Lifestyle Dieases A Global Pandemic

Lifestyle Diseases: A Global Pandemic
Paige Breedon
Mr. Toole
Global Perspectives
Friday, May 10, 2019
Table of Contents
1
Page Number
Preface 3-4
Definition 5 - 16
Significance 17 - 21
Background 22 - 27
Expert 28 - 31
Role of Control 32 - 34
International Organizations 35 - 38
Case Studies
United States of America 39 - 42
China 43 - 47
Uganda 48 - 51
Canadian Connections 52 - 54
Logic of Evil 55 - 56
Politics 57 - 58
Religion 59
Solutions 60 - 64
Conclusion 65
Work Cited 66 - 75
Preface
2
Chronic non-communicable diseases also known as lifestyle diseases account for
approximately 70% of deaths worldwide.1 The World Economic Forum predicts that within the
next twenty years, five chronic diseases alone will cost the global economy $47 trillion (USD).2
Chronic diseases are a significant issue facing the planet today, as the greatest causes of
death globally they jeopardize public health and economic prosperity. This pandemic plays a role
politically, socioculturally, economically, environmentally, and must be addressed within all of
these societal facets.
Chronic diseases have evolved into a pandemic gradually. This escalation is due to many
factors, including the evolution of the food culture and industry, physical inactivity, epigenetics,
psychology, the shift from health priorities, and the seduction of sedentarism.
There are many experts in the field of healthy active living and chronic disease
prevention, specifically Erin Berenbaum, the Research Coordinator of Health Promotion,
Chronic Disease and Injury Prevention for Public Health Ontario.
It is the role of the general public, international and non-governmental organizations, the
private sector, health care professionals, and the government to prioritize global health and make
efforts to prevent the prevalence of lifestyle diseases.
Many international organizations have contributed to helping prevent chronic diseases
and promoting healthy active living globally. Organizations include The United Nations, The
World Health Organization, Global Alliance for Chronic Disease, Centres for Disease Control
and Prevention, and The Global Health Council.
Countries in particular that have been affected by chronic disease regardless of there
varying socioeconomic development, include the United States of America, China, and Uganda.
Additionally, Canada as a developed country like the United States experiences the adverse
effects of chronic disease.
The logic of evil just like the role of control is dispersed among many sectors and
responsible parties. Specifically, people, countries, governments, and the private sector
1
Cullinan, Kerry. “Chronic Diseases Cause 70% of Deaths Worldwide.” Health24, 21 Sept. 2018,
www.health24.com/News/Public-Health/chronic-diseases-cause-70-of-deaths-worldwide-20180921.
2
“Chronic Diseases Could Cost Global Economy $47-Trillion.” The Globe and Mail, The Globe and Mail, 9 May
2018, www.theglobeandmail.com/life/health-and-fitness/chronic-diseases-could-cost-global-economy-47-
trillion/article4199552/.
3
rationalize, support, and justify chronic disease and unhealthy living due to financial and
personal motives.
Politics applies to the current chronic disease pandemic through entities such as the
government, media, human rights, and economy.
Religion is integrated into the cause and effect of chronic disease. For instance, it can
play a role in a person's health: their physical, social, and mental well-being. Also, religion
determines how people cope with the detrimental effects of chronic disease.
Chronic disease is a global issue that requires a corresponding magnitude of response.
Individual people have the most power to change their consumer and personal habits in order to
accommodate a healthier lifestyle free of chronic disease. These people however, are constantly
exposed to influences from the government, organizations, and private sector. Therefore, all
entities must be working together towards the promotion of healthy active living and prevention
of lifestyle diseases.
Definition
4
A lifestyle is a way in which individuals, families, and societies deal with physical,
psychological, social, and economic environments daily.3 It is expressed in both personal and
professional settings, in activities, interests, opinions, and values. It is relative to an individual's
motivation, needs, and wants, as well as can be influenced by factors such as culture, family, and
social class.4 Lifestyles affect an individual’s quality of life, lifespan, physical and mental health,
and well-being. Lifestyle diseases are a form of disease caused by the way one lives their life and
run the gamut from cardiovascular to chronic respiratory, sexually transmitted infections,
deficiencies, denigrative diseases, type two diabetes, obesity, cancers, and depression.
Living a healthy lifestyle entails proper nutrition, regular and vigorous physical activity,
refraining from the use of tobacco, drugs, and alcohol, and sexual abstinence or having protected
sex. Also, healthy active living should include limiting and avoiding sedentary habits such as
excessive screen time, sitting, and inactivity. Although uncontrollable factors are relevant to
one's health, living a healthy lifestyle is pertinent to set the foundation for success in various
societal facets.
Nutrition is an essential component of healthy active living; it is the choice of foods one
decides to consume regularly. Regardless of different nutritional variations, a consensus among
the medical and nutritional science community is that a healthy diet consists of a balance of
macronutrients and micronutrients.
Macronutrients are a type of food, required in large consumptions that provide an
individual with the energy they can employ in sustaining life, in the means of powering general
cellular process and as fuel for vigorous physical activity.5 There are three types of
macronutrients: proteins, fats, and carbohydrates. Proteins are known as the building blocks of
bones, muscles, cartilage, skin, and blood due to their role in building and repairing muscle
tissues, making enzymes, hormones, and other body chemicals.6 Modest consumption is
recommended; approximately 0.36 grams for every pound of body mass or 0.8 grams for every
3
“Which of Your Friends Needs to Learn This Term?” BusinessDictionary.com,
www.businessdictionary.com/definition/lifestyle.html.
4
5
Levy, Jillian. “Macronutrients You Need & Top Macro Food Sources.” Dr. Axe, Dr. Axe, 26 Mar. 2017,
draxe.com/macronutrients/.
6
Osterweil, Neil. “The Benefits of Protein.” WebMD, WebMD, www.webmd.com/men/features/benefits-protein#1.
5
kilogram of body mass, translating to 10 to 35% of overall caloric intake.7 Ideal protein sources
include seeds, nuts, beans, legumes, and fish. Fat is a long-term fuel source that makes up the
highest energy storage in the body.8 There are two main categories of fat; saturated fat, including
saturated and trans fat and unsaturated fat, including monounsaturated and polyunsaturated fat.
Regardless of the controversy, trans fat is known to be the worst type of fat due to its correlation
with increased risk of heart disease. Instead, it should be replaced with unsaturated fat. The
average adult diet should consist of 20 to 35% fat, averaging to 44 to 78 grams per day.9
Examples of foods rich in unsaturated fats include avocados, chia seeds, and nuts. Carbohydrates
are a crucial component in providing short-term energy to an individual, the two types being
simple and complex. Simple carbohydrates are broken down quickly by the body and are rich in
sugars and starches; in excess, they are detrimental to one's health. Examples are candy, soft
drinks, and syrups.10 In comparison, complex carbohydrates keep the individual fuller for longer,
therefore justifying their superior nutritional value. Examples include beans, whole grains, and
vegetables.11 The ideal diet for the average adult should consist of complex carbohydrates
making up 45 to 65% of macronutrient consumption; anywhere between 225 to 325 grams of
carbs per day.12 All macronutrients include calories, which is a unit of energy. To maintain a
consistent weight one must balance the number of calories consumed to the number of calories
exerted.
Micronutrients are a chemical element or substance required in trace amounts for healthy
growth and development of an organism.13 There are two types of micronutrients; vitamins and
minerals. Vitamins are an organic compound needed in small quantities and often found in food.
There are two types of vitamins; fat-soluble and water-soluble vitamins. Fat-soluble vitamins
stored in adipose tissue within the body and liver, include vitamins A, D, E, and K and have
7
“Protein Intake – How Much Protein Should You Eat Per Day?” Healthline, Healthline Media,
www.healthline.com/nutrition/how-much-protein-per-day#what-it-is.
8
“Definition: Fats (for Parents).” KidsHealth, The Nemours Foundation, kidshealth.org/en/parents/fats.html.
9
Katherine Zeratsky, R.D. “Here's an Easy Way to Track Fat in Your Diet.” Mayo Clinic, Mayo Foundation for
Medical Education and Research, 30 Jan. 2016, www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-
eating/expert-answers/fat-grams/faq-20058496.
10
“Simple Carbohydrates: MedlinePlus Medical Encyclopedia Image.” MedlinePlus, U.S. National Library of
Medicine, medlineplus.gov/ency/imagepages/19534.htm.
11
“Complex Carbohydrates: MedlinePlus Medical Encyclopedia Image.” MedlinePlus, U.S. National Library of
12
“Choose Your Carbs Wisely.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 7 Feb. 2017,
www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/carbohydrates/art-20045705.
13
“Micronutrient.” Dictionary.com, Dictionary.com, www.dictionary.com/browse/micronutrient.
6
diverse functions and sources.14 In contrast, water-soluble vitamins can be delivered to tissue
throughout the body but not stored and include the B-complex group of vitamins as well as
vitamin C. They are essential for normal appetite and vision, healthy skin and nervous system as
well as red blood cell formation.15 Sources include cereal grains, bread, meats, eggs, legumes,
sunlight, and fresh vegetables. Minerals help the body to develop and function; they are essential
for good health and include macrominerals and trace minerals. Macrominerals include sodium,
chloride, potassium, calcium, phosphorus, magnesium, and sulphur. Macrominerals have a range
of functions including proper muscle contraction, fluid balance, nerve transmission, blood
clotting, healthy bones and teeth, blood pressure regulation, and immune system health.16 Food
sources can include dairy products, meat, salt, and vegetables. Trace minerals including iron,
zinc, iodine, selenium, copper, manganese, fluoride, chromium, and molybdenum are needed in
smaller quantities. They are essential as enzymes, antioxidants, and in regulating the endocrine
systems hormones and metabolism.17 They can be found in meat products, nuts, whole grains,
and vegetables.
A diet is the foods in which a person, animal or community eats, they can often be
restrictive with the intention of weight loss, have a medical justification or part of a specific
fitness goal.18 Around the world, many diets exist that interpret the knowledge of nutrition and
propose a plan or eating principal that specifies the types and quantities of foods one can
consume. Most diets stem from social values and conventions, culture, and society. Diets can be
healthy or unhealthy and affect individuals and communities accordingly.
Although diets can vary significantly, consistencies among healthy diets include
minimally processed foods, fresh and wholesome ingredients, fruits and vegetables, lean meats,
and high fibre content.19 Examples of healthy diets include the Mediterranean, Nordic,
Okinawan, West African, Indian, and Barbados diets. Healthy diets tend to gravitate towards
14
“Fat-Soluble Vitamins: A, D, E, and K - 9.315.” Extension, extension.colostate.edu/topic-areas/nutrition-food-
safety-health/fat-soluble-vitamins-a-d-e-and-k-9-315/.
15
“Water-Soluble Vitamins: B-Complex and Vitamin C - 9.312.” Extension, extension.colostate.edu/topic-
areas/nutrition-food-safety-health/water-soluble-vitamins-b-complex-and-vitamin-c-9-312/.
16
“Minerals: Their Functions and Sources.” HealthLink BC, www.healthlinkbc.ca/health-topics/ta3912.
17
18
“Diet.” Merriam-Webster, Merriam-Webster, www.merriam-webster.com/dictionary/diet.
19
Medscape Log In, www.medscape.com/slideshow/world-diets-6008977#4.
7
developing or undeveloped countries that have not yet been hampered by the fast, fake, and
unhealthy food culture.
Unhealthy diets usually consist of simple carbohydrates in the form of sugars and
starches, processed foods, saturated fats, and large portion sizes. They include the French, the
United States, and the Czech Republic diet. They primarily occur in developed countries where
there is a dominating fast food culture.
Although modernization can negatively affect the health of the general population, it can
also have positive effects. Modern and developed countries have the power and resources to
promote proper nutrition for their citizens. For example, the Canadian food guide that was
initially released in July of 1942 but continues to evolve to match the most current nutritional
science, serves as a guide to help Canadians make healthy eating choices.20
In addition to nutrition, the human body consists of 60% water and humans can only
survive three days without water.21 Water is an essential component of life physiologically in
cells, organs, and tissues to regulate temperature and bodily functions as well as in other aspects
including religion, sports, and entertainment.22 Unfortunately, not every person is allocated
sufficient clean drinking water due to external factors like geographic location, infrastructure,
social class, and precipitation. A benchmark for water intake would be eight, eight-ounce
glasses, which is two litres or half a gallon per day, a key indication being the feeling of
hydration. Side effects of dehydration include constipation, kidney stones, the risk of bladder and
colorectal cancer, heat injury or stroke, swelling of the brain, and seizures.23
Being active has many benefits in a person's life, by working on one's strength and
conditioning using a variety of vigorous resistance and cardiovascular training methods, it can
help to physically sustain participants at an ideal and healthy weight, improve athletic
performance, and significantly enhance quality of life and lifespan. It can also provide social
opportunities to make or sustain healthy relationships and develop better social skills that can
later have a professional or academic application. As well as enhance mental, psychological, and
20
“Canada's Food Guide through the Years.” The Globe and Mail, The Globe and Mail, 29 Apr. 2018,
www.theglobeandmail.com/life/health-and-fitness/canadas-food-guide-through-the-years/article635468/.
21
Peshin, Akash. “How Long Can You Survive Without Water?” Science ABC, Science ABC, 12 Oct. 2018,
www.scienceabc.com/humans/long-can-survive-without-water.html.
22
Laskey, Jen. “The Health Benefits of Water.” Stroke Center - EverydayHealth.com, Ziff Davis, LLC, 16 Feb.
2015, www.everydayhealth.com/water-health/water-body-health.aspx.
23
“Dehydration Can Lead to Serious Complications.” Mayo Clinic, Mayo Foundation for Medical Education and
Research, newsnetwork.mayoclinic.org/discussion/dehydration-can-lead-to-serious-complications/.
8
cognitive health and performance. Essentially, physical activity is beneficial to the individual as
a whole. Ideally, the average healthy adult should receive 150 minutes a week of moderate
physical activity or 75 minutes a week of vigorous activity relative to
cardiorespiratory/conditioning training.24 Moderate physical activity could include a brisk walk,
swimming or mowing the lawn, where vigorous exercise entails activities of the running or
aerobic dancing calibre.25 In terms of strength training, two sessions a week is the minimum
baseline for adults. In terms of weight lifting it is recommended they lift moderate to challenging
weights for anywhere between twelve to fifteen repetitions.26 Other means of strength training
can include plyometrics (explosive jumping drills), body weight exercises (i.e. pushups, squats,
situps, etc.), resistance paddling (kayaking or canoeing), and rock climbing.
Smoking, vaping, exposure to poisonous chemical or gasses, and/or any form of tobacco
inhalation including second-hand smoke can have many adverse health repercussions. Nearly
50% of people who smoke die from diseases directly caused by smoking, such include lung or
oral cancers, lung diseases such as chronic obstructive pulmonary disease (COPD), high blood
pressure, blood clots, stroke, and vision problems (cataracts and macular degeneration). 27
Ideally, one should never smoke and avoid all means of smoke exposure to protect one's health.
A drug is a medicine or substance that has a physiological effect when ingested or
introduced to the body.28 Drugs impact although dependent on some physical factors can result
in positive or negative physical, social, and emotional changes to a person's performance and
behaviour. In most cases, drugs receive a negative connotation due to the knowledge of
addiction, depression, overdose, and other side effects that the use of recreational drugs inspire.
