BlessWorld Foundation International

Affecting the World Through Health
A Global Health Initiative

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The recent anti vaccination campaigns, conspiracy theories and possible links to conditions like autism have caused us to rethink the use of mass vaccination. The questions on everyone minds are: should we continue mass vaccination? Is vaccination a safe public health measure? These questions, in recent times, have become socio political, medical, religious and even ethical. The socio political basis of the argument is due to the fact that some political groups like the liberalists are against forced vaccination due to liberality. Also, there are some conspiracy theories about their use in regional subjugation through the spread of infectious agents. The medical argument of course comes from the potential adverse effects and concerns over potentially harmful agents like thimerosal (a mercury containing compound)that have been phased out in many countries including Canada.

The concerns about the public health safety of vaccination exist because of the potential harm that vaccines can cause. Let us briefly discuss vaccines to understand why this potential harm exists. Vaccination is the administration of vaccines (which contain a microorganisms in a weakened or killed state, or proteins or toxins from the organism) in order to stimulate the immune system to defend against an infectious agent. Generally, the closer the organism or virus resembles the original organism, the more the immune response that would be generated but the more likely it would reverse to the original organism, that is, the more the potency the less safe it is. This risk of reversion is why vaccines are contraindicated in high risk groups such as:

  • Children
  • Elderly
  • Pregnant women
  • Immune-compromised individuals e.g. AIDS patients
  • Individuals under immunosuppressive therapy

Despite these risks, vaccination is recommended for some group of people because they are more likely to be exposed to an infectious agent. These groups include:

  • Health workers and Vetenarians
  • Travellers moving to areas of high endemicity
  • Explorers and researchers moving to wild regions
  • Children going to public schools

Amidst the debate, the answer to the question “should we continue mass vaccination?” remains a RESOUNDING YES! Why? Let us look at these facts

  • Immunization currently prevents 2-3 million deaths every year
  • Over 1.5 million children die annually from diseases that can be prevented by vaccination
  • Since 2000, 2.5 billion children have been vaccinated and the number of polio cases has fallen by more than 99%, dropping to just 22 cases in 2017
  • Measles vaccinations averted an estimated 21.1 million deaths between 2000 and 2017

And regarding vaccine safety? Vaccination is safe. Even with the ethical argument about one person in a million being at risk of serious adverse reaction or toxicity, this is not surprising as no procedure is 100% safe. Consider this…

  • The risk for colonoscopy complications, a routine screening procedure is about 0.35%
  • In Canada, the risk of severe pregnancy complications is about 1.5% and 1.6%(700 to 900 deaths) each year in the US
  • For venepuncture, serious complications are seen in 3.4% of these procedures

Food Safety

22.12.2019

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Food Safety is a public health issue that involves the handling, preparation and storage of foods in ways that prevent or reduce the risk of contamination from external sources. Consumption of contaminated foods results in individuals becoming sick from the food, referred to as food borne illnesses. Food safety is a global and public health concern that encompasses a variety of different areas of everyday life. Food contamination is a part of food safety; there is a lot more to food safety than handling, preparing and storing foods properly decrease the chances of contamination. The choice of what and how to eat is perhaps the most important aspect of food safety. We all have to choose between healthy diets (diets high in fibre, low in saturated and trans-fat) and unhealthy diets (diets high in saturated and trans-fat but low in fibre). Unhealthy diet is associated with chronic diseases like cancers particularly colorectal cancer, diabetes and heart disease. Beyond these health benefits/risks, it is also important to stay away from unsafe sea foods such as the puffer fish delicacy. These types of foods are very common in Asia and cause quite a number of deaths; first timers and people not used to these foods should make sure they are properly cooked. Not every food must be eaten!! I mean, you don’t just pick any mushroom in Scandinavia and eat because you want to eat mushroom. You must check if it has white gills like most poisonous ones or you run the risk of eating the death cap.

On a daily basis, avoiding spoilt foods, unlabelled or improperly labelled foods and disfigured canned foods are good food choices. Due to the nature of the 21st century society, people are switching more to produced and processed food which are often stored in containers like cans, sachets etc. This has led to addition of substances to food which act as preservatives, flavours, sweeteners, stabilizers. These food additives, even though they are added for beneficial reasons, some of them like nitrates used in meat preservation are dangerous to health in this case with a known risk of colon cancer. This is why they are tested and guaranteed by the Joint FAO/WHO Expert Committee on Food Additives (JECFA); then clearly written on the food label. This helps people to make better choices if they want to limit the intake of any substance for any reason.

