke (6)
6. Liver Disease (5)
7. Injuries (3)
8. Cancer (2.5)
9. Senility (2)
10. Diphtheria (1.5)

One hundred years later (1997), Canadians face a completely different reality as recorded by Statistics Canada were:

1. Heart Disease and stroke (36.8)
2. Cancer (27.2)
3. Lung Disease (9.3)
4. Injuries (3.9)
5. Digestive System Diseases (3.5)
6. Endocrine diseases (e.g. diabetes) (3.4)
7. Nervous system disease (3.0)
8. Mental Disorders (2.7)
9. Suicide (1.7)
10. Genitourinary diseases (1.7)

In 1900, the top three causes of death were due to infectious disease. Today it barely registers on the map. Indeed, the total number of children dying in 1997 from diphtheria, whooping cough, polio and measles was zero.

Cancer, cardiovascular disease and stroke now account for over 60 per cent of all deaths. Is this due to our present lifestyle, the eradication of previously fatal illness or a combination of both?

The average lifespan of Canadians in 1900 was about 47 years. Many of the diseases we see today require time to develop. Prolonging our life expectancy provides an opportunity for other diseases considered rare in 1900 to be commonplace today. The combined life expectancy for Canadian men and women is 79.7 years, 32 years longer than it was a the turn of the last century.

Life expectancy aside, our lifestyle choices, dietary habits, work environment, genetics and general preventive care have a direct influence upon our health status and disease incidence. In many ways, it is up to the patient to look after his or her own well-being.

Certain diseases like colon cancer, heart disease, rheumatoid arthritis, diabetes mellitus, depression, bipolar disorder, thyroid disease and breast cancer among others are potentially inheritable diseases. Technological advancements and better diagnostic procedures do help in early detection and treatment. However, all this is for naught if the person does not access the health care system or follows treatment recommendations.

For example, hypertension is a root cause of cardiovascular disease and stroke. Treatment in people under 60 years old reduces the risk of stroke by 42 per cent and heart attack by 14 per cent. People over 60 see a reduction of overall mortality by 20 percent, cardiovascular mortality by 33 per cent, stroke incidence by 40 per cent and coronary artery disease by 15 per cent.

Of the 4.5 million Canadians with hypertension, only 16 per cent are treated and controlled. Twenty-three percent are treated and uncontrolled. Most worrisome are the 19 per cent of this group that is aware they have hypertension but remain untreated and that the remaining 42 per cent are unaware that they have hypertension.

This is not a blame-the-patient game. If we are to save our health care system and reduce the incidence of disease, we all must do what is necessary to safeguard our health. There are limits to what health care professionals can do to prevent illness.

Everyone must take responsibility for their health as best they can. Obesity is running amuck. Our children are facing adult illnesses long before their time. Stop smoking, if you drink, do so moderately, exercise three times per week, reduce consumption of junk and fast food and trans-fats (hydrogenated fats), consume lots of colorful foods (green, yellow, red, purple and orange fruits and vegetables) and reduce your weight.

These are not small tasks. Nevertheless, the trends must change if there is to be quality with the quantity of years we have to live. We must change our present course. Only history will tell us if we succeed.

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© Dr. Barry Dworkin 2003