The Silent Killers we face every day

By: Dr Behrooz Dr Bod Behbod MB ChB

Twenty years on from the Chernobyl disaster, we're still facing a growing threat from global warming, bird 'flu (avian influenza), terrorism, nuclear warfare, whilst also recently witnessing the devastating toll of natural disasters such as the Bam Earthquake of 2003, the Asian Tsunami of 2004 & Hurricanes Katrina & Rita of 2005. They are truly horrifying, but perhaps there may be greater terrors we must fear.

Coinciding with the World Press Freedom Day (3rd May 2006), renowned risk perception and communication expert from the Harvard School of Public Health (HSPH), David Ropeik gave a truly eye-opening lecture for journalists and members of the public in Nicosia. Discussing the role of the media in effectively communicating public health risks, Ropeik highlighted the genuine concern that each year there are millions of premature deaths worldwide which could easily be prevented. We may hear about one or two hundred deaths in an unfortunate plane crash and avoid flying, or read about the potential risk of a global pandemic and stop eating chicken, illustrating the power of the news in changing our behaviour. So what would we do if we heard that in 1990 alone, there were three million deaths from smoking across the globe? Baring in mind this is expected to increase to ten million deaths a year by 2030, do we not have the responsibility to take action and save the lives of our children and grandchildren?

The leading causes of death and suffering include chronic degenerative diseases such as heart disease, cancer, diabetes and asthma, with the increasing prevalence of auto-immune diseases such as multiple sclerosis (MS) and inflammatory bowel disease as well as allergies. The state of our health and wellbeing is indeed intimately associated with what we eat, drink, breathe, the water we swim in, the houses & neighbourhoods we live in, the places we work in, the roads we drive on, our financial and social circumstances, and the lifestyles we adopt. The one thing they all have in common is all around us, here, there and everywhere – the environment.

It is estimated that environmental factors contribute 30% to the total burden of disease. Europeans carry 500 chemicals in their bodies that did not exist in people living before the 1920s. These can include the use of pesticides and other toxins in food, tobacco and industrial smoke, dust, asbestos & lead in older buildings. All these can play havoc with our defensive immune system, vital reproductive organs, as well as causing physical and mental developmental problems in children. Asbestos fibres and over 60 chemicals in tobacco smoke are known or suspected carcinogens (agents that have the potential to cause cancer).

Our modern way of life has placed a great emphasis on the use of cars and motorbikes, which sadly leads to a cocktail of problems, including obesity, air & noise pollution, respiratory & heart disease, diabetes, cancer, and unnecessary road traffic accidents. Violence, poverty, crime, alcohol and drug abuse also play a significant part in our psycho-emotional and physical wellbeing and safety. Also of importance is our financial health, which depends on a sustainable and prosperous economy that needs to go beyond reliance on tourism here in Cyprus, to the fields of agriculture and manufacturing.

From 'Earth Day' in April 1970, to Green Week 2006 (30th May – 2nd June) in Brussels, we can see the world's developing interest in environmental issues and the employment of effective and economical preventive measures. It is truly a breath of fresh air to witness the Government of Cyprus' initiative by establishing an international research, education and technology centre right at the crossroads between Europe, Asia & Africa.

"We care about public health; we care about the environment because it touches upon the life of each and every individual in Cyprus, and not only our present generation but generations to come," said President of the Republic of Cyprus Tassos Papadopoulos at the signing ceremony with the Harvard School of Public Health (HSPH) in June 2004. The Cyprus International Institute for the Environment & Public Health (CII) in association with HSPH will be taking on its first cohort of postgraduate students this September 2006 (www.hsph.harvard.edu/cyprus).