The case is quite different for food adulteration which involves addition of inferior and harmful substances that mimic the desired substance but with reduced quality. It is important to note that food adulteration is a criminal offence as individuals have the right to expect a certain quality of food they purchase; and food adulteration tramples on this right with impunity. It is mostly due to profit drive but can also be due to increased demand and lack of strong regulatory food laws. Some adulterants and food involved with ways to detect the adulterant are

  • Mustard oil(adulterant is argemone oil): Shake and heat mustard oil with drops of nitric acid for 2 minutes, argemone oil is present if it turns red
  • Salt/sugar (chalk powder): Stir in a spoonful of the salt in a glass of water. If the solution turns white and a residue settles at the bottom, it indicates the presence of chalk.
  • Turmeric powder (adulterant-metanil yellow, chalk powder, lead chromate): Add a teaspoon of turmeric to a glass of warm water. Do not stir it and leave it still for a while. Check after about 20 minutes. If the powder settles down at the bottom of the glass with clear water above, the turmeric is pure.
  • Chilli powder(brick powder): Adulterant settles on addition of water

These imitations pose serious health risk to consumers and must be taken seriously. As many persons are ignorant of them and the fact that people will not usually carry out these tests, it left for the government to enact strong regulatory laws and policies along with strong surveillance systems to stop this menace. Finally, the fuss about genetically modified foods (or bioengineered foods if you like)  deserves mention. Whether GMOs have future harmful effects is unproven but the general consensus is that they are at least safe for now.

If you have ever developed abdominal pain and discomfort with frequent stooling, chances are that you are just part of the 1 in 10 people who have suffered from diarrhoeal diseases, the most common result of food contamination. Diarrhoea is implicated in, and has been reported as a cause of over 200,000 deaths worldwide. About 600 million people fall ill due to food contamination leading to economic losses of over $950 billion. With the involvement of larger group of people- international and intercontinental outbreaks of food poisoning like the fipronil egg contamination case in Eurasia and many other cases, it has become clear that this problem is worldwide public health priority essential to achieve food safety, better nutrition and food security. Although anyone can get affected, vulnerable populations such as the elderly, sick and children especially those under 5 years of age, are more likely to be affected and even die from food borne diseases which result from contaminated food. Also, people living in developing parts of the world like Africa and Asia (especially South East Asia) are more likely to get food borne diseases due to poor food handling, sanitation, waste management and weak food regulatory laws.

Even though these features are risk factors for contamination, they are not direct causes. The major causes of food contamination include:

  • Biological contaminants: These are microorganisms including bacteria, parasites, viruses, fungi and even the novel infectious agents, prions. Notable agents are salmonella (the cause of typhoid fever), E. coli (the cause of diarrhoea), vibrio (the cause of cholera), rota and noro viruses, the prion protein that caused the disastrous disease, kuru.
  • Chemical contaminants: Chemical substances like pesticides, herbicides, food additives and adulterants added throughout the process of food production and processing can result in contamination. Also, contaminants may find their way into food due to other reasons like poor waste management, water and land pollution.
  • Physical contaminants: These are foreign objects like metal, glass, hair, plastic etc that could be found in food due to poor food production, handling and cooking practices.

It is important to stress the importance of food safety which is the absence of hazards in food. Food safety actually involves everyone from producer to consumer, from farm to fork. That is why the WHO in the quest for better food safety education have provided 5 ways of proper food hygiene which include keeping food clean, separating raw and cooked food, cooking thoroughly, keeping food at safe temperatures and using safe water and raw materials. Food safety education should also involve teaching the public to make better food choices and other good food handling practices like proper spacing when storing foods in the refrigerator and following producer directions on containers that should not be put in a microwave. Those involved in food production and processing must be regulated by strong regulatory laws from the government who should be influenced by WHO/FAO codex alimentarius.

Food Insecurity

8.12.2019

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Hunger is an unpleasant feeling reflected by abdominal pain, discomfort, irritability or headaches. These feelings tell our brain that we’re hungry so we can find something to eat. In the case of food insecurity, there is the unavailability or lack of access to food in the face of hunger. Food insecurity is fear of hunger because there is nothing to, something that is more common than we think. Food insecurity is a global problem and needs to be addressed as public health emergency. Although the statistics in the developing nations of Africa, Asia and South America is alarming, the problem of food insecurity is far from being restricted to these regions; there is a lot of food insecurity in North America including US, Canada and other developed nations. About 1 in 7 people have food insecurity in the US; some regions like Milwaukee are even worse with 1 in 4 people living with food insecurity (Nunavut and other parts of northern Canada have more than 40% of people living in food insecurity). There is a direct correlation between food insecurity and protein energy malnutrition with resulting effects like psychosocial problems (depression and anxiety), stunting growth and other developmental problems predominantly seen in children. In addition, food insecurity is a risk factor that sits at the heart of many public health problems such as marginalization, food safety, political Instability and mass migrations, etc.

