Masako Imamura writes:

According to the World Health Report in 1995, poor countries had three times more deaths than rich countries. And one can see that the causes of death among adult is different so much between the developing country and the developed country.

In general, communicable diseases such as tuberculosis and respiratory infections are main causes of deaths especially in the developing countries whereas in the developed, death has been caused more by noncommunicable diseases such as heart disease and cancer. Especially in the developing, it will be immediately improved if they have more money or more help to get good medical system and public health and in fact, the condition is improving gradually by means of a global effort.

But there are some common problems between both kinds of countries. For example, sexually transmitted diseases (STDs) like HIV and AIDS continue to spread relentlessly. Also noncommunicable diseases that are perceived as problems of the developed are becoming one of the main causes of deaths in the developing recently. Further more, smoking and diabetes caused by an irregular lifestyle are growing serious public health problems. The report said the figure that smoking will kill people is expected to reach 10 million by the year 2020. These diseases give rise to not only medical costs but also expenses of medical insurance, so there is a possibility that the development of economics of countries is disturbed and also we have to pay out more and more to take medical care and make good medical care system near future.

These problems are not only medical but also include many other factors, for example, economics, social issues, politics, education, and so on. So what can we do to help solve these complex problems as members of the Japanese medical community?

First, we can offer big help to poor countries in terms of financial support, not only money but also medical technique including construction of some hospitals, introduction of medical machines, supply of medical staff who instruct people in these countries.

Second, more improvement in the way of treatment for cancer or HIV etc. and development of some antibiotics or vaccine through the research are also important.

But, we are now facing a more serious crisis, I think. We should notice that the causes of deaths in the developing world are changing recently and both developed and developing countries have common problems like STDs, smoking and diseases caused by lifestyle. Also we should recognize that these problems are improved dramatically by the our own behavior (in contrast with those diseases that are solved only when some some special treatment is applied or diseases that have no cures). For example, with regard to disease caused by lifestyle, many STDs could be avoided if condoms were used, smoking and diseases caused by lifestyle can be also avoided by our own efforts. In particular, the important and effective improvement against these problems is related to education. Although the levels of education are higher especially in the developed countries, is it enough in all cases all over the world to simply provide knowledge about sex, mortality and medical conditions? I think it isn't. To supply condoms and other practical assistance to all students in school or home can be one additional effort.

Especially as medical students or doctors, things we can do to further improve these health problems are maybe limited. For example, we can attend some campaign or symposium and get appropriate knowledge about world health problems. It is true that these efforts will bear fruit only in small ways over time, but surely one person's attempt is the most important thing. As a doctor, to teach the people proper knowledge and address the problems of world health based on some clinical data is also important. Further, doctors are needed to help patients accept new ways of treatment in adaptation to changes in our understanding of the causes of death, for example, the affect of lack of exercise or improper diet on lifestyle diseases.

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