Naoki Murai writes:

It is well known that the health of adults differs from country to country. For example, about 50% of deaths in developing countries are caused by communicable disease such as tuberculosis and respiratory infections, whereas about 75% of deaths in developed countries are caused by noncommunicable diseases such as heart disease and stroke, that is, deaths caused mainly from diseases related to lifestyle. But ther are some common diseases in both the developing and the developed countries. One such disease is diabetes mellitus, which is a growing public health problem in both developed and developing countries. A recent WHO expert group estimated that more than 100 million people will suffer from diabetes by the end of this century. Most of them by non-insulin dependent (NIDDM) form. Many people think that diabetes is caused by taking a high-calorie diet to excess. But still the lack of proper nutrition leading to state of starvation can also cause diabetes. Both of these cases of diabetes (that is, diabetes caused either by high-calorie intake or starvation) induce high amounts of blood glucose.

Diabetes and many other diseases not only claim the lives of patients, but also causes economic problems. For instance, the direct and indirect costs of malaria are estimated in Africa alone as US $1.8 billion by 1995. Some recent estimates put the cost of diabetes in the USA alone, both direct and indirect, at US $92 billion a year. For the developing countries, this cost interrupts the economic development of the country and together with other factors will be one reason for the lag of stabilization of medical conditions.

For the developed countries, diesease will lead to the rise of medical costs. And it will give raise to another serious problem, the problem of medical insurance. Even in developed countries, ability to obtain medical care differs between the insured and uninsured person. According to Health Care Financing review (1992), population of the uninsured people (excuding people who obtain Medicare; 13%) reaches to about 15% of the total US population. And even worse, ability to obtain medical care varies across communities for the uninsured. According to Analysis of the 1996-1997 Community Tracking Study Household Survey (a nationally representative sample of the US civilian), differences between communities with the highest percentage of uninsured persons reporting difficulty obtaining care and communities with the lowest percentage were more than 2-fold (40% vs 18%). Now one can see that in addition to where they live, whether people are uninsured is an important factor in determining the difficulty they have in obtaining care.

Many attempts are made to address these health problems, but how effectively? Here is an example of one attempt to reduce smoking. John P. Pierce and his coworker examined trends in smoking before, during, and after the California Tabacco Control Program. According to their examination, per capita cigarette consumption declined about 50% faster in California in the early period than previously, and the decline was significantly greater in California than in the rest of the US. But they concluded that the initial effect of the program to reduce smoking in California did not persist. There is another attempt against health problem something like the Diabetes Awareness Campaign. The National (US) Diabetes Education Program (NDEP) recently launched an educational campaign with the message that aggressive and preventive measures and medical treatment will delay or even forestall diabetes-related morbidity and mortality.

As seen in the California Tabacco Control Program, not only launching initiatives but also persisting in them is also important for solving health problems. Although we Japanese tend to depend on government, at least as members of the medical community, some of us might at first enlighten ourselves. Most of all, we must recongnize the serious situation all the world and attempt to achieve some global view. Although we tend to consider helping only the developing countries, it might be neccesary to consider those countries that on the surface seem to be healthy, including even our own country. The problem is not easy, because it entails not just medical problems but also political, social, environmental and cultural problems, which together make the question of hoe best to tackle these problems much more complicated. As medical students, we can attend several kinds of symposiums or meetings related to health problems to obtain some knowledge about health problems we are now facing. We can also join in a signature collecting campaign to support grass-root movements.

Discussing the problem at the governmental level, temporal financial support is not enough for solving the variety of adult health problems, such as diabetes, malaria, and so forth. Besides this financial support, manpower is thought to be required. Vaccines may help some kind of infectious diseases, but other ways like instructing people in some medical technologies are more practical and therefore better in solving problems for the long term. Building medical service branches and providing medical staffs will help greatly, also. Applying pressure to the government by way of a grass-roots movement to increase medical budgets to address worldwide health crises may also be needed.

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