Monday, June 12, 2017

Lifestyle and Non-Communicable Disease

By Jasmine Swyningan

As humans, we are bombarded with choices on a daily basis.
  • Do I go on a diet or maintain my current eating habits? 
  • Should I go to work today or play sick and watch movies all day? 
  • Should I get the chocolate chip cookie or oatmeal raisin cookie? 
  • Should I go for a run or go to a kickboxing class? 
  • Should I call my grandmother or aunt? 

You get the idea. 

These choices, when looking beyond this week (or this month, or this year), can have a significant impact on our long-term health. Here’s one way to think about this phenomenon: we are lucky to live in a time where our own lives literally make us sick. We are familiar with the endless amount of diet and fitness fads in the United States (like Beachbody, or Herbalife, or Shakeology, or encouraging a “Gluten Free” or “low carb” or “high fiber” diet), and efforts by political leaders and celebrities to encourage exercise (like Play60, or Worldwide Day of Play, or Let’s Move). Why do so many people obsess over diet and exercise? Because our “Western” lifestyle is, well, in many cases, a synonym for the term “sedentary.” And there has been a significant increase in the prevalence of non-communicable diseaseparticularly hypertension (high blood pressure) and type II diabetesover the past 3 decades, not only in the US, but globally. 

Of course, this is a major problem in the US, having lasting impact on people’s quality of life, and also changes the way we need to approach the debate on healthcare. Hypertension and type II diabetes are examples of diseases requiring ongoing care and potentially complex medication regimens. When we think about these issues on a global level, the effect is even more complicated.

The Imperial College London completed and published findings from their 30-year-long project to track diabetes rates globally. What they found was a stark increase in the prevalence of type II diabetes, particularly in countries in sub-Saharan Africa and the Pacific Islands. Especially problematic about the increase in non-communicable diseases in these areas is a clear lack of infrastructure to treat these diseases. Additionally, researchers believe that this issue of non-communicable disease (or NCD) morbidity (having a disease) and mortality (dying from a disease) isn’t going away anytime soon. In fact, NCD rates are expected to surpass those of infectious diseases (like HIV/AIDS, tuberculosis, or malaria) in lower and middle-income countries by the year 2035. 

Why is this happening? Are there more doctors with the ability to diagnose the disease? 


What research is telling us, however, is lifestyle may be more to blame than we’d like to admit. As countries in Africa continue to globalize and urbanize, their citizens begin to adopt a lifestyle that accommodates accommodations. People are: 
  • Walking less and driving more.
  • Not traveling as far to access clean water.
  • Eating more processed foods.
  • Smoking and drinking more often. 
When these changes happen in a short amount of time, say, over the span of one person’s lifetime, their metabolism comes to a screeching halt, and anticipated weight gain due to moving less often and eating more often (and eating lower-quality foods) is exacerbated as a result. Further, myths around health and wealth, unfortunately, encourage this type of lifestyle in lower and middle-income countries. The ability to smoke, drink alcohol, drive, and eat processed food is a sign of wealth; also, weight loss is a symptom of many infectious diseases. Therefore, ailments such as hypertension or type II diabetes are known as the “rich person’s disease.” Infrastructure to manage these types of diseases are scarce, and motivation for patients to make lifestyle changes reminiscent of a time before accommodations were in place (or to take medication that won’t heal, but will only treat their disease) is lacking.

In my own travels, I have witnessed public health efforts to combat obesity and spread awareness about non-communicable disease. Sometimes people don’t believe these diseases exist because they take years to develop. Other times people know about the disease but simply do not care. Most intriguing, though, is working with people who both know about long-term problems associated with eating processed foods and not exercising, but who also respond to calls for lifestyle change with something like, “I don’t live in an area that sells produce.” Or they live in an area where beer is cheaper than water. Or (in the US) where dialysis centers are more plentiful than grocery stores.

The choices we make about our own lifestyle has a domino effect on our health, and research is telling us that such choices are changing the face of disease, both in the US and globally.

Thursday, June 1, 2017

Capstone 2017 – Jasmine Swyningan

Presented May 4, 2017, Jasmine Swyningan offered a look into the lifestyle factors that influence hypertension specifically as they are effecting countries in East and West Africa. As noted in Jasmine’s research, along with other non-communicable diseases (NCDs), researchers have documented a significant increase in hypertension and type 2 diabetes over the past 35 years. The lack of research documenting the contributing factors and gaps in treatment and prevention knowledge are limiting elements to the mounting burden of these types of diseases in Sub-Saharan African countries.

Comparing data gathered on non-pregnant women in Kenya and Ghana, Jasmine was able to support some key public health predictions within these areas. Her findings replicated the positive relationship between age/BMI and hypertension. Additionally, as the wealth index increases, so does the prevalence of hypertension. An individual living in an urban environment, having a higher education and being covered by health insurance is more likely to be diagnosed as hypertensive. While all of these factors are a result of movement toward economic development and increased wealth, these are also causing changes in the environment and behaviors that influence the health of the population.

As lifestyle continues to change at varying rates between and even within, countries must look to prepare themselves for the health impact of NCDs. Unfortunately, it may be outside financial reach to install effective prevention efforts that combat the effects of lifestyle changes. However, work could be done to leverage the existing healthcare networks—targeting clinician and patient education—to help curve the long-term effects of NCDs.

Jasmine joined Loyola University’s Master of Health Program with a BS in Economics from Iowa State University and MA in International Relations from the University of Chicago.

Learn more about Jasmine’s capstone experience.

Why did you choose to pursue an MPH? 
My desire to pursue an MPH and specialize in Epidemiology was organic in nature. I was brought to the University of Chicago for a few reasons that have remained unchanged throughout my academic career at Loyola: I am fascinated by economic development, and its intersection with other facets of society (e.g., education, health, gender, culture); I have a passion for enhancing my surroundings in a holistic manner; I love learning and engaging in both sides of an argument. I felt that an MPH at Loyola would allow me to grow in all of these areas.

What led you to your topic? 
Lifestyle and type II diabetes among women in sub-Saharan Africa was the focus of my MA thesis back in 2011, shortly after Imperial College London completed and published findings from their 30-year-long project to track diabetes rates globally. What they found was a stark increase in the prevalence of type II diabetes, particularly in countries in sub-Saharan Africa and the Pacific Islands. Before I even began studying public health, I became obsessed with understanding the social, economic, and cultural forces at play in these low-and-middle-income countries that are influencing the increase in NCD prevalence. After I completed my MA thesis in 2012, I presented my observations at African Studies conferences at Michigan State University Stanford University. At both conferences, people encouraged me to continue pursuing this topic and to look at everything from a public health lens. The transformation of this project has been an interesting challenge that I have come to greatly appreciate.

What personal skills helped you the most in completing your project? 
Time management! I spread out my capstone over two semesters which allowed me to do most of the background during the first semester, and then run the data (and rerun, and rerun, and RERUN the data...) during the second semester. Over the duration of my project, I also worked full-time (sometimes on weekends), completed 2-3 other courses, and started planning my wedding! Time management and an open dialog with my faculty advisers were key to completing this project. I also think that a genuine interest in the topic helped quite a bit.

A student’s Capstone project is a professional presentation, which demonstrates his/her ability to apply the program learning to a specific public health topic. Selected by the student, the project reflects a culmination of the course curriculum, field experience and independent study. This experience helps students explore their academic passions while preparing them for a competitive job market.