Although some drugs are medically prescribed and needed, recreational drugs would be
considered a preventable lifestyle practice. The main types of recreational drugs are stimulants,
24
“How Much Water Should You Drink Per Day?” Healthline, Healthline Media,
www.healthline.com/nutrition/how-much-water-should-you-drink-per-day#section1.
25
26
27
“Smoking: The Top 10 Things You Need to Know.” Canada.com,
bodyandhealth.canada.com/channel/smoking/smoking-basics/smoking-the-top-10-things-you-need-to-know.
28
“What Are Drugs?” Drug Aware, drugaware.com.au/getting-the-facts/faqs-ask-a-question/what-are-drugs//#what-
is-a-drug.
9
depressants, opium-related painkillers, and hallucinogens.29 Alcohol is a form of depressant that
is commonly consumed around the world, recreationally, religiously, and socially. Long-term
effects of excessive alcohol use include nerve damage, liver disease, weight fluctuations, gout,
brain damage, and ulcers.30 Drugs and alcohol are an unhealthy lifestyle choice that can cause
many chronic non-communicable disorders when consumed in excess.
Sexual relations make participants susceptible to infectious diseases. Infectious diseases
can be disorders caused by organisms such as bacteria, viruses, fungi or parasites that can be
passed on from person to person.31 Sexually transmitted disease (STD) is the umbrella correlated
to unprotected sexual relations.32 Therefore to prevent receiving a sexually transmitted disease,
one should use means of protection and if not in a marriage or monogamous relationship, abstain
from sex to avoid sexually transmitted infections as well as unplanned pregnancies which can
affect one's mental and physical health.
In today's society, the advancement of technology, white collar jobs, and industrialization
have contributed to a trend in global inactivity. People of all ages are tempted by the luxury of
screen time, sitting, sedentary habits, social media, videogames, and technology. Results of this
lifestyle include the obesity epidemic in developed countries like Canada and the United States.
More physical labour is being done by the use of machines, keeping most of the jobs in more
sedentary office settings that limit activity and require less movement. Urbanization and modern
infrastructure discourage active transportation making living a healthy lifestyle challenging.
Consequences of being caught in the realm of sedentary habits include varicose veins, deep vein
thrombosis (DVT), diabetes, heart disease, anxiety, depression, some cancers, metabolic
syndrome, and weight gain.33
29
“Recreational Drugs and Alcohol.” Clinical Negligence | Mind, the Mental Health Charity - Help for Mental
Health Problems, www.mind.org.uk/information-support/types-of-mental-health-problems/drugs-recreational-
drugs-alcohol/types-of-recreational-drug/#stimulants.
30
“Short- & Long-Term Effects of Alcohol - Negative Side Effects on the Body - Drug-Free World.” Foundation for
a Drug-Free World, www.drugfreeworld.org/drugfacts/alcohol/short-term-long-term-effects.html.
31
“Infectious Diseases.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 3 Jan. 2018,
www.mayoclinic.org/diseases-conditions/infectious-diseases/symptoms-causes/syc-20351173.
32
“Sexually Transmitted Infections (STIs) and Related Conditions.” RELATIVE EFFECTIVENESS OF BIRTH
CONTROL METHODS* | Options for Sexual Health, www.optionsforsexualhealth.org/sexual-health/sexually-
transmitted-infections.
33
Department of Health & Human Services. “The Dangers of Sitting: Why Sitting Is the New Smoking.” Better
Health Channel, Department of Health & Human Services, 10 Aug. 2016,
www.betterhealth.vic.gov.au/health/healthyliving/the-dangers-of-sitting.
10
A disease is a disorder or abnormality to an organ, structure or function present in a
human, animal or plant that has specific signs and symptoms and/or affects a particular location
on the body that is not caused by a physical injury.34 Diseases are caused by genetic development
errors, infections, poisons, nutritional deficiencies or imbalances, toxicity or unfavourable
environmental factors.35 More specifically a lifestyle disease also known as a non-communicable
or chronic disease is preventable as it is dependent on how an individual lives one's life. In most
cases, lifestyle diseases tend to last longer and occur in adults.36 As previously illustrated a
healthy active lifestyle is key to avoiding these diseases. Types of lifestyle diseases include
cardiovascular, chronic respiratory, sexually transmitted infections, deficiencies, denigrative
diseases, type two diabetes, obesity, cancers, and depression.
Cardiovascular diseases are the number one cause of death globally and the leading cause
of death among Canadian men and women.37 Cardiovascular diseases are a group of disorders
affecting the circulatory system including the heart and/or blood vessels. Most common types of
cardiovascular diseases include ischemic heart disease, cerebrovascular disease, peripheral
vascular disease, heart failure, and hypertension.38 Ischemic heart disease is the most common
cardiovascular diseases in Canada and other developed countries. It pertains to issues of
circulation to the heart muscle; it is often caused from a partial blockage of cardiac tissue causing
symptoms including angina (also known as chest pain) and dyspnea (shortness of breath). In
most cases, the obstruction is due to adipose tissue (fat). If this escalated to a complete blockage
of the tissue it would result in necrosis which is damage to the tissue or myocardial infarction
often known as a heart attack.39 Cerebrovascular disease is a type of cardiovascular disease that
specifically hampers circulation to the brain and/or nervous system. Symptoms include sudden
34
“Definition of 'Disease'.” Take Heed/Pay Heed Definition and Meaning | Collins English Dictionary,
www.collinsdictionary.com/dictionary/english/disease.
35
“Disease.” Dictionary.com, Dictionary.com, www.dictionary.com/browse/disease.
36
“Non Communicable Diseases.” World Health Organization, World Health Organization, www.who.int/news-
room/fact-sheets/detail/noncommunicable-diseases.
37
Public Health Agency of Canada. “Six Types of Cardiovascular Disease.” Canada.ca, Innovation, Science and
Economic Development Canada, 23 July 2010, www.canada.ca/en/public-health/services/chronic-
diseases/cardiovascular-disease/six-types-cardiovascular-disease.html.
38
39
11
headache, blurred or darken vision, and dizziness.40 Blood vessels in the brain are also at risk of
bursting which can have further long-term effects.41 Peripheral vascular disease affects
circulation anywhere but the heart and brain, most often the legs but it can also burden the arms,
stomach, intestines, and kidneys. Blood vessels within these areas experience a narrowing effect
known as atherosclerosis which is due to the buildup of fat deposits on the artery walls. If this
disease is left untreated it can result in organ damage or loss of fingers, toes, and limbs. Signs
and symptoms include a feeling of heaviness or numbness, affected areas experiencing a change
from blue to purplish colour, cramps, and long-term ulcers. Primary causes of peripheral vascular
disease include smoking, high blood pressure, diabetes, and high cholesterol.42 Heart failure
sometimes referred to as congestive heart failure occurs due to certain conditions, such as
coronary artery disease or high blood pressure which eventually lead to the heart being too weak
to continue to fill and pump. Symptoms include shortness of breath, swelling in legs, ankles, and
feet, rapid or irregular heartbeat, fatigue, and weakness. Causes of heart failure are coronary
artery disease, heart attack, hypertension, cardiomyopathy (damage to heart muscle), heart
arrhythmias, and other chronic diseases.43 Hypertension is a common category of conditions that
are due to the long-term force of blood on the artery walls to a point in which it can result in
serious health repercussions. Symptoms are irrelevant until the condition has significantly
escalated; they include headaches, shortness of breath, and nose bleeds.44 Cardiovascular
diseases are a leading cause of death globally, yet in most cases are preventable given lifestyle
changes.
Chronic respiratory diseases hamper the airways and/or respiratory structures like the
lungs. Typical examples include chronic obstructive pulmonary disease (COPD), pulmonary
hypertension, and asthma.45 COPD is a lifestyle disease combining chronic bronchitis and
40
Hulsken, Astrid. “Cerebrovascular Disease: Causes, Symptoms and Treatment.” International CAA Association,
13 Oct. 2017, caaforum.org/cerebrovascular-disease-causes-symptoms-and-treatment/.
41
42
“Peripheral Vascular Disease.” Healthline, www.healthline.com/health/peripheral-vascular-disease.
43
“Heart Failure.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 23 Dec. 2017,
www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142.
44
“High Blood Pressure (Hypertension).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 12
May 2018, www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410.
45
“Chronic Respiratory Diseases (CRDs).” World Health Organization, World Health Organization, 24 Jan. 2019,
www.who.int/respiratory/en/.
12
emphysema.46 Up to 90% of cases are caused by smoking and other risk factors include exposure
to tobacco, pipe, cigar, and cannabis smoke.47 Signs and symptoms of COPD include consistent
coughing over a long period, coughing up mucus, having trouble breathing while completing
simple tasks, contracting lung or respiratory infections (i.e. flu, pneumonia) that last longer than
the average time, wheezing, feeling fatigued, and unintended weight loss.48 Pulmonary
hypertension is a type of high blood pressure that affects the arteries in the lungs and the right
side of the heart. In this case, tiny arterioles and capillaries become narrowed, blocked or
destroyed. As the pressure builds, the right ventricle must work harder to pump deoxygenated
blood to the lungs to obtain oxygen.49 Over time the weakening of the heart muscle will lead to
heart failure. Symptoms include shortness of breath, fatigue, chest pain, dizziness, and/or heart
palpitations.50 Any detrimental lifestyle habits such as smoking, doing drugs, and being
overweight can contribute to a higher risk. Asthma is a condition that entails airways narrowing,
swelling, and producing extra mucus. Asthma makes breathing difficult, especially during
activity. Symptoms include shortness of breath, pain or tightening of chest, and wheezing.51
Although there can be a genetic component, lifestyle choices such as being overweight and
smoking can increase the risk. Chronic respiratory diseases make everyday life significantly
more difficult, however have a simple solution involving lifestyle re-evaluation.
Infectious diseases caused by bacteria, viruses, parasites or fungi can be acquired from
person to person through a bodily fluid exchange or exposure to certain environmental factors.
Vaccines can usually prevent them. Symptoms range depending on the type of infectious
disease.52 Although most infectious diseases are caused by uncontrollable environmental factors,
sexually transmitted infections are a type of infectious disease that can be prevented by
46
“Chronic Obstructive Pulmonary Disease (COPD).” American Lung Association, www.lung.org/lung-health-and-
diseases/lung-disease-lookup/copd/.
47
“Chronic Obstructive Pulmonary Disease (COPD).” The Lung Association BREATHE, www.lung.ca/copd.
48
49
“Pulmonary Hypertension.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 28 Dec. 2017,
www.mayoclinic.org/diseases-conditions/pulmonary-hypertension/symptoms-causes/syc-20350697.
50
51
“Asthma.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 13 Sept. 2018,
www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653.
52
13
practicing safe sex, which can be considered a lifestyle choice. Sexually transmitted infections
are associated with physical and social repercussions in today's society.
Nutritional deficiencies or being malnourished occur in people who do not receive
enough of a particular nutrient or calories in general. The most common deficiencies are due to a
lack of iron, Vitamin A, Thiamine (B-1), Niacin (B-3), Folate (B-9), Cobalamin (B-12), Vitamin
D, and Calcium.53 Symptoms include paler skin, fatigue, weakness, trouble breathing, hair loss,
constipation, sleeplessness, and depression.54 Physicians or nutritionists will likely recommend
to a patient to make dietary changes, potentially giving them an eating plan and/or suggesting the
use of supplements that will help to provide specific nutrients that one may be lacking. In long-
term situations, nutritional deficiencies can lead to lasting adverse health outcomes, such as
stunted growth and depression. Therefore, patients should recognize the signs and consult a
healthcare professional to make the appropriate lifestyle changes.55
A degenerative disease is one in which the function or structure of a tissue or organ
worsens over time. Most well-known examples include osteoarthritis, osteoporosis, Alzheimer's
disease, and dementia.56 Osteoarthritis refers to the weakening of the joints in the body, a
common cause being obesity due to the physiological composition of the joint being challenged
by extra weight. Symptoms include pain, loss of flexibility, tenderness, stiffness, and bone
spurs.57 Osteoporosis is the weakening of the bones, which is often caused by nutritional
deficiencies. Symptoms include back pain, bone fractures, and loss of height.58 Both
osteoarthritis and osteoporosis can be reduced in risk by strength exercises and proper nutrition
emphasizing calcium intake. Alzheimer's and dementia are progressive mental diseases also
known as neurodegenerative diseases that affect middle to older aged people and entail the
denigration of the brain. Alzheimer’s is a type of dementia that causes problems with memory,
53
“Nutritional Deficiencies (Malnutrition).” Healthline, www.healthline.com/health/malnutrition#long--term-
outlook.
54
outlook.
55
outlook.
56
“NCI Dictionary of Cancer Terms.” National Cancer Institute, www.cancer.gov/publications/dictionaries/cancer-
terms/def/degenerative-disease.
57
“Osteoarthritis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Mar. 2018,
www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925.
58
“Osteoporosis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 7 July 2016,
www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968.
14
thinking, and behaviour. Symptoms include memory loss, difficulty thinking, swallowing, and
speaking.59 The six pillars of Alzheimer's prevention include regular exercise, social
engagement, healthy diet, mental stimulation, quality sleep, and stress management.60 By
applying these principles, one can reduce risk or slow down the process of Alzheimer's. In the
big picture, dementia hampers language abilities, behaviour, memory, thinking, and judgment,
often preventing self-sufficiency. Symptoms include being repetitive, confused, change in mood,
and subtle changes in short-term memory.61
Type two diabetes is a chronic condition that affects the bodies ability to metabolize
sugar (glucose) as fuel for the body. Symptoms include increased thirst and appetite, fatigue,
blurred vision, and frequent infections.62 Factors often entail lifestyle choices such as activity,
weight, and nutrition. Type two diabetes is a burden to live with and increases the risk for other
severe health conditions such as heart and blood disease, nerve, kidney, and eye damage, skin
conditions, and Alzheimer's disease.63 It is especially popular among developed countries with
the dominant fast food industry.
Obesity means having excess weight in the form of adipose tissue also known as fat.
Obesity puts people in a very vulnerable position in terms of health with a higher risk of
obtaining many other chronic diseases and often shorter longevity. Obesity can also have effects
beyond physical, including social effects and hampering one's mental state such that results in
poor self-esteem and acceptance. One can determine where they are on the weight spectrum by
calculating their body mass index (BMI) which will give them an indication if they are in a
healthy weight range. In conclusion, obesity is detrimental to an individual's overall health and
well-being, however can often be preventable by instituting lifestyle changes.
Cancer is an umbrella of a large number of diseases characterized by abnormal cell
growth; cells divide uncontrollably and destroy healthy body tissue. Symptoms include
59
“What Is Alzheimer's?” Alzheimer's Association, Alzheimer's Association, www.alz.org/alzheimers-
dementia/what-is-alzheimers.
60
“Preventing Alzheimer's Disease.” Healthy Eating Tips to Prevent, Control, and Reverse Diabetes, 13 Feb. 2019,
www.helpguide.org/articles/alzheimers-dementia-aging/preventing-alzheimers-disease.htm/.
61
“What Do You Want to Know about Dementia?” Healthline, www.healthline.com/health/dementia#symptoms.
62
“Type 2 Diabetes.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 9 Jan. 2019,
www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193.
