Ruth Armstrong: The long haul

RECENTLY, while settling in to see the movie August: Osage County, I was so struck by the film’s opening line (a quote from from TS Eliot’s poem, The hollow men) that I barely heard the rest of the introductory monologue.

“Life is very long.”

The statement was unsettling because it is a position rarely taken: the more usual observation is that life is too short. When it comes to health and health care, however, setting ourselves up for the long haul can be a necessary approach.

MJA InSight’s lead news story this week brings into focus an interesting longitudinal study from the US, which involved monitoring the blood pressure (BP) of young adults for 25 years, to determine if certain BP “trajectories” were associated with atherosclerosis in middle age.

While the study was limited by the use of surrogate rather than clinical end points, its findings highlight the long lead-times to experiencing the chronic effects of high BP. As one expert put it: “One in three people live to be 100 — if we want them to do that with quality of life, we have to look after these chronic problems. We need to start decades earlier.”

Public health practice could be seen as the ultimate long-haul career choice but, as the tobacco control community would attest, decades of work produce results if you relentlessly chip away.

There have been attempts over the years, renewed recently, to apply the same pressure to “big food” but they are frustrated by practical, legal and political obstacles.

In response to a call from Diabetes Australia for a sugar tax on sweetened drinks, deputy chief executive of Australia’s Food and Grocery Council, Geoffrey Annison, reportedly said: “There’s no demonstration that sugar of itself is particularly obesogenic or related to any health outcomes.”

In a stroke of good timing, just last week researchers who linked results from the US National Health and Nutrition Examination Survey with mortality data have addressed Annison’s yen for evidence, by finding that that high consumption of added sugar more than doubles the risk of cardiovascular mortality. The study and its relevance to Australia is the subject of another of our news stories.

In the same way that youth is wasted on the young, could it be that insights into the illness experience are wasted on patients? InSight’s blogger Jane McCredie takes a look this week at the stories of doctors whose practice has been profoundly affected by their own experiences in life’s long haul as health care consumers.

Of course, life is not always very long. In many populations, including the most disadvantaged Australians, it is, on average, depressingly short.

Public health veteran and the MJA’s Editor-in-Chief, Professor Stephen Leeder told MJA InSight this week that hypertension, smoking and nutritional factors were contributing to a burden of cardiovascular disease in less developed countries akin to the rates experienced in developed countries in the 1960s.

Is this the epidemic they had to have, or can countries like Australia use the experience of our own long haul with cardiovascular disease to provide the opportunity for very long and full lives to their future generations?

 

Dr Ruth Armstrong is the medical editor of MJA InSight.