It is necessary to know the components of food insecurity to understand how it is caused. The four components of food insecurity are:

  • Availability: Sufficient quantities of appropriate food are unavailable from domestic production, commercial imports or food assistance.
  • Access: Adequate income or other resources are unavailable to access appropriate food through home production, buying, exchange, gifts, borrowing or food aid.
  • Utilization: Food eaten is unsafe from contaminants and nutritionally inadequate to meet the needs of the individual
  • Stability: Adequate food is lacking at all times so that access and availability of food is curtailed by acute or recurring emergencies

The most common cause of serious food insecurity is political instability due to conflicts and wars. It is almost impossible to see any war where hunger is not used as a war strategy; Yemen, South Sudan, Syria…These disrupt food availability to as much as 30-50% of the population. Aside conflict, government policies like reduced budget allocation to agriculture, reduced incentives and loans to farmers could increase the likelihood of food insecurity. Also, Poverty which is related to unemployment and low income leads to food insecurity by reducing access to available food. It is more common in developing countries, rural areas and marginalized groups. More so, extreme climate events like global warming and natural disasters such as droughts and floods are also important causes of increasing food crisis and insecurity. One of the oldest examples come from the biblical Egyptian famine story where Joseph saved the Egyptians by storing food in the good times.

With that said, we would expect to address food insecurity by working on the above causes but it’s not that simple. First, natural disasters and conflicts are out of control most times, plus poverty which remains a persistent problem. One of the most important things is to address the stigma around food stamps which leads to low self-esteem, anxiety, depression and shame. Food supports should be available and accessible to people in need; not by increasing production as, sadly, one-third of the world food is wasted. This is why there should be food policies that would facilitate proper food distribution. There are lots of stereotypes about people living in food insecurity; that hunger should have a certain appearance (ragged clothes) but there are well dressed people who do not know where their next meal would come from. Public health programs, education and awareness are needed to correct these unfounded beliefs.

Wildfires are large, uncontrolled and destructive fires that spread quickly over woodland, brush or an area of combustible vegetation, mostly in rural regions. Depending on the kind of vegetation involved, wildfires may also be referred to as forest fires, grassland fires, bush fires, brush fires, urban fires or wildland fires. Wildfires could happen in most parts of the world except places like the Antarctica. Fire is always seen as a good servant and a terrible master; in the case of wildfires, it evolves from being not just a terrible servant but an enraged god causing loads of destruction to life, properties, environment and natural resources.

Wildfires can occur naturally and spontaneously due to factors like lightning and heat- extremely dry heat waves can produce enough heat to spark a wildfire. Dry weather and drought convert green vegetation into dry, flammable fuel; strong winds spread fire quickly over the land and warm temperatures encourage combustion. Additionally, humans also contribute to this disaster either accidentally or deliberately through campfires, careless cigarettes disposal, burning etc. According to the national interagency fire center, human beings cause about sixty one thousand eight hundred and fifty two (61,852) fires yearly.

Wildfires can burn hundreds to millions of acres of land at rapid speeds consuming everything on its path from trees to animals and humans. The largest single fire ever recorded was that of the 2003 Siberian Taiga fires- 27 million Acres of land engulfed in flames and about 47 people died, emissions from the fire equaled the emission cuts promised by the European Union under the Kyoto protocol. The scars caused by this fire are still seen in present day environmental studies on ozone depletion.

Some countries like Canada and Australia have accepted wildfires as an integral component in shaping their forests. Their ecological system has developed symbiosis with the fire which in turn affects the air quality and landscape. Wildfires and industrial activities result in the release of greenhouse gases which increase the level of heat through the depletion of the ozone layer- the heat in turn increases the rate to which the wildfires can occur. This causal sequence explains the increased frequency of fires around the amazon basin as well as the recent California fire outbreaks.

The war on climate change is far from ending if the problems of wildfires are not properly addressed. Wildfires pose immediate and serious public health threats to individuals living around the region and also to everyone on planet earth- there are already increased reports of respiratory diseases among Brazilian children.Wildfire prevention starts from different agencies that cover restrictions but ultimately depends on the behavior of the general public. In order to stop and reduce the rate or frequency of wildfires, regulating bodies need to be vigilant and enact the necessary laws and policies important in tackling this issue. Data of previous fire incidents should be continuously reviewed and compared with the weather forecast to recognize dangerous patterns so as to know how to manage them effectively. People living in fire susceptible areas should be well educated and constantly informed through various means of communication about any slight change in their environment. Programs like firewise, community wildfire protection plan and fire adapted communities are plans that work to protect people, properties and natural resources by emphasizing forest fire readiness and creating fire resistant community designs. These and more regulations will help in preventing and containing wildfires as well as minimizing spreads and damage to the environment.