63
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lumps/abnormalities, skin and weight changes, trouble breathing, and fatigue.64 Types of cancer
that could be influenced by lifestyle factors include pharynx, bladder, mouth, esophagus, lung,
colorectal, larynx, pancreatic, prostate, gallbladder, gastric, breast, and endometrial. According
to new scientific research, factors outside of the genetic realm contribute significantly to
cancer.65 Specifically, a British statistician claimed that if external factors (lifestyle) where to be
eliminated so would 70 to 80% of cancers.66 Such external factors include diet, obesity, physical
inactivity, sun exposure, smoking, infections, and stress.
Depression is a mental health disorder that can be caused by a variety of factors in one's
life; mostly it is constant sadness. Certain lifestyles that include poor nutrition, inactivity,
excessive drug use, alcoholism, and sedentarism can result in depression. Although depression is
only one example, it emphasizes how daily choices can directly pertain to one's mental health.
Furthermore, addiction is a mental health disorder that can be caused by repetitive lifestyle
choices and can harm one's health. Addictions commonly occur in drugs, food, and other
detrimental lifestyle habits.
Significance
In the big picture, the most critical value is human life, if humans are not alive they
cannot grow up, experience pleasure and pain, have a family, have a job, make money, and have
ambitions. The way one lives their life; the foods they choose to fuel their body with, the amount
of time they dedicate to exercise, whether or not they smoke, do drugs, drink excessively, and
have unprotected sexual relations as well as if they practice sedentary habits or not can
significantly alter their health. Science illustrates that the healthier choices one makes, the better
off they will be physically, socially, and mentally as well the increased longevity and better
quality of life. Thus, allowing them to be an active participant in traditional pastimes and
significant experiences. Those who choose to make unhealthy choices can often experience
64
“Cancer.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 12 Dec. 2018,
www.mayoclinic.org/diseases-conditions/cancer/symptoms-causes/syc-20370588.
65
Admin. “Causes of Cancer: Genetics vs. Lifestyle {Infographic}.” FoodPrint by Nutrino, 21 May 2017,
nutrino.co/what-causes-cancer/.
66
Knapton, Sarah. “Nine in 10 Cancers Caused by Lifestyle.” The Telegraph, Telegraph Media Group, 17 Dec.
2015, www.telegraph.co.uk/news/health/news/12055206/Nine-in-10-cancers-caused-by-lifestyle.html.
16
extreme repercussions in the form of lifestyle diseases. Chronic diseases which are the world's
biggest killers, are jeopardizing global health and have a political, sociocultural, economic, and
environmental relevance around the world.
Chronic diseases are of political significance as they demonstrate the responsibility and
ownership of various political parties, representatives, and governments to encourage positive
change towards healthy active living. Despite knowledge of the importance of healthy active
living and chronic disease prevention; global and national policies have failed to stop and even
contributed to this issue. This ignorance has resulted in the global chronic disease pandemic and
the problem escalating from technical to political.67 Politically, acknowledgment and efforts to
improve the quality of life of citizens can help them to be active in the polls, improve national
and global economies, benefit the environment as well as enhance parties and representatives
public image. If citizens have poor health, they will be limited to being productive and enjoying
positive experiences in life, including exercising their political power as voters and
changemakers. Also, it is in the best interest of politics and government to prioritize health
because it has many added benefits beyond the physical realm, including improving the
economy, environment, and quality of life of people. Therefore regardless of whether the
motivation is intrinsic or extrinsic, politicians, parties, and governments who appreciate healthy
active living are those who will likely be viewed favourably. Ultimately, chronic diseases can
hamper the sustainability of global healthcare, which is a pressing concern that has a role in
governance and ethical obligation to be addressed politically.
Sociocultural factors can be a part of the cause and effect of chronic diseases. They play a
role in causing lifestyle diseases because they include education, income, living situation,
spiritual and religious values, all of which can impact the life choices and daily practices of an
individual.68 Also, from both the epigenetic and psychological perspectives, one's lifestyle can
employ a chain reaction, in which that person negatively influences their family, community, and
offspring. On the contrary, having a lifestyle disease can become a physical or psychological
barrier limiting an individual's participation in social, religious, and cultural conventions. Such
67
Geneau, Robert, et al. “Raising the Priority of Preventing Chronic Diseases: a Political Process.” The Lancet, 11
Nov. 2010, www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61414-6/full text.
68
Staff, Familydoctor.org Editorial. “Social and Cultural Factors That Can Influence Your Health.”
Familydoctor.org, Familydoctor.org, 2 Apr. 2018, familydoctor.org/social-cultural-factors-can-influence-health/.
17
conventions are oftentimes valued by many people around the world and being excluded in these
activities can be detrimental to one's social and mental well-being.
The economic relationship to lifestyle diseases is illustrated in various ways, including
direct, indirect, and intangible costs. Also, global economic repercussions vary according to the
development of countries as well expenses can be evaluated at the macroeconomic and
microeconomic levels.
Chronic diseases can be costly on behalf of the patient and government including direct,
indirect, and intangible costs.69 Direct costs include those associated with the prevention,
diagnosis, and treatment of the chronic disease. They would consist of an ambulance, inpatient
and outpatient care, rehabilitation, community health services, and medication.70 Indirect costs
would be the measure of human loss of resources caused by morbidity or premature death; this
can include money forgone due to being too ill to work.71 Intangible costs are immeasurable,
they include human life and the psychological effects associated with having a lifestyle disease.72
The correlation between the development of a country and the economic wrath of chronic
disease that follows, supports the trend that the more developed, the higher the cost. This can be
due to many factors including health care standards and prevalence of chronic disease. Firstly,
health care standards vary between nations; less developed nations often have a poor quality of
life for their citizens. In terms of health, this means limited access to medical resources and thus
they are less concerned about chronic disease. Also, if the country is less developed, it most
often has less opportunity for sedentarism, inactivity, and poor nutrition. For example, African
countries have poor living conditions and citizens often have to walk/forcibly exercise to survive.
Therefore, they have little time to practice sedentary habits. Food culture is also less of a priority
and the small amounts of food people consume are not rich in sugar, starches, and full of empty
calories. However in developed and North American countries, food culture is much more
unhealthy and industrialization has shaped trends in inactivity and sedentarism. Due to these
distinct changes in infrastructure and societal norm, the prevalence of chronic disease is much
69
Suhrcke, Marc, et. al. Confronting the Epidemic of Chronic Disease. 2006,
www.who.int/management/programme/ncd/Chronic-disease-an-economic-perspective.pdf?ua=1.
70
71
72
18
higher in developed countries compared to undeveloped or developing. Therefore, more money
must be attributed to combating these diseases in developed countries and thus the economic
repercussions are greater.73
Chronic non-communicable diseases are not just a problem for the rich; they impact the
world as a whole. A new study by the World Economic Forum predicts that within the next
twenty years, a group of five lifestyle diseases will cost the global economy $47 trillion (USD).74
These five include cancer, diabetes, mental illness, heart disease, and respiratory illness. Today,
these big five kill 36million people a year, it is estimated by 2030 that non-communicable
diseases will cause 52 million deaths a year, making up 80% of the total global deaths annually.75
Controversy surrounds lifestyle diseases as they are considered reserved for rich people.
However, it is evident that no country is unscathed with the burden of chronic disease. Chronic
diseases can be regarded as equally as destructive to an economy as infectious diseases. They are
becoming more common and require more expensive treatment methods.
At the macroeconomic level, the trend of chronic diseases can have an impact on the
economic growth of a country, specifically on the financial loss and decline in the gross domestic
product (GDP) of a nation. Gross domestic product is the total value of goods produced and
services provided in a country per year.76 An example of how chronic diseases impact the GDP
of a country: the cost of healthcare in 2016 in the United States was $1.1 trillion. Including the
loss of economic productivity the total impact was $3.7 trillion, this is equivalent to 20% of the
United States GDP. To break that down even further, being overweight or obese attributed to
$1.7 trillion or 47% of the total cost. Also, 8.7% of the health-care spending budget was
attributed to cigarette smoking, 60% of that was paid by Medicare, Medicaid, and other U.S.
federal and state health programs which deal with combating chronic disease. Also, health care
73
Majid, Aisha. “The Global Epidemic of 'Lifestyle' Disease in Charts.” The Telegraph, Telegraph Media Group, 29
Mar. 2018, www.telegraph.co.uk/news/0/mapped-global-epidemic-lifestyle-disease-charts/.
74
75
76
“Gross Domestic Product (GDP).” Investing Answers Building and Protecting Your Wealth through Education
Publisher of The Next Banks That Could Fail, investinganswers.com/financial-dictionary/economics/gross-
domestic-product-gdp-1223.
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problems caused by excessive alcohol use costed $27.4 billion in 2010.77 Unless people make
significant lifestyle changes and/or the food industry changes the way they promote healthy
eating, these numbers will continue to rise, growing the economic burden by costing economies
and gross domestic products trillions of dollars.
The microeconomic level pertains to economic consequences endured by a household or
individual. The dimensions of economic outcomes at the microeconomic level differentiate
between consumption and savings, labour supply and labour productivity as well as effects
education and human capital accumulation.78 The use and savings refers to the family or affected
individual’s financial contributions towards treatment and goods, perhaps those causing chronic
diseases such as alcohol and tobacco. Also, the ability of the person to sustain consumption even
in the face of chronic disease, which results in a significant welfare loss that can potentially
require public policy intervention. Medical care expenses include medication, treatment, and
rehabilitation costs for those with a chronic disease.79 For those in developing countries and who
are impoverished, this can take a devastating toll on their family and financial savings.
Chronic diseases are relevant to planetary health, which demonstrates the connection
between humankind health care and the condition of the Earth.80 The more industrialized and
urbanized the community the more often the city experiences more significant risks of chronic
disease, all of which contribute to a negative ecological footprint. Chronic diseases can increase
toxic elements, naturally occurring substances, pesticides, persistent organic pollutants, volatile
organic compounds, and plastics used for the food industry. All of these can play a role in
hurting the environment, causing pollution and climate change.81
77
Waters, Hugh, and Marlon Graf. “Chronic Diseases Are Taxing Our Healthcare System and Our Economy.”
STAT, STAT, 30 May 2018, www.statnews.com/2018/05/31/chronic-diseases-taxing-health-care-economy/.
78
79
80
McCosker, Anthony, et al. “Policies, Politics, and Paradigms: Healthy Planning in Australian Local
Government.” MDPI, Multidisciplinary Digital Publishing Institute, 29 Mar. 2018, www.mdpi.com/2071-
1050/10/4/1008/htm.
81
Sears, et al. “Environmental Determinants of Chronic Disease and Medical Approaches: Recognition, Avoidance,
Supportive Therapy, and Detoxification.” Advances in Decision Sciences, Hindawi, 19 Jan. 2012,
www.hindawi.com/journals/jeph/2012/356798/.
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Background
Chronic non-communicable diseases are a global issue because they are a profound and
unsettled matter posing a significant threat politically, socioculturally, economically, and
environmentally to the world.
Although the beginning of human’s existence is a controversial topic; some arguing on
behalf of science, others religion, a logical standpoint must assume that humans originated as
hunter-gatherers. Meaning to survive they had to spend all of their time hunting, gathering,
building fires, and shelters. Therefore, they had little to no downtime to practice sedentary habits,
overeat, smoke, drink, and be inactive. At the time, chronic diseases were non-existent as they
had no cause. However, as humans began to evolve, finding more civilized means of living, the
uproar of industrialization, modernization, and advancements in knowledge, medicine, and
technology have gradually lead to a lifestyle disease pandemic. It is a pandemic because it is a
worldwide spread of a new disease.82
82
“What Is a Pandemic?” World Health Organization, World Health Organization, 21 June 2015,
www.who.int/csr/disease/swineflu/frequently_asked_questions/pandemic/en/.
21
The process humans have undergone in sacrificing capability for convenience and
comfort poses a significant issue for future generations.83 Zooming in on this escalation of
chronic disease, it did not happen overnight any more than is one factor responsible for the
destruction of human health and competence. Many factors have contributed to this pandemic;
evolution of the food culture and industry, physical activity, epigenetics, psychology, the shift of
health priorities, and the seduction of sedentarism.
There seems to be a direct correlation to the growth in the unhealthy and fast food culture
of developed countries like the United States and chronic disease. For instance, in the U.S. since
1970 the number of fast food restaurants have doubled, so has the number of obese Americans.84
According to the Food Institutes analysis of data from the Bureau of Labor Statistics, Millennials
spend 45% of their food budget eating out.85 Fast food has been proven to have adverse effects
on the body, hampering many systems and resulting in common chronic diseases such as obesity,
type two diabetes, and heart failure. Like anything the fast food industry is continuously
evolving, over the last thirty years many menus have increased in variety, caloric content, and
portion size.86 A team of researchers conducted a study in which they analyzed three decades
(1986, 1991, 2016) of fast food chain menus, looking at entrées, sides, and desserts to see the
evolution of the fast food variety and nutritional content. The paper published in the Journal of
the Academy of Nutrition and Dietetics observed dietary variables of portion size, energy, and
sodium. Overtime, each item increased by approximately 62 kilocalories each decade and portion
size increased by 13 grams for entrées and 24 grams for desserts.87 This research can serve as a
justification for the staggering obesity epidemic in countries with fast food chains.
Physical activity originated as a means of survival; from the beginning of human
existence to approximately 10,000 BC humans were physically active due to natural selection.88
83
“Physical Activity to Combat Chronic Diseases and Escalating ... : Current Sports Medicine Reports.” LWW,
Oxford University Press, journals.lww.com/acsm-
csmr/Fulltext/2008/05000/Physical_Activity_to_Combat_Chronic_Diseases_and.4.aspx#O3-4.
84
“The Effects of Fast Food on the Body.” Healthline, www.healthline.com/health/fast-food-effects-on-
body#effects-on-society.
85
“The Effects of Fast Food on the Body.” Healthline, www.healthline.com/health/fast-food-effects-on-
body#effects-on-society.
86
Cohut, Maria. “Has Fast Food Become Worse for Our Health in the Past 30 Years?” Medical News Today,
MediLexicon International, 2 Mar. 2019, www.medicalnewstoday.com/articles/324589.php.
87
88
“The History of Physical Fitness.” MovNat: Natural Movement Fitness, 20 Oct. 2016, www.movnat.com/the-
history-of-physical-fitness/.