The World Health Organization (WHO) sees the Mediterranean region as a key area for protection and for concern about public health in the future. In fact, public health traces its origin in Greek mythology to the god of healing, named Asklepios. Asklepios mastered the art of medicine, and had a number of children including three daughters. The daughters were Hygieia (Health), Iaso (Healing), and Panakeia (Cure-all). Hygieia represented the preservation of health and prevention of illness.
So what does this actually mean for each and every one of us?
To help answer this, try and identify everything that's wrong with this fairly 'normal' day:

08:00 you're pretty tired with a headache, so you wake-up later than usual, grab a quick chocolate bar and coffee to have whilst driving to work.
08:20 stuck in traffic, so you decide to wind down the window and get some 'fresh' air whilst sending a text message.
08:45 arrive at work, where your colleagues have already lit their cigarettes – you've got asthma, and you reach for your inhaler.
10:30 coffee break, with another dose of passive smoking.
13:00 go across the road to get lunch, where you notice graffiti, litter, and stubbed-out cigarettes.
17:00 another working day over, but you're not happy with your current salary. Whilst driving home, you feel pressured by the car tailing you and urging you to go faster. This car eventually takes over from your left and passes a red-light, causing a near-crash.
17:30 you're home, and having read a recent article in the paper, you decide to take up cycling to get fit. Even though you've got the latest mountain bike and safety gear, you're forced into cycling on main roads, with drivers paying no respect, even honking their horns at pedestrians and cyclists.
21:00 have a meal with your friends, and end up in the local bar – again you need your asthma medication.
02:00 as you reach home, you remove your seatbelt to reverse into the parking bay, whilst still using your mobile phone. To make it worse, you've had several pints of beer and a doner kebab on the way back.
03:00 you're still trying to sleep, but have difficulty due to the noise of loud cars & motorbikes!

In just under 24 hours, you've had to deal with pain, chronic disease, poor nutrition, excess caffeine, passive smoking, air & noise pollution, litter, vandalism, job dissatisfaction, risky driving, alcohol, no seatbelt, and more passive smoking… anything else?

As part of Cyprus' new initiative with Harvard University, it is hoped that students, scientists, journalists, politicians, managers, policy-makers, health professionals, as well as the general public, will team up to fight all these 'silent killers'. Since there are no borders or boundaries when it comes to the practice of public & environmental health, these efforts are envisaged to yield tremendous results for the wellbeing of the entire Mediterranean, Middle East, North Africa and world has a whole! Here are just some of the goals:

• Ensure the availability of clean drinking and washing water;
• Educate healthy, nutritious eating & lifestyle behaviours;
• Increase the provision and use of a range of exercise and leisure/play facilities;
• Promote public transport, reducing single-car use;
• Build safer, cleaner, more picturesque residential areas, that include adequate pedestrian walkways, traffic lights, and cycle lanes;
• Develop new homes and buildings with adequate sound insulation & energy efficiency;
• Reduce noise, air, water and light pollution;
• Effective waste management & recycling;
• Safer roads, with enhanced traffic law enforcement;
• Address substance and alcohol misuse;
• Ban / limit smoking in public places & at work;
• Influence employers to ensure the health of their staff, e.g. work / life balance;
• Occupational health & safety;
• Prevention of accidents & injuries;
• Control of infectious diseases;
• Design protocols on effective crisis prevention and management in the event of natural disasters, emergencies, infectious diseases or terrorism.

The main take-home message from this article is to raise our awareness of the common issues that are threatening our daily lives, as well as future generations. The best thing we can do in the fight for health and a greater quality of life is to become more conscientious on the roads, at work, at home, to take up regular exercise, eat healthy nutritious meals, drink plenty of clean water, give up smoking, keep our neighbourhoods & nature clean, and to keep up-to-date with public health news. For more information, visit the following websites:

The Cyprus International Institute for the Environment & Public Health
www.hsph.harvard.edu/cyprus

World Health News
www.worldhealthnews.harvard.edu

The World Health Organization
www.who.int

Dr Behbod completed his medical training in the UK, and is now one of the first cohort of twenty postgraduate students at CII's Environmental Health Masters Program, starting September 2006.

Photos courtesy of: www.freefoto.com & www.who.int & Behrooz Behbod