By Dr. Ian Clarke

I said in my column last week that having a doctor-focused perspective on health is not the right approach, because the doctor only comes in at the end of the process of disease, and we should be focused on preventing the disease in the first place. It is often something we are doing, or not doing, that provides the conditions for a disease to develop, and many diseases are affected by two of the most basic behaviours of human beings: what we put into our bodies and how we maintain the condition of our bodies. We know these principles when it comes to keeping our cars in good working order, yet when it comes to our own bodies we abuse them and think we will escape the consequences.

What we put into our body refers primarily to what we eat, and how much we eat, though if we put in harmful substances such as drugs, nicotine and excessive alcohol, we will also cause damage. Regarding what we eat: in Uganda our diet is high in carbohydrates and sugar. If we belong to the urban middle class, in the morning we like our tea with three sugars, then we heap our plates at lunch with matoke, rice, beans, vegetables, (and meat or chicken if it is available), then we like some muchomo and beer on the way home from work. With this diet, and with a sedentary lifestyle, it is no surprise that we put on weight.

Our diet consists of carbohydrates, such as potatoes, which have a high glycaemic index, meaning that they are readily converted into sugar by our bodies. This results in high levels of sugar circulating in our vascular system, which causes a low-grade inflammation of the walls of the blood vessels. This, in turn, causes slight roughness of the blood vessels, predisposing them to develop fatty plaques causing narrowing, which results in blockages causing strokes and heart attacks. Ugandans are also prone to essential hypertension (high blood pressure), which makes the heart work harder to push the blood through the circulation, so the heart muscle enlarges like any muscle that is exercised. This enlarged heart muscle makes greater demands for oxygen and nutrients, but if the person has a high intake of carbohydrates and sugar the blood vessels are likely to be narrowed due to the roughness and build up of plaques, so the increased demands of the muscle, together with narrowing of the vessels, is likely to result in a heart attack.

The other critical factor is exercise. When we overeat we put on weight and find it difficult to exercise, so we put on more weight, and it become a vicious cycle. However, if we watch our weight, and exercise, there is a positive effect on the prevention of almost all diseases, including type two diabetes, cancer, and Alzheimer’s. The reason is due to improving the circulation through strengthening the cardiovascular system, therefore there is an increased blood flow to the brain and other vital organs. Exercise also improves musculoskeletal strength.

Does this mean that Ugandans are all going to die of strokes and heart attacks? No, but it does mean there is an increased risk which we can address through modification of our habits. The simplest change would be to eat less, because if we load ourselves up with carbohydrates and sugar, we will put on weight, take less exercise, and increase our risk. However, if we cut out the sugary drinks and moderate the portions that we eat, maintain an ideal weight and exercise, our vascular system will stay in good condition. It is a case of less being more.

I have dealt mainly with us reducing our risk of disease as individuals, but government can also improve the health of the nation by concentrating its resources on preventive health, and proven interventions. These include expanding the vaccination program, provision of treated mosquito nets, indoor residual spraying, ensuring the constant supply of antiretroviral drugs, provision of clean water, provision of family planning and reproductive education, and basic health education and early detection of disease through the village health teams. There are many shocking statistics in Uganda, such as the rate of maternal mortality, which will not be changed by employing more doctors. They will change when we make interventions, such as reducing the rate of teenage pregnancy from 25%, and the fertility rate from 5.8. They will change when women in the village are no longer having twelve pregnancies. We will bring down our maternal mortality by concentrating on the root causes of risky pregnancy.

If we want to stop swimmers from going over a waterfall, don’t station rescue boats at the waterfall, move the swimmers upstream.

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