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This may seem obvious. But winding invisibly through our life choices, is the effect of when we are in the world. Not just the stages of our individual life – birth to old age – but the social environment.
Health is a complex issue involving individual choices as well as external factors such as consumer protection with regards to food safety, safety in the workplace and environmental and social policies.
Back at the turn of the 20th century, for instance, the most common cause of death was infectious diseases. If you caught pneumonia, your chances of dying were high. We solved that problem, but in the 1950s, our lifestyles and behaviours threw up new life-inhibiting factors.
“Non-communicable or non-infectious diseases – a group of conditions that includes cardiovascular disease, cancer, mental health problems, diabetes mellitus, chronic respiratory disease and musculoskeletal conditions – cause more than 85% of deaths in Europe,” says Eurostat, a department of the European Commission.
Those figures are lower in South Africa because we’ve got world-record HIV/Aids infection rates. But they’re still high, and if you’re living here, now, they are what you should look out for.
Risk factors increasing
There is overwhelming evidence that the “common risk” factors which cause lifestyle diseases like cancer and heart disease include the increasing use and abuse of alcohol and smoking, and the higher incidence of stress and obesity. Obesity in turn is itself to some extent a result of poor eating choices and low activity levels.
All of these are factors over which we exercise greater or lesser control. Yes, there are genetic issues involved in some situations, but most of us can choose not to smoke, to not sit on the couch in front of the TV all weekend, and to not subsist entirely on fast foods.
At a literary festival recently, a panel discussion involved three cookbook writers, one of whom is also a chef. Her training is classic French, and her background is Afrikaans. The delicious results are red meat dishes, lots of butter and a generosity of cream. A member of the audience wanted to know how she could encourage this “unhealthy” cooking when people were being exhorted to live “healthy lifestyles”. Her response was simple. “Have you heard of portion control?” she asked sweetly.
Portion control is a perfect metaphor for guiding our actions. By and large, we live in a comfortable world, and most of our efforts are directed towards increasing our creature comforts. There's nothing wrong with that, except that we need to clarify exactly what benefits those comforts obtain for us in the long run. There is nothing wrong (and a lot right) with a glass of wine with a meal; there is something wrong if you're drinking the entire bottle.
There is nothing wrong with a steak fried in butter; there is if you do it every day and it is 500g big and you help it down with a barrel of fries. And you don't have to become a triathlete: there is nothing wrong with your exercise consisting of a daily walk around the local park.
There is, unfortunately, nothing right about lighting a cigarette.
The rub is that all the diseases due to a “non-portion control” life can probably be contained by medical intervention. Yes, you will continue living; but there is overwhelming evidence that your quality of life will be compromised.
For one thing, financially you will be severely constrained. Back in 1983, Dr Marius Barnard came to the realisation that while medicine could extend people's lives, patients were being financially destroyed by the costs incurred by critical illness, or what some refer to as “dread disease”. As he says: “It became obvious to me that my patients did not only need insurance because they were going to die, but because they were going to live.”
Critical illness insurance policy
Working with the insurance industry, Barnard helped develop the original critical illness (CI) insurance policy that pays out when the patient is diagnosed with a critical illness, when they really need the money. “Back then, dread disease only encompassed four diseases: heart attack, cancer, stroke and coronary artery surgery,” says Andrew Edwards, executive principal officer at Liberty medical scheme.
“Today, this category of insurance can span more than 26 listed diseases.” It pays out a fixed one-off, pre-agreed lump sum to the policyholder. This money is yours to spend as you need to, and goes a long way to offset the often unexpected costs that arise.
Of course, lifestyle factors will determine the cost of your policy. If you smoke, it will cost you; if you drink excessively, it will cost you some more; and if you don't exercise and are overweight, that will also add to your premium.
But find the money to pay the premiums. And more importantly, find the time and space to create a better and healthier quality of life.