22
This period served as an opportunity for humans to develop fundamental movement skills that
would help them to not only survive but begin to live more comfortably. Transitioning from
Primal to Neolithic times, which is the time allocated between 10,000 BC to 8,000 BC, the
Agricultural revolution is said to have kick-started civilization. The evolution from Nomadic
hunter-gatherer to farmer did not pose an issue in a reduced volume of physical activity; instead,
it kept the pace with chores and daily labour to maintain crops and livestock. However, it did
refine the fundamental movement skills to a limited range of simple movements.89 During
Ancient times, between 4,000 BC and the fall of the Roman Empire in 476 AD, civilizations
endured the hardships of war and in some cases reaped the benefits of conquest. Assyrians,
Babylonians, Egyptians, Persians, Greeks, and Romans enforced a challenging physical regiment
to young males in an attempt of preparing them for battle. Physical activity experienced a
reduction in demographics due to its exclusive male practice. This period also experienced a rise
in physical activity for leisure in the form of sports and the Olympics. The philosophy at the time
was that a sound body was key to a sound mind and that it was an essential component of a
young mans education. The Dark Ages that lasted from the fifth to the fifthteenth century
experienced a succession of kingdoms and empires, waves of barbarian invasions, and
destructive plagues.90 Christian teachings strayed away from physical health and focused on
mental education. At this time only the highest of social echelons participated in physical activity
and the poor relied on physical labour. The Renaissance, from 1400 to 1600 was full of
innovation and interest in biology, health, and physical education. In 1420 Vittorino da Feltre
created the first child-friendly and centred education program that focused on physical activity. 91
The Industrial Revolution brought with it new manufacturing processes around 1760 that
changed the way people lived, worked, and moved as well had a social, economic, and cultural
significance.92 The twentieth century sparked a revolution of its own with the rise of the sports
and fitness market and industry. Today, reflecting on the evolution of the fitness industry both
good and bad conclusions can be drawn. Positively, evolution has emphasized the importance of
89
90
91
92
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sports, fitness, and activity among humans and its benefit in modern society. Unfortunately,
many sources have confirmed that humans today are more sedentary than ever and have declined
in fitness rather than inclined. This decline cannot be blamed on the evolution of fitness, rather
other influential factors.
One of the main reasons lifestyle diseases have trickled down through generations is due
to epigenetics; furthermore, the psychological perspective of parenting and childhood influences.
Epigenetics is the study of the process in which genetic information is translated into the
substance and behaviour of an organism.93 In the realm of chronic disease, if an individual has
acquired a chronic illness due to poor lifestyle habits, that disease has the biological ability to
hamper that person's genome which is a full set of chromosomes.94 If that person decides to
procreate, any offspring then has the chance of inheriting a gene affected by chronic disease,
thereby increasing their chances of illness. In terms of psychological influences, the way a child
is raised within their formative years by their parents or family members impacts their future
lifestyle choices significantly. For instance, if their parents drink pop, alcohol, and eat fast food,
they will likely fall into that vicious cycle which will hurt their health and potentially continue
this chain for future generations. This idea justifies how lifestyle diseases are becoming more
prevalent as they are being passed down to the next generations.
The United States is an ideal country to illustrate the shift in the leading cause of death
from infectious to chronic diseases. In 1900 the most significant causes of death in the United
States were pneumonia/influenza, tuberculosis, and diarrhea/enteritis. At this time 60% of deaths
were due to communicable diseases caused by infections, injuries, poisonings, and war. In
contrast, lifestyle diseases and cancers were ranked in the number four to eight range.95 Today
with the help of modern science, improvements in sanitation, antibiotics, and medicine,
infectious and communicable diseases have taken a backseat, leaving lifestyle diseases to take
the wheel as the most significant cause of death globally. Curing infectious diseases could be
deemed possible because health innovation is very concise and scientific. However, humans have
personal tendencies about them that makes lifestyle decisions much more complex and
multidimensional with room for error. Therefore, implementing change on the professional,
93
“Epigenetics.” Dictionary.com, Dictionary.com, www.dictionary.com/browse/epigenetics.
94
“Genome.” Dictionary.com, Dictionary.com, www.dictionary.com/browse/genome?s=t.
95
“Lifestyle Diseases.” The Natural Health Perspective, naturalhealthperspective.com/home/civilization.html.
24
scientific level which solves infectious diseases is much easier than on the psychological,
personal level which is key to solving lifestyle diseases.
Modern technological advances have played a significant role in providing people with
comfort and convenience at home, in the workplace, and various other environments. Many
people reap the benefits of being virtually connected as well, enjoy the improved efficiency,
increased productivity, and decreased labour modern technological advancements provide.96 On
the contrary, these devices have consumed lots of leisure time keeping people stationary and
inactive. Research proves that being idle for long periods can cause serious health complications
such as chronic disease.
Previous efforts of resolution made by governments include displaying calories on
menus, tobacco, alcohol, and other drug laws as well as government organization initiatives. In
2018, the United States revised a law that all businesses that serve food are required to display
calories on menu items.97 The motive was to get Americans thinking about their choices as
consumers and hopefully inspiring the adoption of a healthier way of life. It is likely the food
industry will manipulate this idea and find a loophole to promote further unhealthy choices that
increase their profits. However for now, this is a step in the right direction politically and will
hopefully reduce chronic disease. Many other governments including Ontario have implemented
similar laws to cater to similar goals. Other governmental laws enforced in Canada and primarily
developed countries revolve around smoking, drinking, and drug use. Tobacco laws include
smoke-free places in which fines are instituted to prevent second-hand smoke exposure in
workplaces and residential spaces. As well as, specific laws have been implemented to limit
tobacco industry sponsorship and to shelter youth from the dangers of smoking.98 Also,
packaging and labelling around tobacco products must be explicit with warning signs. Alcohol,
another form of drug has its own set of laws such as impaired driving which is an offence with
serious consequences and prohibition of fake identifications relative to the legal drinking age.
96
Oxford University Press, journals.lww.com/acsm-
97
Court, Emma. “New Federal Requirement to Put Calorie Counts on Menus Might Make Americans Eat Better -
but Not in the Way You'd Think.” MarketWatch, MarketWatch, 7 May 2018, www.marketwatch.com/story/adding-
calorie-counts-on-menus-might-make-americans-eat-better-but-not-in-the-way-youd-think-2017-04-13.
98
“Canada.” Nicopure Labs, LLC v. Food and Drug Administration | Tobacco Control Laws,
www.tobaccocontrollaws.org/legislation/country/canada/summary.
25
Most drugs with aims of recreational use are illegal and punishable with jail time and fines.99
Most recently Canada legalized cannabis, however just like alcohol or tobacco it has its own set
of laws that limit the demographic of users. Physically and psychologically marijuana as a
lifestyle choice can be detrimental. Canada like many developed countries has its own set of
organizations that promote healthy active living such as ParticipACTION, Canadian Sport for
Life and Physical Health Education Canada.
Non-governmental efforts of resolution are attributed to a variety of organizations,
companies, and/or athletes. An example of this being Jumpstart; a program created by Canadian
Tire that provides sports opportunities to financially disadvantaged youth, thus promoting a
healthy active lifestyle to an impressionable demographic.100 This program receives donations
online, through fundraising as well as using various sporting good stores to spread awareness and
raise money. Jumpstart is a prime example of a company lead initiative with professional athletes
promoting the cause. These athletes include Connor McDavid, Wayne Gretzky, and Jonathan
Toews.101
Regardless of powerhouses like the media, governments, and organizations, it comes
down to personal choices. These platforms cannot force change, individuals must make their
own choices. Platforms can only try to persuade and educate people on the importance of healthy
active living as well as the dangers of chronic disease. It is up to the individual to decide between
luxurious sedentary habits or their personal well-being.
99
Government of Canada, Royal Canadian Mounted Police. “Alcohol.” Biology Services - Royal Canadian
Mounted Police, 7 July 2016, www.rcmp-grc.gc.ca/cycp-cpcj/dr-al/al-eng.htm.
100
“ABOUT JUMPSTART.” Jumpstart Charity â Canadian Tire,
jumpstart.canadiantire.ca/content/microsites/jumpstart/en/about-jumpstart.html.
101
“Canadian Tire: Wayne Gretzky, Connor McDavid or Jonathan Toews Limited Edition Toasters Available Now
for $24.99.” RedFlagDeals.com, www.redflagdeals.com/deal/appliances/canadian-tire-wayne-gretzky-connor-
mcdavid-or-jonathan-toews-limited-edition-toasters-available-now-for-2499/.
26
Expert
There are many highly educated people around the world who specialize in chronic
disease and healthy active living. Specific careers and/or fields of study within this realm include
nutritional scientists, medical professionals, professors, researchers, epigeneticist/geneticist,
psychologists, and athletes. Erin Berenbaum; the Research Coordinator of Health Promotion,
Chronic Disease and Injury Prevention for Public Health Ontario answered the following career
and chronic disease based questions. These questions were asked on March 6, 2019 by Innisdale
Secondary Student Paige Breedon and answered on March 7, 2019 by Erin Berenbaum.
I am curious as to your journey on becoming the research coordinator of health
promotion, chronic disease and injury prevention for Ontario. How did you get into your
current career field, what education did you pursue as well what interested you in healthy
active living and chronic disease prevention in the first place? I have been active my whole
life (I do gymnastics), so I was interested in physical activity. That led me to choose to do a
Bachelor’s degree in Kinesiology (BSc.Kin) after high school. While doing my bachelors, I also
did a minor in psychology and took many courses such as exercise psychology, sports
psychology, and health psychology. I then did a Master’s degree in health promotion (it was part
of the Health Studies and Kinesiology department, so most of my work there was focused on
promoting physical activity using psychology – so combining the use of my kinesiology and
psychology backgrounds). I did much work on behaviour change theory (e.g., how do we
motivate people to change their behaviours such as eat healthily and exercising more). That led
me to get a job in health promotion after I graduated. I started as a research assistant at Public
Health Ontario helping to report on effective interventions to address childhood obesity (it
focused a lot on promoting physical activity and healthy eating). From there I became a research
coordinator working on more diverse projects on a wide variety of topics (not just obesity).
27
What does your department in Public Health Ontario do? What does your job
entail? What have you/Public Health Ontario contributed to preventing chronic disease
and promoting healthy active living? The mandate of Public Health Ontario is to provide
scientific and technical advice to our clients (i.e., to primarily provide scientific ‘evidence’). You
can read more about the mandate on the Public Health Ontario website. Our department is called
the “Health Promotion, Chronic Disease and Injury Prevention” department. We focus on
providing scientific and technical advice related to those areas. Our ‘clients’ are mostly the
Ministry of Health and Long-term Care and Public Health Units across Ontario. For example,
let's say a public health unit wants to create a physical activity program for their community
because people there are not very active, they can ask us for evidence on how effective certain
interventions are to help them plan their program. We mostly provide knowledge products (e.g.,
reports, fact sheets, briefing notes, etc.). Within my department I am on a team called
‘Knowledge Synthesis Services’ – we mainly do knowledge syntheses which are systematic
reviews. So for example, we might get asked “what are the harms of e-cigarettes?” or “does
smoking e-cigarettes lead youth to start smoking cigarettes?” and then we would gather all the
evidence on this topic (usually scientific journal articles) and then synthesize them into reports.
You can see many reports on our website – if you search ‘electronic cigarettes’ in the PHO
website you can see some examples of what I am referring to.
What is the most challenging aspect of your job, that you face when attempting to
promote healthy active living and preventing chronic disease among Ontarians? One of the
most challenging parts of our job is that we are not an advocacy agency and therefore cannot
advocate for change - we can only provide the evidence. It is up to the policy makers and those
who make decisions to act on the evidence we offer them. For example, we can provide lots of
evidence to the Ministry of Health that increasing the availability of alcohol (e.g., extending
LCBO store hours) and lowering the price of alcohol (e.g., buck-a-beer) causes people to drink
more and leads to more alcohol-related harms (e.g., liver disease, cancer). However, if health is
not in their political agenda, then they will make those decisions regardless. They may favour
profits from the LCBO over the health of its customers.
How do you analyze and interpret this issue? Why do you feel that chronic diseases
are an issue? What types of diseases are more important and therefore should be
prioritized and why? Chronic diseases are an issue because they: have huge costs associated
28
with them (such as direct costs like health care costs, and other indirect costs such as lost
productivity at work) and they reduce individuals’ quality of life, etc. It’s difficult to say which
types of chronic diseases are more important. They are all important, but some are more
important or have more of a burden in certain populations or communities than others. One way
to prioritize is to look at the data for a particular community or population that you are interested
in addressing. For example, if your local Public Health Unit looks at statistics for Barrie and sees
that, for example, 60% of people in Barrie have diabetes (I’m making up these numbers) and
only 5% have heart disease then they might decide to prioritize intervention that focuses on
preventing diabetes in this community.
What do you consider the cause of chronic disease? Relative to the background and
history of chronic disease what factors are/or have been most influential? (Perhaps schools,
media, government, organizations, etc.) There are many causes of chronic diseases and that is
why they are difficult to prevent. One model that explains all of these factors well is the Social
Ecological Model showing factors causing diabetes. For example, the causes may stem from
individual-level factors (such as the individual not having the knowledge about healthy eating
and physical activity) to community-level factors (e.g., having lots of fast food restaurants
nearby) to policy or government related issues (such as laws that force restaurants to provide
calorie information on their menus). All of these factors play a role and I can not say which ones
have been most influential.
What demographic of people are most susceptible to chronic diseases in Ontario,
Canada, and/or globally? The answer to that question differs depending on the type of chronic
disease you are interested in. I would suggest looking at documents from Public Health Ontario,
Health Canada, and the World Health Organization to find relevant information for Ontario,
Canada, and globally, respectively for specific chronic diseases.
What do you feel the best solution is for preventing chronic diseases? This is a great
question, but one that is very difficult to answer. I think the key to preventing chronic disease is
collaboration and effort across many different sectors including health organizations, the food
and beverage industry, the government, and individuals themselves, among others. We need to
be addressing all levels of the ecological model to prevent chronic diseases successfully. For
example, we can’t just educate people about proper nutrition and diet or change the laws – it
29
needs to be a combination of addressing all of those things and that takes collaboration from
many different sectors.
What can I do to promote healthy active living in my community and life? Another
great question. In terms of developing healthy living personally, you can familiarize yourself
with some of the guidelines that are available related to preventing chronic disease. For example,
there are Canada’s Physical Activity Guidelines, Canada’s new food guide, and there are also
Canada’s Low-Risk Alcohol Drinking Guidelines. You can help to share this information with
friends and family members. There are also volunteer opportunities that you can get involved
with. For example the Heart and Stroke foundation used to have a Health Promotion volunteer
group for students and young people where you can help develop a health promotion program for
your community. (I volunteered in this group many years ago, and we worked on a ‘walking
program’ for the community to encourage people to walk more.) I am not sure if this group still
exists, but it’s worth checking out or contacting someone from the Heart and Stroke Foundation.
Erin Berenbaum; the Research Coordinator of Health Promotion, Chronic Disease and
Injury Prevention for Public Health Ontario responses and input on the current chronic disease
pandemic underline the importance of healthy active living. Chronic disease is a major societal
issue because of its economic repercussions and its ability to decimate the quality of life for
citizens. According to the ecological model she discussed, controllers of chronic disease range
on individual, interpersonal, institutional, community, and policy levels. These levels can be part
of the cause and solution if they exercise their shared role in making change.
30
Role of Control
The role of control is primarily on the general public. However, influences in these
people's lives affecting their day to day choices are distributed among international and non-
governmental organizations, the private sector, health care professionals, and the government.
The general public plays a significant role in chronic disease, they control what food,
products, and services they buy as consumers as well the lifestyle habits they adopt. They are
responsible for their life and the choices they make, what they decide will determine if they will
face the risk of chronic disease. The chronic disease pandemic is unique from other health-
related conflicts because the role of control is possessed by the same people who are affected by
the issue. This can be an advantage or disadvantage depending on how the people in control
exercise their power. Due to the escalation of this issue, it makes it evident that this uniqueness is
a disadvantage and calls into question whether or not the majority of the public can handle
governing their own lives. Legal capacity is a human right in which it states that all humans are
entitled to making their own decisions — therefore shifting the power of decision making and
lifestyle choices to a higher body such as the government could be considered unethical and a
human rights violation.102
International and non-governmental organizations play a significant role in promoting
healthy active living and discouraging chronic disease. They do this by creating initiatives,
fundraisers, and drawing attention to the importance of healthy living in a way that will appeal to
the public.
