Issue 4 / 10 February 2014

RECENTLY, while settling in to see the movie August: Osage County, I was so struck by the film’s opening line (a quote from from TS Eliot’s poem, The hollow men) that I barely heard the rest of the introductory monologue.

“Life is very long.”

The statement was unsettling because it is a position rarely taken: the more usual observation is that life is too short. When it comes to health and health care, however, setting ourselves up for the long haul can be a necessary approach.

MJA InSight’s lead news story this week brings into focus an interesting longitudinal study from the US, which involved monitoring the blood pressure (BP) of young adults for 25 years, to determine if certain BP “trajectories” were associated with atherosclerosis in middle age.

While the study was limited by the use of surrogate rather than clinical end points, its findings highlight the long lead-times to experiencing the chronic effects of high BP. As one expert put it: “One in three people live to be 100 — if we want them to do that with quality of life, we have to look after these chronic problems. We need to start decades earlier.”

Public health practice could be seen as the ultimate long-haul career choice but, as the tobacco control community would attest, decades of work produce results if you relentlessly chip away.

There have been attempts over the years, renewed recently, to apply the same pressure to “big food” but they are frustrated by practical, legal and political obstacles.

In response to a call from Diabetes Australia for a sugar tax on sweetened drinks, deputy chief executive of Australia’s Food and Grocery Council, Geoffrey Annison, reportedly said: “There’s no demonstration that sugar of itself is particularly obesogenic or related to any health outcomes.”

In a stroke of good timing, just last week researchers who linked results from the US National Health and Nutrition Examination Survey with mortality data have addressed Annison’s yen for evidence, by finding that that high consumption of added sugar more than doubles the risk of cardiovascular mortality. The study and its relevance to Australia is the subject of another of our news stories.

In the same way that youth is wasted on the young, could it be that insights into the illness experience are wasted on patients? InSight’s blogger Jane McCredie takes a look this week at the stories of doctors whose practice has been profoundly affected by their own experiences in life’s long haul as health care consumers.

Of course, life is not always very long. In many populations, including the most disadvantaged Australians, it is, on average, depressingly short.

Public health veteran and the MJA’s Editor-in-Chief, Professor Stephen Leeder told MJA InSight this week that hypertension, smoking and nutritional factors were contributing to a burden of cardiovascular disease in less developed countries akin to the rates experienced in developed countries in the 1960s.

Is this the epidemic they had to have, or can countries like Australia use the experience of our own long haul with cardiovascular disease to provide the opportunity for very long and full lives to their future generations?

 

Dr Ruth Armstrong is the medical editor of MJA InSight.

4 thoughts on “Ruth Armstrong: The long haul

  1. David Penington says:

    Australia itself still has many challenges in disease prevention. We have done well on smoking and on early treatment of hypertension, but we are going backwards on obesity which will be such a huge contributor in Type 2 diabetes, in disability associated with spinal, hip and knee problems in older people, let alone in vascular disease.

    We have no realistic national startegy for obesity, even though it is appearing in school age children let alone the middle-aged.

    We need also to get into play realistic and effective strategies to curb the huge problem of deaths , trauma and disabiltiiy conseqhuent on alcohol abuse  – a much bigger problem than illicit drugs, athough the current ‘ice’ epidemic is going to leave behind many badly damaged brains, let alone damaged families resulting from psychotic behaviour.

    We still have a lot to do as a nation.

     

  2. Dr FHC Wilson says:

    The general “lack of knowledge” of what constitutes an examination, particularly of a new patient, and also of follow up cases

  3. James Kidd says:

    Some statistics can cover a long time but are we willing to use them. In the 70s the Professor of Medicine at a New York University reported on the meta analysis of the BP readings for life assurance in the USA. The reading, age of insurance and the age of death were all easy to obtain and ran into bilions of people. The result, he presented, was that a BP of 106/64 or below didn’t shorten one’s life. This had an effect on me such that when it was suggested that we should aim for 140/90 in a hypertensive I always aimed lower with care to prevent orthostatic hypotension. Did it work? I have no idea but as the aim of the Cardiologists has dropped maybe it has.

    Many other statistics have been presented over the years but this one stuck and I saw any reason to change my aim in the long haul.

  4. Michael Fasher says:

    Nice editorial & thanks for the comments

    An aspect not yet discussed is the importance of the years 0 to 5 for long term health.

    The ACE [Adverse Childhood Experiences] study – http://www.cdc.gov/ace/findings.htm – finds a co relation between the quantum of adverse childhood experience and almost any health/social outcome of interest over the life span.

    One of the key researchers tells a story of succesfully treating an obese middle aged woman in the study. Progress faltered and then reversed. On exploring why – the woman described how losing weight had resulted in unwanted sexual attention from men. This was reversed by regaining weight

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