Personal care medicine: Social health

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“Health is not just the absence of disease, but a state of complete physical, mental and social well-being”. This is a well-recognized definition of health as given by the World Health Organization (WHO).

As this definition clearly states, the social contexts of health and disease or “social health” also form important aspects of health. These are the conditions in which we live, learn, work and age i.e. the conditions of day-to-day life, which in turn are influenced by the political, social and economic systems of the country. How a person gets along with other people and how do people talk about a person behind his back is also social health.

These social determinants of health are equally important or perhaps even more important in influencing the health and well-being of an individual. For this reason, they have also been called “the causes of the causes”.

The WHO has identified 10 social determinants of health:

1. Social gradient
2. Stress
3. Early life
4. Social exclusion
5. Work
6. Unemployment
7. Social support
8. Addiction
9. Food
10. Transport

Social gradient is measured by variables such as income, education, housing or occupation.

Education inculcates healthy behaviors. Housing determines better access to healthy foods and health services. Conflicts, gender inequality are also important social determinant of health as they may also influence availability and access to health services.

Food- and water-borne diseases are due to lack of access to safe food and clean drinking water and poor sanitation. These are more often than not the consequence of poverty or low income, which is associated with poor housing, overcrowding and poor sanitation. So, you may treat that one episode of diarrhea but, the patient who lives in areas of poor housing and sanitation may come back to you with recurrent episodes of diarrheal diseases.

Air pollution is a major environmental risk to health. NCDs, such as cardiovascular diseases including stroke, chronic respiratory diseases and cancers have been linked to outdoor air pollution. Exposure to biomass smoke, or indoor air pollution, is a major risk factor for COPD.

A patient who is struggling to meet his daily needs may not be amenable to advice about lifestyle modifications – quitting smoking, physical activity/exercise, healthy food. These will not be a priority for him.

Social isolation and loneliness will only further aggravate the condition in a patient of depression.

Persons whom we come in contact with daily, be it family or friends, also influence healthy behaviors. If your family and friends exercise regularly, it is more than likely that you will also pick up this healthy habit. But remember, bad habits are also catching, for example, alcoholism, substance abuse, smoking, etc.

A research published in the May 22, 2008 issue of the New England Journal of Medicine had shown that when one person quits smoking, than others are likely to follow. One person quitting can cause a ripple effect, making others more likely to kick the habit.

• If your spouse stops smoking, you’re 67% less likely to continue smoking.
• If your friend kicks the habit, it’s about 36% less likely that you’ll be smoking.
• When a sibling gives up cigarettes, your risk of smoking decreases by 25%.
• Risk of smoking drops by 34% if a coworker in a small office quits smoking.
So, have positive influences around you. Keep the company or “sangat” of good people to spend time with. Adi Shankaracharya has described Sangat as the main force for living a spiritual life.

India is facing the double burden of infectious diseases and non communicable diseases, undernutrition and overnutrition (overweight and obesity). This is a reflection of the health inequities in the country.

Therefore, achieving the desired health outcomes is not just dependent on treating the disease alone. Addressing the social determinants of health is equally important, first to achieve the desired results and then to sustain them. A healthy person is more productive and contributes to the growth and development of society.

The concept of “One Health” recognizes that the health of people, animals and the environment are connected. Many diseases in humans or zoonoses are spread from animals.

Treat the person in totality and not just the disease.

As Sir William Osler said, “The good physician treats the disease; the great physician treats the patient who has the disease.”

Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award,Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medalist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

Revised WMA Declaration of Delhi on Health and Climate Change: For comments

Health Care, Medicine Comments Off

Document no: SMAC 206/Climate Change REV2/Apr2017 Original:
Title: Revised WMA Declaration of Delhi on Health and Climate Change
Destination: Constituent Members Action(s) required:
For Comments
Note: The Associate Members submitted this proposed statement to the General Assembly in Taipei (October 2016), under the initiative of the Junior Doctors Network (JDN). The General Assembly passed it to the 204th Council Session, which decided to circulate it to the members for comments. The Council in Livingstone (April 2017) considered the compromise version based on the comments received and decided to return the draft to the rapporteur for further work in view of the discussion during the meeting, before a new circulation.
Suggested Keywords: Climate change, air pollution, environment, Paris Agreement, Marrakesh Agreement, COP, mitigation, heat waves, flooding

1.      Compelling evidence substantiates the numerous health risks posed by climate change, which threaten populations of low, middle and high-income countries. These include more frequent and potentially more severe heat waves, droughts, flooding and other extreme weather events including storms and bushfires. The resulting climate change, especially warming, is already leading to changes in the areas in which disease vectors flourish. There is reduced availability and quality of potable water, and worsening food insecurity leading to malnutrition and population displacement. Global warming is universal but its effects are unevenly spread and many of the areas most strongly affected are least able to manage the challenges it poses.

2.      Tackling climate change offers opportunities to improve health and wellbeing both because of the health co-benefits of low carbon solutions and because mitigation and adaptation allow action on all the social determinants of health.  Transition to renewable energy, the use of active transport, dietary change including a reduction in consumption of red meat, may all contribute to improving health.  Mitigation actions, such as those on reducing indoor and outdoor air pollution, will reduce health harms suffered predominantly by poorer people.

3.      The social determinants of health are those factors that adversely affect health through exposure before and after people are born and as they grow live, and work.  They are worse in the poorest populations of all countries and also vary between countries.  Those with generally the poorest health and lowest life and health expectancy will be least able to adapt to deal with global warming exacerbating adverse social determinants of health.  Assisting these countries is a common but differentiated responsibility.