The private sector consists of the media, agricultural food production, food and beverage
industry, retailers, catering companies, sports good manufacturers, advertising, and recreational
business.103 All of these are very influential in society and human culture, unfortunately, these
companies and sectors bottom line revolves around money and often this can override concerns
of health. In most cases, they try to get the public as consumers addicted to sugar, saturated fat,
alcohol, and tobacco so they will purchase products and services more often, thus giving those
companies more money. The private sector could have a positive influence, given its power it
102
“What Is Legal Capacity?” Canadian Association For Community Living, 2 Feb. 2018, cacl.ca/2017/11/15/what-
is-legal-capacity/.
103
“Report of the Commission on Ending Childhood Obesity: Implementation Plan.” World Health Organization,
http://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_31-en.pdf.
31
can promote healthy active living on a global scale, it is just a matter of using that power with the
right intentions.
Health care professionals and the medical industry encompass the resources and
knowledge required to conclude, make connections, and form a plan for prevention. They are
responsible for scientific research and providing evidence they can present to the public, media,
and government to persuade positive change. This industry is key to bridging the gap between
lifestyle choices and chronic disease, illustrating the correlation scientifically and providing
motivation for healthy active living. This industry includes nutritional scientists, physicians,
professors, researchers, epigeneticists/geneticists, psychologists, and athletes. The statistics and
trends achieved through their research can be important in defining chronic diseases for the
general public and determining who cares about this issue.
The government is the highest power in most countries that have the right to make laws
and policies that can shape human life. This power tells the public what they can and cannot do
as well as can limit public exposure to certain unhealthy habits in the case of restricting tobacco
sponsorship unless it is only at adult venues. This is an example of how a government is trying to
protect specific demographics from the dangers of smoking.
The main group of people who care about lifestyle diseases are those facing them
personally or vicariously through family and friends. Unfortunately, by this progressive stage it
is often too late to fully reverse or treat the physical and psychological damage done by the
chronic disease. Ideally, the global population as a whole should care about chronic disease
enough to value their life and make changes to become healthy; this would spark a decline in
lifestyle disease. Besides cumulative groups of people, industries and governments should also
care about reducing chronic disease. Not only because it affects people's day to day lives and
mortality, more so to prevent the economic and environmental burden that chronic diseases
continue to cost the world. All people and pockets within society should be educated and aware
of the importance of healthy living practices as well as examine the significance on a deeper
level. Which means understanding that the chronic disease pandemic is bringing with it an
abundance of repercussions that are in the best interest of the globe politically, socioculturally,
economically, and environmentally to resolve.
32
International Organizations
Various international organizations have recognized the importance of promoting healthy
active living and the prevention of chronic non-communicable diseases. Organizations include
the United Nations; the World Health Organization, Global Alliance for Chronic Disease,
Centres for Disease Control and Prevention, and the Global Health Council.
33
The United Nations is an international organization established on October 24, 1945.
They aspire to affirm human rights by prioritizing justice, respect, and freedom to achieve
worldwide cooperation and peace by tackling international social, economic, cultural, and
humanitarian problems.104 The World Health Organization (WHO) is an agency of the United
Nations that came into force on April 7, 1948.105 WHO is committed to ensuring universal health
coverage, protection from health emergencies, and providing better health and well-being for
everyone.106 They have many programs that offer support to a wide range of people suffering
from health-related conflicts including chronic diseases. They claim that non-communicable
diseases such as heart disease, stroke, cancer, diabetes, and chronic lung disease, are collectively
responsible for 70% of deaths worldwide.107 To combat this global issue, WHOs Department of
Chronic Diseases and Health Promotion have launched various priority projects including the
Bangkok Charter for Health Promotion, a Global Strategy on Diet and Health as well as Cancer
Prevention and Control.108 The Bangkok Charter for Health Promotion consists of school and
youth health promotion as well as emphasizes the importance of advocacy, marketing, and
education.109 School and youth health promotion is a way that the charter is preventing behaviour
that is conducive of chronic disease such as detrimental dietary and hygiene practices, tobacco,
alcohol, and drug use as well as unprotected sexual relations.110 Secondly, a global strategy on a
diet encompasses many websites, programs, and campaigns that aim to target issues like obesity,
tobacco, and alcohol use, salt intake, physical inactivity, and unhealthy nutrition.111 Cancer
prevention and control is a list of policies WHO has created with the intention of reinforcing
104
Mingst, Karen, et al. “United Nations.” Encyclopædia Britannica, Encyclopædia Britannica, Inc., 20 Dec. 2018,
www.britannica.com/topic/United-Nations.
105
“Who We Are.” World Health Organization, World Health Organization, 1 Sept. 2016, www.who.int/about/who-
we-are/en/.
106
“What We Do.” World Health Organization, World Health Organization, www.who.int/about/what-we-do.
107
“NCDs | Noncommunicable Diseases and Their Risk Factors.” World Health Organization, World Health
Organization, 4 Jan. 2019, www.who.int/ncds/en/.
108
“Action: Priority Projects.” World Health Organization, World Health Organization, 21 Dec. 2015,
www.who.int/chp/action/en/.
109
“Global Forum on Chronic Diseases Prevention and Control.” World Health Organization, World Health
Organization, 21 Dec. 2015, www.who.int/chp/about/global_forum/en/.
110
“School Health and Youth Health Promotion.” World Health Organization, World Health Organization, 9 Jan.
2018, www.who.int/school_youth_health/en/.
111
“NCDs | Prevention of Noncommunicable Diseases.” World Health Organization, World Health Organization, 26
Feb. 2019, www.who.int/ncds/prevention/en/.
34
cancer control programs.112 WHO is a very ambitious organization that has implemented various
initiatives improving the quality of life for many people globally. Like any organization, it
continues to set goals and make a change.
Global Alliance for Chronic Disease (GACD) is an international alliance of researchers
and professionals, knowledgeable of the dangerous trend in chronic non-communicable diseases
and committed to working towards the prevention of diseases such as heart, lung, diabetes,
mental health, and some cancers.113 The strategy they employ is to target low to middle-income
countries and conduct research that will help justify policymaking. The initiative would be
carried out systematically, starting with coordinating research among members and agencies,
followed by building a platform in which to spread awareness beyond the original founding
members. Lastly, capacity building would entail developing and maintaining global-knowledge
as well as sharing outlets to conduct and manage global chronic disease research.114 Specific
project examples include a community health assessment program in the Philippines, the
development of an interactive social network for metabolic control of diabetic patients in
Mexico, using HIV/AIDS infrastructure as a gateway to chronic care of hypertension in Africa,
and a school-based education program to reduce salt intake for children and families in China.115
All of these projects have played a role in awareness, promotion, and implementation of chronic
disease solutions.
The Global Health Council formerly known as the National Council of International
Health, is a United States non-profit membership-based organization created in 1972 with a
purpose of promoting global health.116 It considers chronic childhood disease a personal, local,
and worldwide struggle and advocates for chronic health conditions in resource-poor
countries.117 It has participated in Wishbone day 2017; promoting osteoporosis awareness among
children and joined in World Diabetes day in 2018.118 Initiatives include the commission on
112
“Cancer Prevention and Control: World Health Assembly Resolution Approved.” World Health Organization,
World Health Organization, 27 Nov. 2013, www.who.int/cancer/eb1143/en/.
113
Cghe. “Global Alliance for Chronic Diseases.” GACD, www.gacd.org/about/what-we-do.
114
Cghe. “Global Alliance for Chronic Diseases.” GACD, www.gacd.org/about/strategy.
115
Cghe. “Global Alliance for Chronic Diseases.” GACD, www.gacd.org/research-projects.
116
“Global Health Council.” World Health Organization, World Health Organization, 23 July 2011,
www.who.int/workforcealliance/members_partners/member_list/ghc/en/.
117
“Chronic Childhood Disease: A Personal, Local, and Global Struggle.” Global Health Council, 30 May 2017,
globalhealth.org/chronic-childhood-disease-a-personal-local-and-global-struggle/.
118
“News.” CLAN, www.clanchildhealth.org/news.html.
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ending childhood obesity which has a detail-oriented plan that emphasizes the importance of
ownership and giving each controller of the issue goals for future change.119 As well it prioritizes
women's, children's, and adolescent health, specifically promoting accountability and striving for
change.120
The Centre for Disease Control and Prevention (CDC) established on July 1, 1946, is a
leading public health institution in the United States.121 Its mission is to promote health and
safety, fight diseases, and support communities and citizens to do the same, specifically
responding to emerging health threats faced by Americans.122 The CDC has many success stories
including expanding enhanced fitness to improve arthritis outcomes, the use of referral tools to
help Latinos in San Diego County prevent chronic disease, and the creation of a healthy corner
store which increased access to healthy food for Pennsylvanians.123 The CDC recognizes the
prevalence of arthritis as 51% of New Yorkers 65 plus have been diagnosed with this disease. By
implementing an Enhanced Fitness program at 130 YMCA locations statewide, from July 2015
to May 2018, the number of active participants increased from 150 people to 700.124 In San
Diego, Latinos face a lack of health care insurance, access to healthcare, and delays in care. The
initiative referred to as “Project ALCANCE” (Advancing Latino Chronic Disease Prevention
through Awareness, Networking, Collaboration, and Education) is aimed at providing Latin
patients will connection to organizations that could help to treat and prevent chronic disease for
lower costs.125 From October 2014 to September 2016 the program connected 1,554 Latin people
to appointments or chronic disease prevention organizations for free or low prices.126 Lastly, the
Pennsylvania healthy corner store initiative, intended to combat lack of food affordability and
119
120
121
“10 Things You Didn't Know About the CDC.” U.S. News & World Report, U.S. News & World Report,
www.usnews.com/news/national/articles/2009/05/08/10-things-you-didnt-know-about-the-cdc.
122
“Mission, Role and Pledge | About | CDC.” Centers for Disease Control and Prevention, Centers for Disease
Control and Prevention, www.cdc.gov/about/organization/mission.htm.
123
“NCCDPHP Success Stories.” Centers for Disease Control and Prevention, Centers for Disease Control and
Prevention, nccd.cdc.gov/nccdsuccessstories/searchstories.aspx.
124
Centers for Disease Control and Prevention, Centers for Disease Control and Prevention,
nccd.cdc.gov/nccdsuccessstories/TemplateSeven.aspx?s=16651&ds=1.
125
126
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accessibility, provided children with healthy food options to purchase when walking to and from
school, in comparison to the chips, candy, and sugary drinks they usually bought. It created a
store with matching morals and within four years the one store turned into 150 across ten cities
and provided 890,000 Pennsylvania's with healthier food options.127 A lot of these initiatives
exemplify extraordinary changes that the CDC have made as an organization.
Case Studies
The United States of America
The United States of America, consists of 50 states and an area of 9.629 million square
kilometers. With over 325 million people, it is the third largest country by population. 128 It is a
very diverse country linguistically and geographically. Often considered a cultural melting pot,
127
128
“United States.” Wikipedia, Wikimedia Foundation, 27 Mar. 2019, en.wikipedia.org/wiki/United_States.
37
meaning a fusion of nationalities, cultures, and ethnicities into one homogeneous group. It is an
exemplar of development and expresses technological and resourceful advancements.
Regardless of its access to technology, medical science, and education, approximately
half of the American adult population, has at least one chronic disease.129 Also, around 29% have
a loved one affected by chronic disease.130 This country, although blessed with knowledge and
resources, is the poster child for chronic disease. The irony of the situation questions whether or
not developmental superiority can prevent chronic disease. With chronic diseases attributing to
75% of all deaths in America, the United States is one of the countries affected the most by
lifestyle diseases. The most significant are heart disease, cancer, chronic lower respiratory
diseases, stroke, Alzheimer's disease, and diabetes.131
Consequences of this prevalence in America include death, economic repercussions, and
unsustainable stress on the healthcare industry. However, before death, the quality of life of the
patient is compromised. The socioeconomic advantage that allows them to prolong death when
faced with chronic disease has positive and negative effects on a patient. Positively, they have
more time with loved ones. Consequently, many patients live out the remainder of their lives on
prescription drugs, bed bound, and watching their health deteriorate before their eyes, which can
be psychologically challenging.132 Once that patient dies, the direct, indirect, and intangible costs
hamper the family and United States government. The U.S. has paid hundreds of billions of
dollars dealing with chronic disease.133 The United States does not have Universal Health Care
Coverage, although they aim to by 2030.134 This goal intends to alleviate the financial stress of
those combating chronic disease; however, chronic disease patients should not view free health
care as an excuse to live a poor lifestyle. The United States already spends the most money out
129
MacGill, Markus. “Half of All American Adults Have a Chronic Disease - CDC.” Medical News Today,
MediLexicon International, 2 July 2014, www.medicalnewstoday.com/articles/279084.php.
130
Fox, Susannah, and Kristen Purcell. “Adults Living With Chronic Disease.” Pew Research Center: Internet,
Science & Tech, Pew Research Center: Internet, Science & Tech, 3 Jan. 2014,
www.pewinternet.org/2010/03/24/adults-living-with-chronic-disease/.
131
Nichols, Hannah. “The Top 10 Leading Causes of Death in the United States.” Medical News Today,
MediLexicon International, 23 Feb. 2017, www.medicalnewstoday.com/articles/282929.php.
132
“Chronic Conditions in America: Price and Prevalence.” RAND Corporation, 12 July 2017,
www.rand.org/blog/rand-review/2017/07/chronic-conditions-in-america-price-and-prevalence.html.
133
134
Stratfor. “Health Care: A Universal Problem Without A Universal Solution.” Forbes, Forbes Magazine, 8 Jan.
2019, www.forbes.com/sites/stratfor/2017/08/08/health-care-a-universal-problem-without-a-universal-
solution/#331381052607.
38
of every country in the world within this sector; the rise in chronic disease is extremely
dangerous to their economy.135
The cause of this pandemic’s prevalence in America is related to the sociocultural
standards held by the American population. In all facets of life, Americans are overwhelmed by
negative, unhealthy influences; taught through the media, jobs, food availability, and
infrastructure. The dominating private sector plays a significant role in influencing consumers to
increase fast food purchases and unhealthy choices. In 2010, $4.2 billion was spent advertising
fast food in the United States.136 This money equipped with strategic methods of advertising can
be very deadly to the American population by persuading poor lifestyle choices. Advertisements
can be expressed through social and mass media and include sponsorships and celebrity
endorsements that target various demographics. For instance, world-renowned ice hockey player
Sidney Crosby has sponsorship deals with Tim Hortons and Gatorade. Both companies feature
menu items with low nutritional value, empty calories, and excess sugar. However, because the
admirable athlete Sidney Crosby endorses it, other people may be more compelled to purchase
products as consumers. Furthermore the white collar job trend, which strays away from
traditional physical labour, keeps Americans in a sedentary state. Many workplaces entail long
hours on the computer or behind a desk, with limited active breaks. Also, American cuisine
which was influenced by Europeans and Native Americans in early history consists of many
unhealthy foods that are well known for their detrimental effects.137 These include hot dogs,
potato chips, macaroni and cheese, meatloaf, jerky, and dried meats. Styles of cooking relevant
to American religions include southern-style cooking with dishes like fried chicken and
cornbread. Spanish and Mexican cooking styles embodied in Texas and the Southwest, including
chilli, burritos, and food with excess cheese and beans.138 These unhealthy eating trends have
played a significant role in setting a societal precedent conducive to chronic disease.
