Is health in the western world at the bottom of a nasty J-curve?

For most of human history one of the major threats to a long life was scarcity: in particular scarcity of food and medicine. Hunger and disease made life – to paraphrase the 17th century philosopher, Thomas Hobbes – ‘poor, nasty, brutish, and short’. Indeed, average life expectancy from the Neolithic period through to 19th century England was less than 40.

Today, average life expectancy for the world has climbed to over 70 from 48 in 1950. With the spectre of global food and remedy shortages waning, and advances in medicine, the horizon for humanity and life expectancy is surely on the up and up, right? Well, perhaps not.

According to Professor Jenny Gunton from the Westmead Institute for Medical Research and Sydney Medical School, researchers are warning of a health epidemic stemming, almost perversely, not from food or medical shortages but from lifestyle choices made in the context of superabundance.

So, despite living in an unprecedented age of plenty, the rise in lifestyle-related chronic diseases like obesity and diabetes is setting Australia up for a significant health crisis, and all the attendant social and economic knock-on effects that entails.

The most common causes of death in Australia are all lifestyle related, stemming from obesity and physical inactivity. According to a 2016 report from the Centre for International Economics (CIE) the cost of diabetes alone is as high as $14 billion per year with no sign of abatement. The percentage of Australians with diagnosed with diabetes has tripled between 1990 and 2015.

And it’s a pattern replicated in other western societies. According to the Mayo Clinic in the United States, one in six American children is obese, while obesity in children aged 2-5 has grown from 9% to 14% over just a four-year period. Shockingly, children are now regularly presenting to medical professionals with type 2 diabetes, sleep apnoea, and fatty liver disease.

According to the World Health Organisation (WHO), worldwide obesity almost doubled between 1980 and 2008. But obesity doesn’t function as an outlier, where there are healthy people and a small percentage that are obese, but rather is part of a dietary continuum.

According to the same WHO report, over 50% of adults in the European Region are overweight, with 23% of women and 20% of men obese.

While exercise is undoubtedly important for our muscles and cardiovascular fitness, the increase in childhood obesity – including amongst babies who are not yet able to exercise – is like the canary in the coalmine, indicating that diet is the major contributing factor to being overweight and being at risk of developing chronic disease.

The abundance of high-sugar and high-carb food on offer, the decreasingly physical nature of work, and the paucity of time available for exercise means the calories from these foods are increasingly hard to burn off and being stored as fat. To burn off the calories of a donut, for example, a 150-pound person needs to run for 30 minutes or walk for 90.

The HbA1c test, which measures the glucose level of haemoglobin, allows pathologists to detect and monitor diabetes or prediabetes at an early stage. With early detection of elevated blood sugar, people are able to halt the progression of diabetes or even to reverse it.

Because of our ready access to sugary foods or those with high carbohydrate content, conditions like diabetes are reaching alarming proportions. The CIE report states that 1.5 million Australians currently live with diagnosed diabetes, with a further 500,000 having undiagnosed diabetes. As with obesity, diabetes is part of a continuum with many hundreds of thousands more most likely at prediabetes stage.

As a major cause of kidney disease, heart attack, eye disease and amputation, diabetes is a peculiarly modern, man-mad scourge, requiring human engineered solutions, such as the HbA1c test.

Not only does that mean better health outcomes, but better economic ones. The CIE report suggests that treatment costs for diabetes can be halved if detected early through the HbA1c test.

For more information on how pathology testing saves money and lives visit knowpathology.com.au