4.      Climate change research and surveillance is important and the WMA supports studies seeking to describe the patterns of disease that are attributed to climate change, including the impacts of climate change on communities and households; to quantify and model the burden of disease that will be caused by global climate change including emergent diseases; to describe the most vulnerable populations.

5.      The Paris Agreement highlights a transition to a new model of global collaboration to address Climate Change and represents an opportunity for the health sector to contribute to climate action.  It includes a series of actions to be undertaken in each nation to attempt to limit the global increase in average temperature to less than 1.5 C.


6.    The World Medical Association and its Constituent Members:

6.1     Urge national governments urgently to recognize the serious health consequences of climate change and to adopt strategies to adapt to and mitigate the effects of climate change;

6.2        Urge national governments to work to ensure fulfillment of national commitments to the Paris Agreement, including both mitigation and adaptation measures as well as action on losses and;

6.3     Urges national government to ensure that climate financing must include designated funds to support the strengthening of health systems, and health and climate co-benefit policies and through this, to ensure the availability of sufficient global, regional and local financing for climate mitigation, adaptation measures, disaster risk reduction, and the attainment of the Sustainable Development Goals (SDGs);

6.4        Urge national governments to engage with health sector representatives in developing and implementing climate change plans and emergency planning and response on local, national and international levels;

6.5        Urge national governments to provide for the health and wellbeing needs of people displaced by environmental causes both within their countries and others including those becoming refugees due to the consequences of environmental changes.

7.      National Medical Associations and their physician members should:

7.1        Advocate for sustainable, environmentally responsible low-carbon practices across the health sector to reduce the environmental impact of health care facilities and practices.

7.2        Prepare for the infrastructure disruptions that accompany major emergencies, in particular by planning in advance for the delivery of services during times of such disruptions and increased patient care demands;

7.3        Encourage and support advocacy for environmental protection and greenhouse gas emissions reductions including through emissions trading systems and/or carbon taxes.

8.      The WMA and its Constituent Members should:

8.1        Encourage sustainable low-carbon living including active lifestyle, low-carbon agricultural and food production processes and diet, and sustainable production and consumption patterns;

8.2        Seek to build professional and public awareness of the importance of the environment and global climate change to personal, community and societal health;

8.3        Work towards the integration of key climate change concepts and competencies in undergraduate, graduate and continuing medical education curricula;

8.4        Collaborate with WHO and other organizations as appropriate, to produce educational and advocacy materials on climate change for national medical associations, physicians, other health professionals, as well as the general public;

8.5        Work towards increasing resilience including by preparing physicians, physicians’ offices, clinics, hospitals and other health care facilities for the infrastructure disruptions that accompany major emergencies, in particular by planning in advance the delivery of services during times of such disruptions;

8.6        Seek to ensure that physicians are involved in the planning and delivery of primary ill-health prevention strategies in relation to climate change, working with NGOs, IGOs and governments;

8.7        Advocate for their respective governments adequately funded climate change research and collaborate with governments, NGOs and other health professionals to develop knowledge about the best ways to address health impacts of climate change;

8.8        Work collaboratively with government and NGOs to develop systems for event alerts in order to ensure that health care systems and physicians are aware of climate-related events as they unfold, and receive timely accurate information regarding the management of emerging health events.

9.      The WMA urges National Medical Associations to:

9.1        Work with health-care institutions, and individual physicians to adopt climate policies and act as role models by striving to reduce their carbon emissions, for instance by adopting more sustainable travel policies and increasing the use of on-line meetings.

9.2        Recognize environmental factors as a key element inherent within the social determinants of health (SDH) agenda, and encourage governments to foster collaboration between the Health and non-health sectors in addressing these determinants.

Dr KK Aggarwal
National President IMA & HCFI

Air pollution increases risk of heart disease by lowering the good cholesterol

Health Care Comments Off

Air pollution is a reality today and has been a subject of much discussion recently. Several studies have demonstrated the association of poor air quality with diseases such as respiratory and heart diseases, global warming making it a major public health problem of concern.

Yet another new study reported in the journal Arteriosclerosis, Thrombosis, and Vascular Biology has highlighted the increased risk of cardiovascular diseases due to traffic-related air pollution and proposed an explanation for the relationship between air pollution and cardiovascular disease.

The study says that traffic-related air pollution may increase risk of developing heart diseases via its effects on the good high-density lipoprotein cholesterol (HDL-C).

The study involving more than 6000 middle-aged and older adults in the United States found that people who live in areas with high levels of air pollution, especially traffic-related air pollution, have lower levels of the good HDL-C. Over a period of one year, those with higher exposure to black carbon, emitted from vehicles, had considerably lower levels of HDL-C compared to those with lower exposure to black carbon. Higher particulate matter exposure over three months was associated with a lower HDL particle number. Compared to men, women had much lower levels of HDL-C.

Keep your total cholesterol lower than 160mg/dL. HDL is good cholesterol, keep it more than 40mg/dL. LDL is bad cholesterol and should be kept as low as possible; keep it lower than 80 mg/dL. A 1% rise in bad cholesterol increases the chances of heart attack by 2% and 1% reduction in good HDL-C reduces the chances of heart attack by 3%.

(Source: AHA news release, April 13, 2017)

Dr KK Aggarwal
National President IMA & HCFI

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