Infrastructure in most United States cities often discourages means of active transport and
provides fewer opportunities to practice healthy active living. For instance, built environment
135
Davis, Dr. Kenneth L. “The Real Reason Healthcare Is Bankrupting America.” CNBC, CNBC, 11 Jan. 2018,
www.cnbc.com/2018/01/11/the-real-reason-health-care-is-bankrupting-america.html.
136
Philpott, Tom, and Tom Philpott. “The Fast-Food Industry's $4.2 Billion Marketing Blitz.” Grist, Grist, 10 Nov.
2010, grist.org/article/food-2010-11-09-the-fast-food-industrys-4-2-billion-marketing-blitz/.
137
Zimmermann, Kim Ann. “American Culture: Traditions and Customs of the United States.” LiveScience, Purch,
13 July 2017, www.livescience.com/28945-american-culture.html.
138
Zimmermann, Kim Ann. “American Culture: Traditions and Customs of the United States.” LiveScience, Purch,
13 July 2017, www.livescience.com/28945-american-culture.html.
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barriers common in the United States include crowded sidewalks, less biking, running or
rollerblading trails. In summary, the wealth of America has spawned the unhealthy culture
surrounding its citizens thus resulting in chronic disease, if no changes are made this culture will
kill the United States population and economy.
Due to the prevalence of chronic disease, the United States has a corresponding group of
organizations, including the National Health Council, Centres for Disease Control and
Prevention, American Heart Association, American Cancer Society, American Lung
Association, and the National Heart, Lung, and Blood Institute to name a few. All of these
organizations use websites, social media, initiatives, and programs to promote healthy active
living and combat chronic disease. These sources provide information on nutrition, exercise, and
lifestyle alternatives key to losing weight or becoming healthier. Furthermore, these
organizations provide opportunities to donate blood, volunteer, and get involved in the local
community. However, controversy could evaluate the integrity of these organizations and their
questionable correlation with the American government. For instance, the American Lung
Association has received accusations of misrepresenting federal air quality data; this situation
diminishes credibility and is an abuse of power trend seen within similar lifestyle disease based
American associations.139 Corruption and interior motives within these organizations are
counterproductive and dangerously influential in dictating consumer choices. Similarly, the
private sector including factory farming and fast food chains are dominant in countries of similar
sociocultural status like the United States. They manipulate and control the demographics
perception of healthy active living and are one of the most dominate bodies in terms of causing
and affecting Americans everyday lives.
The United States government has in some cases taken advantage of its development by
investing in medical and technological advancements that are attempting to cure or treat chronic
diseases. In the U.S., 260 organizations exist that are committed to fighting Cancer, the budgets
of these organizations have topped $2.2 billion.140 These efforts which have been promoted and
supported by the government are attempting to eliminate the personalized tendency of the human
population and yield a lesser chance of chronic disease. However, the cost of band-aid fix
139
“When NGOs like the American Lung Association Go Bad, Even the Alarmist EPA Has to Disavow Them.”
Watts Up With That?, 12 Sept. 2015, wattsupwiththat.com/2015/09/12/when-ngos-like-the-american-lung-
association-go-bad-even-the-alarmist-epa-has-to-disavow-them/.
140
“Universal Declaration of Human Rights.” www.ohchr.org/EN/UDHR/Documents/UDHR_Translations/eng.pdf.
40
solutions is much greater than if the government focused on promoting healthy living for future
generations. Their specific interest in the scientific direction of curing chronic disease may
illustrate a relationship between the government and private sector. Hypothetically, if the
government were in cahoots with the food and beverage industry for some form of economic
payoff, this would explain why they want to prolong unhealthy living and seek a loophole in the
form of a scientific solution.
China
China is located in East Asia and features geographic attributes ranging from grasslands
to mountains, deserts, rivers, lakes, and 14,000 km of coastline.141 The national language of
China is standard Mandarin known as Putonghua. China is overpopulated: consisting of an area
of 9.597 million square kilometers and 1.4 billion people. It has the world's fastest growing
economy with a rise in gross domestic product from $150 million in 1978 to $12.24 trillion in
2017.142 The People's Republic of China has been ruled by the Communist party since 1949
when it won the Chinese Civil War by overthrowing the Nationalist government.143 China like
141
“China.” Wikipedia, Wikimedia Foundation, 29 Mar. 2019, en.wikipedia.org/wiki/China.
142
143
Pariona, Amber. “What Type Of Government Does China Have?” WorldAtlas, 20 Oct. 2016,
www.worldatlas.com/articles/what-type-of-government-does-china-have.html.
41
Brazil, India, and Russia is still considered a developing or emerging country in terms of
economic status.144
In China, 86.6% of deaths are due to chronic disease.145 Also, China has approximately
300 million patients with chronic disease and half of them are under 65 years of age.146 Chronic
respiratory diseases are common due to the poor air quality; specifically, 8.6% of the adult
population in China have COPD which is approximately 100 million people.147 Factors including
environmental and societal pressures contribute to an astronomically high 173 million people
suffering from mental health illnesses.148 Most recently, the explosive urbanization and trends in
fast food culture have created increased cardiovascular diseases; heart disease and stroke.149
Economically, it is estimated that between 2010-2030 chronic disease will cost China $16
trillion (measured in USD and based on the year 2010).150 Besides the economic effects, due to
the high concentration of mental health illness, China has one of the world's highest suicide rate;
approximately 287,000 people commit suicide annually and two million people attempt suicide
every year.151 Suicide poses its own set of social, physical, economic, and psychological
challenges for families and countries.
The Chinese way of living and environment is responsible for breeding a more
personalized set of common chronic diseases; specifically in terms of mental health disorders
and chronic respiratory diseases. Factors causing lifestyle diseases include increased
industrialization, the priorities of China's government, societal expectations, the ageing
population, globalization of dietary patterns, and increased sedentary lifestyles.152
144
“Emerging Market.” Wikipedia, Wikimedia Foundation, 9 Mar. 2019,
en.m.wikipedia.org/wiki/Emerging_market.
145
“Nearly 300 Million Chinese People Suffering from Chronic Diseases.” People's Daily Online,
en.people.cn/n3/2016/0811/c90000-9098949.html.
146
Nearly 300 Million Chinese People Suffering from Chronic Diseases.” People's Daily Online,
147
“Almost 100 Million Adults Have COPD in China.” ScienceDaily, ScienceDaily, 9 Apr. 2018,
www.sciencedaily.com/releases/2018/04/180409185331.htm.
148
“Mental Health in China.” Wikipedia, Wikimedia Foundation, 8 Apr. 2019,
en.wikipedia.org/wiki/Mental_health_in_China.
149
Truong, Kevin. “China International Centre for Chronic Disease Prevention.” The George Institute for Global
Health, 21 Feb. 2016, www.georgeinstitute.org/projects/china-international-centre-for-chronic-disease-prevention.
150
E, David, et al. “The Economic Burden of Chronic Diseases: Estimates and Projections for China, Japan, and
South Korea.” NBER, 20 July 2017, www.nber.org/papers/w23601.
151
“China's Suicide Rate 'among Highest in World'.” AsiaOne, www.asiaone.com/health/chinas-suicide-rate-among-
highest-world.
152
“Chronic Disease in China: Health Care and Public Health Challenges.” FSI,
scpku.fsi.stanford.edu/content/chronic-disease-china-health-care-and-public-health-challenges.
42
Firstly, China's rapidly growing economy corresponds with increased greenhouse gas
emissions, population, and industrialization. All of which contribute to environmental pollution
which is a cause of chronic respiratory disease and mental health illness. Specifically, exogenous
stressors resulting from this air pollution can lead to chronic respiratory disease and
depression.153 The mental health of citizens has been tied to environmental factors as illustrated
by the Center for Epidemiological Studies Depression scale; depressive symptoms ranged
between 7 - 28 (average 11.623). A 1% increase in sulphur dioxide and total suspended
particulate emission intensities was associated with depressive symptoms scores that were 1.266
and 1.318 higher.154 For people who already had chronic diseases this increased depressive
symptoms.155
China was prosperous in the past in dealing with infectious diseases; however, along the
developmental journey a shift in health care priorities has strained existing systems and spawned
health care reforms.156 Notably, China's challenges include reliance on hospital-based care,
increasing health care costs, limited primary care capacity, and dual systems of traditional
Chinese medicine and western medical services.157 Furthermore, mental health has never been a
priority among the Chinese government.158 A recent research report concluded that two-fifths of
first-year students at Peking University, one of the most prestigious universities in China,
thought of life as meaningless.159 In total, 100 million people have depression in China, which
contributes to approximately one-seventh of people who have mental disorders in the world.160
153
Qing Wang, and Zhiming Yang. “Does Chronic Disease Influence Susceptibility to the Effects of Air Pollution
on Depressive Symptoms in China?” International Journal of Mental Health Systems, BioMed Central, 18 June
2018, ijmhs.biomedcentral.com/articles/10.1186/s13033-018-0212-4.
154
155
156
157
158
“Mental Health in China: Challenges and Progress.” The Lancet, vol. 102, no. 2609, 1873,
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960893-3/fulltext?code=lancet-site.
159
宋薇 . “100 Million People Suffer Depression in China.” China, www.chinadaily.com.cn/china/2016-
11/28/content_27501518.htm.
160
宋薇 . “100 Million People Suffer Depression in China.” China, www.chinadaily.com.cn/china/2016-
11/28/content_27501518.htm.
43
This abundance of mental health illness is due to the culture and values held by families and
communities in China. Additionally, societal expectations can often be high and impressionable
youth not mentally tough enough to endure these academic and professional standards their
parents and communities enforce.
The number of Chinese citizens aged 60 is expected to rise by 490 million in 2050.161
Which is more than combined populations of Germany, Japan, France, and Britain.162 Not only is
this an issue as it diminishes the productive labour force, but it also increases chances of chronic
disease, burdening pensions, health care, and social security systems.
Another relevant factor in causing chronic disease is the globalization of dietary habits.
Many western-style eating trends have spread to Asian countries resulting in a rise of fast food
culture.163 The danger of this culture is evident within the American population, as it spreads like
wildfire from developed to developing countries the prevalence of chronic disease is expected to
skyrocket.
In 2017, the State Council released a medium to long plan (2017-2025) on the prevention
and treatment of chronic diseases. The plan is intended to decrease the financial burden of
medical expenses, improve the average life expectancy, and boost the health of the general
population.164 Required measures include strengthening education and improving healthy active
living awareness, diagnosing diseases in the early stages and providing intervention and
diagnosis for high-risk demographics over 30 to 40 years old, improving tiered medical services,
and establishing a medical quality management and control platform.165 Also, promoting the
coordination of prevention and treatment of diseases and urging the set up of centres for
Traditional Chinese Medicine.166 Furthermore, the measures include providing policy support
161
“Aging China: Is China Ready to Take Care of Its Aging Population?”
https://news.cgtn.com/news/3d3d414e30557a4d7a457a6333566d54/share.html.
162
163
Pan, An, et al. “Exporting Diabetes Mellitus to Asia: the Impact of Western-Style Fast Food.” Circulation, U.S.
National Library of Medicine, 10 July 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3401093/.
164
State Council Issues Plan to Prevent Chronic Diseases,
english.gov.cn/policies/latest_releases/2017/02/14/content_281475567482818.htm.
165
166
44
and reducing individual medical costs by improving medical and social insurance. Promoting
environmentally friendly practices using policies including strict smoking, food safety, and
drinking water regulations.167 Lastly, the health services industry will receive more funding and
support in terms of scientific research and data transformation.168
Similarly, the China International Centre for Chronic Disease Prevention aligned with the
George Institute for Global Health mission entails developing, implementing, and evaluating
strategies for treatment and prevention of chronic diseases. They will execute this by creating
programs with targeted health care initiatives, capacity building, and policy engagement.169 With
proper implementation this centre will provide disadvantaged Chinese people with better health
and quality of life which will decrease chronic disease in the country. Within the organization,
China applicable initiatives consist of women and children's health, diabetes, nutrition and
lifestyle, heart health research centre, trauma and injury, research centres, cardiac and stroke
care.170
Treatment of chronic disease in China ranges from modern technology to Traditional
Chinese Medicine.171 Traditional Chinese Medicine is a unique form of treatment reflective of
2,500 years of Chinese tradition and teachings; it encompasses acupuncture, cupping, herbs,
meditation, moxibustion, and Tai Chi.172 This philosophy of treating disease holds a cultural
and/or spiritual significance and although results may vary, most suggest a decrease in painful
side effects and an increase in quality of life for the patient.173
167
168
169
Health, 21 Feb. 2016, www.georgeinstitute.org/projects/china-international-centre-for-chronic-disease-prevention.
170
“Projects.” The George Institute for Global Health, www.georgeinstitute.org/projects.
171
“Treatment of Chronic Conditions with Traditional Chinese Medicine: Findings from Traditional Chinese
Medicine Hospitals in Hubei, China.” Mary Ann Liebert, Inc., Publishers,
www.liebertpub.com/doi/abs/10.1089/acm.2014.0125?journalCode=acm.
172
“What Is Traditional Chinese Medicine?” WebMD, WebMD, www.webmd.com/balance/guide/what-is-
traditional-chinese-medicine#2.
173
“What Is Traditional Chinese Medicine?” WebMD, WebMD, www.webmd.com/balance/guide/what-is-
traditional-chinese-medicine#2.
45
Uganda
Uganda, officially known as the Republic of Uganda is a landlocked African country;
bordered by Kenya in the east, South Sudan in the north, the Democratic Republic of the Congo
in the west, Rwanda in the south-west, and Tanzania in the south.174 Official languages include
English and Swahili. Uganda is of modest size, with an area of only 0.242 million square
kilometers and a 2018 population of approximately 44.3 million people.175 The Uganda people
were hunter-gatherers until 1,700 to 2,300 years ago when Bantu-speaking populations migrated
to the south of the country.176 Uganda is considered an undeveloped country due to its economic
and sociocultural resources and status.
Today, 25% of Ugandans die from a chronic disease and this statistic is on the rise.177
Approximately 15% of Ugandans are overweight and 25% suffer from high blood pressure also
174
“Uganda.” Wikipedia, Wikimedia Foundation, 18 Mar. 2019, en.wikipedia.org/wiki/Uganda.
175
176
177
“Chronic Diseases: The New Challenge for Uganda's Health System.” Www.newvision.co.ug,
www.newvision.co.ug/new_vision/news/1458355/chronic-diseases-challenge-ugandas-health.
46
known as hypertension.178 Similarly to middle-low developed countries like China,
environmental exposure to chemicals can result in a prevalence of respiratory disease.179
Chronic disease in Uganda poses threats uncommon to developed or financially
advantaged countries. These repercussions consist of poor quality of life, damage to the
economic and sociocultural condition of the country and people as well as disabling the
government's role in control, thus increasing the vulnerability of the people. In middle-low class
countries like Uganda, it can be challenging to work and provide for one's family given the
added stress of chronic disease, this hardship fuels the vicious cycle keeping people in poverty
and away from treatment options.
Factors causing lifestyle diseases in Uganda include the transition to a developing
country, the added stress of infectious diseases, the limited access to medical supplies associated
with the poverty of the country, and the elderly.
The growth of African cities like Uganda's capital Kampala drives the increase in African
wealth, thus putting the country on the path to development. Unfortunately, the wealth associated
with urbanization and economic development inevitably results in a rise of non-communicable
diseases.180 These diseases in Uganda are a byproduct of lifestyle habits manifested within the
last decade and most Ugandans are unaware of how these choices can result in health
problems.181
The situation for Uganda's healthcare system is unique from developed or developing
countries because not only is it fighting chronic disease but infectious diseases as well due to the
sociocultural and economic status of the people. The added stress of the chronic disease
pandemic proves to be financially challenging. Also, infectious diseases increase the risk of
chronic disease. According to a study done with 471 Ugandan participants, half of which living
178
Schwartz, Jeremy, and Mari Armstrong-Hough. “40% Of Uganda's Health Centres Don't Stock Drugs to Treat
Chronic Diseases.” The Conversation, 19 Sept. 2018, theconversation.com/40-of-ugandas-health-centres-dont-stock-
drugs-to-treat-chronic-diseases-91631.
179
Robertson, Nicole M., et al. “Urban-Rural Disparities in Chronic Obstructive Pulmonary Disease Management
and Access in Uganda.” Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation.
journal.copdfoundation.org/jcopdf/id/1222/Urban-Rural-Disparities-in-Chronic-Obstructive-Pulmonary-Disease-
Management-and-Access-in-Uganda.
180
181
47
with HIV, chronic diseases such as COPD, eye problems, diabetes, sleep problems, and
depression increased significantly for HIV participants, illustrating the connection between
infectious and chronic disease.182
Due to Uganda's economic disadvantages, it has limited access to medication; therefore,
chronic diseases can not only be financially detrimental to a family but also deadly as treatment
is scarce. Specifically, medications deemed essential by authoritative bodies including the World
Health Organization are not available at many Ugandan health care centres. For instance, when
WHO visited various medical centres in Uganda, there were shortages in many essential
medications. Metformin; a common diabetes medicine was only available at 79.4% of facilities
expected to stock it. Nifedipine, a high blood pressure drug was available at just under half of the
expected facilities and beclomethasone, an inhaler for chronic lung diseases like asthma was only
available in 2.9% of expected centres.183
Although globally the elderly population (60 plus years old) has increased from 205
million in 1950 to 810 million in 2012 making up 11% of the world's population, in Uganda the
elderly make up 2.7% of their entire population. There are few Seniors in Uganda due to the life
expectancy of 63 years. The elderly are significantly susceptible to chronic and infectious
diseases in Uganda because they are very impoverished and lack social security services,
income, access to proper nutrition, education, and health care services.184
The Uganda Government Ministry of Health has established a non-communicable disease
program with aims of prevention and control. Authorities including the president; Yoweri
Museveni and Minister of Health Dr. Jane Aceng, both agree that chronic diseases are an issue
and Uganda needs to do something about it; however, given the prevalence of infectious diseases
this action will require partnerships.185
182
“Chronic Disease, Risk Factors and Disability in Adults Aged 50 and above Living with and without HIV:
Findings from the Wellbeing of Older People Study in Uganda.” Taylor & Francis,
www.tandfonline.com/doi/abs/10.3402/gha.v9.31098.
183
184
Nawagi, et al. “Sociodemographic Characteristics and Health Profile of the Elderly Seeking Health Care in
Kampala, Uganda.” Current Gerontology and Geriatrics Research, Hindawi, 16 May 2018,
www.hindawi.com/journals/cggr/2018/4147509/.
185
48
Uganda has recently signed a memorandum of understanding with a multinational
healthcare company; Novartis, that allows their country to help diagnose, care, and increase
affordable treatment for citizens. Uganda is the fourth African country to join this access, which
offers fifteen generic and patented medications that address chronic diseases such as
cardiovascular, respiratory, diabetes, and breast cancer.186 The government is working toward
these medications being free for chronic disease affected Ugandans. Essentially with
international help, Uganda is in better shape than developed or developing countries like
America and China in combating these diseases because of decreased western influences.
In terms of helping the elderly demographic, the Ugandan government has created the
Social Assistance Grants for Empowerment (SAGE) Program within fifteen districts in 2010 to
2015 and aims to get to fourty districts out of Uganda's 112 by 2020.187 This program provides
the elderly with 25000 Uganda shillings (8 USD) every two months that they are enrolled.
Unfortunately, this is not equivalent to the elderlies financial needs required for good health.188
186
187
188
49
Canadian Connection
Canada is a North American country, divided into ten provinces and three
territories.189With an area of 9.971 million square kilometers it is the second largest country by
land. Canada has a sparse population of 37.06 million people (2018). Canada has two national
languages which are English and French; reflective of its history of two European powers.190
Canada is considered a developed country due to its advanced economy and technological
infrastructure.
This status however, does not protect Canada from the prevalence of chronic disease.
Instead, repercussions resemble that of its southern neighbour: the U.S., WHO estimated that
from 1970 to 2000 Canada had one million cardiovascular disease deaths.191 In 2017, cancer and
heart disease were the leading causes of death in Canada, followed by cerebrovascular disease,
chronic lower respiratory diseases, and accidents.192
The prevalence of chronic disease costs the Canadian economy approximately $69 billion
a year in direct costs and $52 billion in indirect costs, including loss of productivity and foreign
investment.193 In addition to economic repercussions, chronic disease brings along political,
189
“Canada.” Wikipedia, Wikimedia Foundation, 23 Mar. 2019, en.wikipedia.org/wiki/Canada.
190
Morton, William Lewis, et al. “Canada.” Encyclopædia Britannica, Encyclopædia Britannica, Inc., 26 Mar. 2019,
www.britannica.com/place/Canada.
191
“Facing the Facts: The Impact of Chronic Disease in Canada.”
www.who.int/chp/chronic_disease_report/media/CANADA.pdf.
192
Statistics Canada. “Deaths and Causes of Death, 2017.” The Daily - , 29 Nov. 2018,
www150.statcan.gc.ca/n1/daily-quotidien/181129/dq181129g-eng.htm.
193
Yurtoğlu, Nadir. “Chronic Disease Prevention Challenges in Canada.” History Studies International Journal of
History, vol. 10, no. 7, 2018, pp. 241–264.,
www.healthyenvironmentforkids.ca/sites/healthyenvironmentforkids.ca/files/Morrison-March8-
CDPreventionChallengesinCanda.pdf.
50
sociocultural, and environmental concerns. Politically, chronic disease prevalence affects how
Canada is viewed publicly and globally. The Conference Board of Canada's 2012 report card
established Canada as tenth out of seventeen countries in terms of population health.194 This
score is due to the increase in non-communicable diseases. The general public and other
countries who are less socioeconomically advantaged may view this inadequacy as political
incompetence. Considering that prevention of lifestyle diseases requires cooperation among
government departments, civil society, and the private sector, Canadian political parties are
morally pressured to promote healthy active living and propose solutions to this growing
problem.195 Chronic disease also results in socioeconomic division. In the short-term unhealthy
living is convenient and affordable, unfortunately middle-low class people who take advantage
of this idea have an increased chance of chronic disease and thus are limited as to affording
treatment. This cycle widens the gap between social classes which in the long-term can spawn
conflicts even in a developed country like Canada. Canada’s industrialized food and beverage
practices are not conducive of environmental sustainability; the energy and fuel used produces
carbon emissions and thus causes climate change.196
All sectors in Canada play a role in causing chronic disease; to be specific, the
government, civil society, and the private sector. The government does not create infrastructure
conducive to healthy active living. The general population do not make healthy choices and the
food and beverage industry abuse their power by getting consumers addicted to saturated fat,
salt, and sugar. Therefore, all of these groups are responsible for the lifestyle disease pandemic
affecting Canada, as they are causing or participating in behavioural factors key to chronic
disease.
Aside from the various group roles in chronic disease, a driving factor applicable to
Canada like the United States, is the young and elderly demographics vulnerability to chronic
disease. Especially in developed countries, kids are very impressionable to their parent's
practices and beliefs, this connection can be examined epigenetically and psychologically.
194
Chronic Diseases Are Taking a Toll on Canadians, www.conferenceboard.ca/press/newsrelease/12-03-
01/Chronic_Diseases_are_Taking_a_Toll_on_Canadians.aspx.
195
“2018 Pre-Budget Submission to the House of Commons Standing Committee on Finance.”
www.ourcommons.ca/Content/Committee/421/FINA/Brief/BR9073636/br-
external/ChronicDiseasePreventionAllianceOfCanada-e.pdf.
196
“Carbon Emissions in the Food and Beverage Sector.” Filtration Industry Analyst, vol. 2009, no. 4, 2009, pp. 5–
6., climatesmartbusiness.com/wp-content/uploads/2014/06/CS-Food-and-Beverage-Sector-Industry-Brief-
digital.pdf.
51
Epigenetically, if the parents are unhealthy this alters their genome which is then passed to their
offspring and disadvantages that child. Psychologically, the lifestyle practices and behavior of
the parent; whether they exercise or not, smoke or not, abuse alcohol and drugs or not, and eat
healthily affect their child's behaviour. Half of Canadian children between five to seventeen do
not receive enough exercise for optimal growth.197 These habits and the foundation of the child's
ethics and beliefs can be difficult to reverse later on in life, thus the formative years are key to
setting children up for a healthy life. In terms of the elderly population, the life expectancy of
Canadians is about 82.3 years (2016).198 The high life expectancy in Canada is reflective of
medical resources availability; however, just because people are prolonging death does not mean
they are doing so with their quality of life and health intact.
The Canadian government allocates human and/or financial resources to chronic disease
prevention and healthy active living promotion. Specifically, Ontario in association with Public
Health Ontario has created various online resources to provide education and information for
Ontarians.199 These governmental pockets, act similarly as an organization, prided with common
goals and strategies to effect change.
A Canadian law that has been passed to reduce chronic disease prevalence in Québec
states: no company including those of the food and beverage industry are allowed to advertise to
children under thirteen years of age.200 This law restricts the consumer demographics of the
private sector by hampering their ability to thrive on child addiction.
Canada has its own set of healthy active living organizations, including Canadian Sport
for Life (CS4L), ParticipACTION, Physical and Health Education (PHE) Canada, Active Ageing
Canada, and Jumpstart. These organizations collect data, propose solutions, and take action in
promoting healthy active living and decreasing chronic disease.
197
History, vol. 10, no. 7, 2018, pp. 241–264.,
www.healthyenvironmentforkids.ca/sites/healthyenvironmentforkids.ca/files/Morrison-March8-
CDPreventionChallengesinCanda.pdf.
198
“Life Expectancy.” Google, Google,
www.google.com/publicdata/explore?ds=d5bncppjof8f9_&met_y=sp_dyn_le00_in&hl=en&dl=en.
199
“Health Promotion – Online Learning.” Public Health Ontario, www.publichealthontario.ca/en/education-and-
events/online-learning/health-promotion-courses.
200
“Advertising Directed at Children under 13 Years of Age.”
www.opc.gouv.qc.ca/fileadmin/media/documents/consommateur/sujet/publicite-pratique-
illegale/EN_Guide_publicite_moins_de_13_ans_vf.pdf.
52
Logic of Evil
People, countries, governments, and the private sector rationalize, support, and justify
chronic disease and unhealthy living due to financial and personal motives.
People rationalize unhealthy living because of its convenient, affordable, tempting,
socially relevant, and enjoyable nature. Unhealthy eating and living are very convenient as many
fast food chains are located within proximity to schools, workplaces, and residential areas.
People can even have food directly delivered to their door. Fast food tends to be cheaper than
healthy food and for some people who cannot afford healthy living this can be difficult. What
people do not understand is that the financial score is evened out in the long-term when those
consumers receive a chronic disease that is associated with financial, physical, and psychological
repercussions much greater than the cost of healthy living. Adults also experience influences;
oftentimes in social conventions such as celebrations and group events they can experience peer
pressure to make unhealthy decisions. Frequently, people's attitudes do not appreciate healthy
living and rather support the mentality that they only live once and might as well eat and exercise
as they see fit. Lastly, people may not have education on the dangers of unhealthy living;
therefore, they do not know any better. This unawareness is often associated with poverty and
thus another way chronic disease differs between social classes.
Although the logic of governmental evil varies, common threads include the political
agenda in terms of priorities, the sociocultural status, and money. Regardless of the developed
status of America, their health care system is not currently equipped to handle chronic care.201
Therefore, the political choice of the United States to prioritize universal health care coverage is
a reason they may currently be less invested in the prevention of chronic disease. Furthermore,
undeveloped countries who have been dealing with socioeconomic hardships like poverty, war,
201
“Towards a New Vision of Health Care.” PBS, Public Broadcasting Service,
www.pbs.org/inthebalance/archives/whocares/the_challenge/a_new_vision.html.
53
terrorism, and natural disasters may allocate more resources and attention to solving those issues,
rather than promoting healthy active living. Controversially, certain governments are more
concerned with economic payoff and/or in cahoots with the private sector and thus are less
focused on means of intervention.
The food and beverage industry often care more about the bottom line which is money
than the well-being of the general population. The food and beverage industry thrive on
addiction; thus they attempt to add more sugar, saturated fat, and salt to as many things as
possible in order to get customers addicted to the products. It is a trillion dollar industry and the
more addiction to unhealthy foods the more money the industry accumulates and thus the
government can take its cut.202 Additionally, the weight loss industry is a billion dollar business
and if everyone were extremely fit then selling the idea of weight loss and the perfect body
image would be nugatory. Therefore, the logic behind the private sectors evil is a purely
financial payoff.
202
“Sugar, Salt, Fat: How the Food Industry Got Us Hooked on an 'Unholy Trinity'.” The Globe and Mail, 11 May
2018, www.theglobeandmail.com/life/health-and-fitness/sugar-salt-fat-how-the-food-industry-got-us-hooked-on-an-
unholy-trinity/article8989855/.
54
Politics
Politics applies to the current chronic disease pandemic through entities such as the
government, media, human rights, and economy.
Often, governments are the most significant power within a country; they have the
authority to assert themselves by making laws and appealing to the country's demographics.
Political ideologies based on economic greed held by governments or embedded within society's
expectations are extremely dangerous to the general population's health. If money dictates
politics and/or the government and food and beverage industry are in cahoots there will be
nothing to protect the population from chronic disease ridden foods as well as seductive
sedentary lifestyles messages and products.203Additionally, there will also be nothing to protect
the environment. Respectively, agriculture lands, soils, and aquifers are depleted through oil-
dependent industrial farming.204
The media is one of the most influential and powerful outlets available in the twenty-first
century. It has positive and negative effects on people. It is helpful because it serves as a form of
communication and technology used to achieve academic, professional, or personal success.
Unfortunately, social media users are not necessarily motivated to use it for these means; rather it
can become very addictive resulting in long periods of sedentarism and cause body image or
self-esteem issues which can cause mental health illness. The dark side of social media is
significant by itself in causing chronic disease. Separately, social media can also influence users
and compel them to make unhealthy choices. For instance, fast food chains may employ social
media as an advertising mechanism. This form of advertising can reach large demographics and
be very persuasive.
The human rights declaration is a universal guide of basic human entitlements that
illustrates a foundation of ethics involved in the treatment of human beings and is representative
203
Hyman, Mark, and Mark Hyman. “Our Disease-Creation Economy: How Money In Politics Is Getting In The
Way Of Health Care.” HuffPost, HuffPost, 5 Nov. 2012, www.huffpost.com/entry/health-barriers_n_1858797.
204
Hyman, Mark, and Mark Hyman. “Our Disease-Creation Economy: How Money In Politics Is Getting In The
Way Of Health Care.” HuffPost, HuffPost, 5 Nov. 2012, www.huffpost.com/entry/health-barriers_n_1858797.
55
of various countries and views.205 Unfortunately, this basic outline is seldom fulfilled in
undeveloped or developing countries and thus jeopardizes the health of the general population,
which directly connects to the consequence of lifestyle disease. No human right article
specifically refers to chronic disease; however, some hint at providing discrimination free living
against disabilities or chronic disease (article 7) and adequate living necessities and conditions
(article 25).206 These articles strive to improve the quality of life for chronic care patients and/or
preventive health care deprivations that are conducive of chronic disease. However, all articles
and the whole premise of the declaration clearly emphasizes how humans are entitled to making
their own choices and these choices are not to be dictated by an authority figure, group,
government, or sector. The only effective solution to chronic disease requires individual
cooperation.
The economy is very involved in causing and being affected by chronic disease. The
economy and financial motives of the government and private sector hamper the ability to
protect the general population. This philosophy of greed fully exemplifies the evil of humanity
and the deceptiveness of the chronic disease pandemic. Due to the unwritten ethical rules
established by the evolution of civilization, the government is expected to intervene in the
chronic disease pandemic experienced within its nation or community. Although the government
puts up the front of concern and creates programs and organizations to help dig their people out
of this predicament, the government does not always want enhanced health.
205
206
56
Religion
Religion is a response that a person of a social group makes to what he or she experiences
as the highest power of the known universe that controls significant events in their life,
determines his or her destiny, and sustains any consciousness after death.207 Religion can play a
role in a person's health; their physical, social, and mental well-being. Religion influences
lifestyle and determines how people cope with the adverse effects of chronic disease.
Religion can be associated with increased community involvement, social and mental
health, and correlate with the socioeconomic status of a country. Firstly, various religions and
religious institutions include volunteering in the local community and attending religious
ceremonies which keep people occupied and moving. Religion provides people with meaning
and motivation; opportunities to prioritize social and mental health. Countries that are wealthier
generally have populations with a large contingent of atheists.208 In contrast, impoverished and
socioeconomically disadvantaged countries have a higher religious prevalence. There is a trend
between religion and the concentration of chronic disease. Developed countries where religion is
less common, chronic disease is more common. Undeveloped countries where religion is
widespread, there is less chronic disease. However, religion is not a strong enough control factor
to manage the growing pandemic of lifestyle diseases.
Chronic diseases can be very stressful and psychologically damaging. Religion provides
social and mental ease to those facing a chronic disease and can improve their quality of life and
change their perception.209 Spirituality is a positive mechanism which can allow patients to
accept their situation and begin the healing or coping process.210 Scientifically, religion cannot
treat disease; however, psychological illnesses like depression can be reduced and eliminated by
achieving a certain level of mental understanding and acceptance. By using religion as an outlet,
people can enhance their mental health which can help to conquer the adversities of lifestyle
diseases.
207
“Introduction.” Class handout.
208
Beres, Derek. “Which Religion Has the Longest Life Expectancy?” Big Think, Big Think, 3 Feb. 2019,
bigthink.com/21st-century-spirituality/which-religion-has-the-longest-life-expectancy.
209
“Religious, Spiritual Support Benefits Men and Women Facing Chronic Illness, Study Finds.” ScienceDaily,
ScienceDaily, 27 Oct. 2011, www.sciencedaily.com/releases/2011/10/111026143811.htm.
210
Arndt, et al. “Are Spirituality and Religiosity Resources for Patients with Chronic Pain Conditions?” OUP
Academic, Oxford University Press, 5 Mar. 2009, academic.oup.com/painmedicine/article/10/2/327/1832773.
57
Solutions
Each solution of chronic disease is dependant on contributions from a variety of groups;
civil society, the government, and the private sector. However, it is ultimately in the hands of the
general population to use the advice, knowledge, and resources available to them to make a
lifestyle change.
In terms of the individual role in chronic disease prevention and promotion of healthy
active living, people have the power to change their eating habits to a plant-based, whole food or
vegan diet. In the big picture, going vegan and/or having a plant-based, whole grain themed diet
has been proven to be significant in promoting health individually and globally. Essentially, this
diet entails limiting or stopping the consumption of meat and dairy products. For many people,
this can be extremely difficult due to factors such as convenience, affordability, and taste. Also,
many countries promote meat and dairy as rich in nutrients and shame those who choose to
reduce consumption by selling the idea of susceptibility to deficiencies. However, this idea is
very deceptive anatomically/physiologically, ethically, economically, and environmentally.
Specifically, meat has been proven to be particularly detrimental for the physical health
of humans. In terms of anatomical composition, nature intended for humans to be herbivorous
although they have adopted an omnivorous eating habit. Humans teeth, jaws, nails, stomach
acidity, and intestinal length are all directed towards a plant-based eating style. Humans anterior
teeth are not suited for tearing flesh. Also, the structure of the carnivore jaw differs from the
human jaw. Human jaws cannot only move up and down like carnivores, but side to side to grind
up fruits and vegetables in the back of their teeth.211 Furthermore, nails are too soft to aid in the
carnivorous process. Carnivorous animals swallow their food whole; therefore they need strong,
acidic stomach acid to break down this food and destroy bacteria. However, human stomach acid
is weaker and intended for digesting pre-chewed fruits and vegetables.212 Animals who eat meat
have a shorter digestive tract; specifically, their intestinal length is significantly shorter than
humans. Humans long intestinal length means that meat bacteria will have more time to multiply
and meat will have time to rot in the intestines, increasing the chance of food poisoning and
colon cancer. Meat eaters have a greater chance of cancer, diabetes, heart disease, obesity,
211
“Here Are the Real Facts About Humans and Meat.” PETA, 28 Jan. 2018, www.peta.org/living/food/really-
natural-truth-humans-eating-meat/.
212
“Here Are the Real Facts About Humans and Meat.” PETA, 28 Jan. 2018, www.peta.org/living/food/really-
natural-truth-humans-eating-meat/.
58
foodborne illness as well as exposure to hormones, antibiotic resistance, and a greater risk of
death.213
The inaccurate representation of milk and alternatives in the media which suggests they
are needed for good bone health and osteoporosis prevention is wrong; instead, they are rich in
artery-clogging saturated fat and linked to causing many chronic diseases such as diabetes, heart
disease, Alzheimer's, breast, ovarian, and prostate cancers.214 Research done by the British
Health Journal illustrates that milk and/or dairy consumption does not relate to a decreased risk
in bone breaks or fractures.215 Therefore, milk and alternatives have no nutritional purpose for
humankind.
Aside from the obvious health benefits of restricting meat and dairy consumption, going
vegan has a major personal, economic, and environmental payoff. It protects animals from abuse,
neglect, and extinction, providing them with a better quality of life.216 Economically, of the
world's richest countries; the U.S. could save $250 billion a year if they got rid of meat
consumption, many other countries could experience similar savings.217 Eliminating meat would
conserve the estimated 90 million acres of land currently used to grow corn for factory-farmed
animals. It can protect workers from various workplace hazards brought on by the farming of
animals. Veganism can veer off antibiotic resistance, which is a dangerous situation caused by
factory-farming methods of pumping animals with antibiotics while they are living in close
quarters. By going vegan, it would eliminate major emissions causing environmental conflicts
such as climate change. It would also save water; as 576 gallons of water are required for one
pound of pork, 880 gallons to produce one gallon of milk and 1,799 gallons of water for one
pound of beef.218 Given ample evidence, veganism is the conclusion to the nutritional debate and
213
Krantz, Rachel. “8 Reasons Meat Is Bad For You.” Bustle, Bustle, 17 Dec. 2018,
www.bustle.com/articles/137865-8-reasons-meat-is-bad-for-you-yes-even-chicken.
214
“Health Concerns About Dairy.” Physicians Committee for Responsible Medicine, www.pcrm.org/good-
nutrition/nutrition-information/health-concerns-about-dairy.
215
“Health Concerns About Dairy.” Physicians Committee for Responsible Medicine, www.pcrm.org/good-
nutrition/nutrition-information/health-concerns-about-dairy.
216
“Here Are 17 Great Reasons to Eat Vegan in 2017.” ChooseVeg, 8 Feb. 2019, chooseveg.com/blog/16-reasons-
to-eat-vegan-in-2016/.
217
Davis, Lauren Cassani. “How Much Money the World Would Save If Everyone Became Vegetarian.” The
Atlantic, Atlantic Media Company, 30 Mar. 2016, www.theatlantic.com/business/archive/2016/03/the-economic-
case-for-worldwide-vegetarianism/475524/.
218
“Here Are 17 Great Reasons to Eat Vegan in 2017.” ChooseVeg, 8 Feb. 2019, chooseveg.com/blog/16-reasons-
to-eat-vegan-in-2016/.
59
although it has taken all of human existence to find this optimal way of living, controversy
should not hamper this clear solution.
Besides nutrition, people can also limit alcohol consumption, not smoke, and/or have
unprotected sexual relations. Furthermore, people can control their exercise level by using active
means of transportation and/or an active job, avoiding sedentary habits and hobbies like playing
video games, watching TV, and browsing social media. A potential way of avoiding these habits
could entail joining a community recreational program or team. By making all of these efforts it
will improve the quality of life of the individual and provide them with other social, emotional,
and cognitive benefits.
Surrounding the person and influencing their decisions is various international and non-
governmental organizations, the private sector, health care professionals, and the government.
All of these bodies play a role in providing people with information and resources they can use
to promote healthy active living and thus reduce the chronic disease pandemic facing the world
today.
Besides personalized lifestyle changes, a more professional and/or global action plan can
help to reach a greater demographic and ensure change. The action plan can be categorized into
preparation, execution, and follow through stages. Each stage when carried out correctly will
lead to the reduction and eventually elimination of chronic disease.
The preparation stage involves research and estimation of population need. Firstly, each
country should assemble a task force consisting of international and non-governmental
organizations, private sector representatives, health care professionals, and government officials.
Today there are 195 countries, therefore there would be 195 task forces assuming every country
is participating. Each task force should democratically assign a leader that would be willing to
travel internationally and represent their country’s health and participation in the chronic disease
pandemic. These leaders would then meet to discuss chronic disease data and prevention
strategies. Each task force should mandate an anonymous survey with questions relating to diet,
physical activity, sedentarism, and drug use and abuse. These questions can get more personal in
order to determine if the data exemplifies a geographic or sociocultural connection with chronic
disease. Questions could include: Where do you live? What class best expresses your
sociocultural status? Do you feel you are well informed on chronic disease prevention and
healthy active living promotion? Do you receive 150 minutes of physical activity a week? Do
60
you eat a balanced diet equipped with appropriate portions of macronutrients and micronutrients?
These questions can be specific or vague, multiple choice or open-ended. These surveys can be
translated into various languages and completed online, physically or verbally in order to ensure
a diverse demographic of responders. Going forward, each city or as many cities as possible
within that country should complete various randomized standardized physical tests to collect
blood pressure, height and weight ratios, and lipid or glucose statuses.219 Once all of this data is
received each nation should publish a report illustrating trends and areas of specific and
immediate concern. This can help these countries to make an individualized plan of action.
Sharing with other countries can allow them to gain a greater perspective and perhaps fine-tune
their action plan to improve quality and effectiveness.
The execution stages will vary depending on the needs and prevalence of each country;
however, it may entail enforcement of fiscal policies; limiting the power that the food industry
has over this pandemic, increased physician education on nutrition allowing them to be a more
reliable source for patients, and healthy active living promotion. Also, it could include the
establishment of a tier system which would propose the order in which to address various
diseases. Enhancing doctor-patient relationships by increasing patients access to health records,
perhaps making a two way portal of communication. The execution phase could also entail
increasing awareness of chronic disease by gaining collaboration across sectors and political
platforms. Basing infrastructure and communities around supporting the cause; making cities
closer together to accommodate active transport, increasing walking and biking trails, making all
vending machines in recreational and community centres sell only healthy food. Also, increasing
education on nutrition and healthy active living in schools and providing students with daily
physical activity sessions to get them up and moving.
The follow-through stage is key to sustaining healthy active living promotion. All sectors
and bodies are required to carry out these tasks and make decisions that will benefit the health of
the population. This stage allows the accountability to be dispersed among all controllers and
gives them an opportunity to redeem themselves, becoming a part of the solution.
Although organizations and governments have and continue to make efforts to prevent
chronic disease, it is ultimately reflective of individual’s lifestyle choices. Many attempted
219
“Preventing Chronic Diseases: a Vital Investment.” Bmj, vol. 315, no. 7100, 1997,
https://www.who.int/chp/chronic_disease_report/part4.pdf.
61
initiatives and solutions have been proposed and executed around the world with ranging levels
of success. Mainly, reasons that initiatives are not as successful include the disregard for the
country’s individual needs. In theory, a plan may be very logical and intelligent; however, if that
plan does not incorporate specific demographics and prevalence, it will not succeed.
Additionally, some countries like the United States do not have cooperation among civil society,
the government, and private sector; this makes populations hard to appeal to as they are receiving
mixed messages.
Conclusion
Chronic non-communicable disease or lifestyle diseases are those caused by unhealthy
daily habits. Lifestyle diseases are globally detrimental as they have political, sociocultural,
economic, and environmental effects. The escalation in chronic disease prevalence is primarily
due to the growing greed of the private sector, including the food and beverage industry and
companies of sedentary motives.
62
Many educated people, including Erin Berenbaum; the Research Coordinator of Health
Promotion, Chronic Disease and Injury Prevention for Public Health Ontario understand the
importance of healthy active living and the effects of the chronic disease pandemic.
Specifically, the controllers of chronic disease range on individual, interpersonal,
institutional, community, and policy levels. These levels although the cause, have the ability to
be the solution if they exercise their shared role in making change.
Global organizations, including The United Nations, The World Health Organization,
Global Alliance for Chronic Disease, Centres for Disease Control and Prevention, and the Global
Health Council attempt to help people become healthier and more educated on preventing
chronic disease.
Countries of diverse development, including developed in the case of the U.S. and
Canada, developing such as China, and undeveloped, example Uganda, suffer from chronic
disease among their populations differently. The more developed a country is does not
necessarily mean that the country is immune to non-communicable diseases. Trends suggest that
development leads to increased fast food and sedentary culture and thus, it is counterproductive
to preventing chronic disease.
Many people and groups justify their chronic disease conducive habits due to personal
and financial convenience. Politics and religion are embedded in society and are significant to
everyday life, they have the ability to be part of causing lifestyle diseases as well as solving
them.
Lifestyle diseases are a multidimensional global issue that require collaborative efforts in
order to effectively resolve.
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