Health care workers are often at increased risks of infections due to their immediate work environment. The potential risk to their health is an important public health issue that is particularly neglected in many developing countries. The 2006 World Health Report-Working Together for Health reported a severe health workforce crisis In fifty-seven (57) countries- most of them in Africa and Asia. In Nigeria for example, during the 2014 Ebola outbreak, Dr Stella Adadevoh and some other health care workers lost her lives while trying to prevent Ebola spread from Port Harcourt to Lagos and other parts of the country- sadly without receiving a national honour or credit for their efforts and bravery. It is a costly price for health workers to lose their lives in the course of their service but unfortunately, the list of healthcare workers that have lost their lives in a similar fashion is unending. There are various kinds of hazards to which health workers are exposed-they include, Biological hazards which is a group of hazards including infectious agents like Ebola mentioned above, HBV, HIV etc. Other forms of hazards can be physical hazards, chemical hazards and psychosocial hazards.

Biological hazards such as infectious agents pose serious risk to the lives of every health care personnel. These workers may be exposed through inhalation, contact with bodily fluids and more importantly, needle stick injuries. In fact, the WHO global burden of disease from sharps injuries to health-care workers showed that 37% of the hepatitis B among health workers was the result of occupational exposure. Sometimes, these are due to either mistakes from the health worker or poor disposal of wastes.

Health workers are also affected by physical hazards including fire and radiation as well as work related violence just like industrial workers. Fire hazards have been reduced due to widespread public health measures but there are still risks of harmful radiation exposure as radiation is a part of diagnostic medicine. Work related violence is a common problem in developing countries- studies have shown that over 90% health workers especially nurses, have been abused physically or verbally.

Chemical hazards from toxic substances used in routine medical practice mostly result in injury unlike biological hazards that can lead to death. Also, allergy from latex gloves is an important form of chemical hazard. Similar to biological hazards, they can also be due to mistakes from the health worker and poor disposal of wastes. Finally, there are psychosocial hazards that affect the mental health of health workers. These are mostly due to very long work time leading to physical and emotional exhaustion, low pay in developing countries and stress induced illnesses such as hypertension. These emotional hazards inflict invisible wounds that reduce the efficiency and efficacy of health workers. This is then reflected in the poor quality of care and health systems experienced by the public at large.

The WHO and other international health organisations continue to advocate for better occupational health through practices like use of post exposure prophylaxis, vaccination of health workers, increase in wages and trainings to prevent occupational hazards and its consequences in the health care system.

According to World Health Organization (WHO), healthcare associated infections (HCAIs)constitute a significant public health burden with about 15% of hospitalized patients affected- leading to an increase in morbidity, mortality and healthcare costs. Also known as nosocomial infections, healthcare associated infections are regarded as infections that occur within 48 hours of hospital admission, 3 days of discharge or 30 days of an operation. HCAIs pose serious problems because the organisms implicated are usually drug resistant, the most common ones being methicillin resistant staphylococcus aureus (MRSA) and multi-drug resistant gram negative bacteria.

Given to the presence of several risk factors, intensive care unit (ICU) patients are by far the most affected group by nosocomial infections. The risk factors associated with HCAIs include:

  1. Health status: Since most patients are exposed to similar conditions, the current health status and immunity of a patient determines the risk of infection of particular patients. Some vulnerable and immune-compromised patients may be malnourished or elderly.
  2. Invasive procedures: Some hospital procedures, especially surgery, involves the use of materials like catheters, lines and drains which when left for a long time can serve as a nidus for infection
  3. Treatment: Some treatment modalities can pose risk to infection e.g. blood transfusion, hemo-dialysis and immunosuppressive treatments
  4. Poor and unhygienic hospital practices: Poor sanitation and improper disposal of hazardous healthcare wastes can expose patients to infectious pathogens. Also, healthcare workers could play a role as vectors of infectious agents when they fail to take standard precautions.

Perhaps, the most important historical guide on addressing HCAIs was by the Hungarian physician- Ignaz Semmelweiz, who demonstrated that hand washing drastically reduced the incidence of puerperal fever in childbearing women. Even though his teachings were not accepted by physicians at that time, it laid the foundation for antisepsis. Till today, regular and proper hand washing remains the single most important measure in infection control. Proper hand washing should involve the use of alcohol disinfectants or medicated soap after removal of jewellery like watches, rings and should not be replaced with gloving. Hospitals should provide more wash sinks and easier to use disinfectants like sprays to encourage regular hand washing. To improve hygiene in general, healthcare facilities should provide enough personal protective materials such as overalls, gloves and nose masks which must not be reused. Also, healthcare workers must endeavour to engage in regular daily cleaning of stethoscopes with alcohol and observing complete aseptic procedure in invasive procedures to reduce the risk of infection.

In addition, it is pertinent that the healthcare system ensures enlightenment of caregivers and students alike on the importance of standard precautions of everyday practice in reduction of nosocomial infections. Also, there must be proper disposal of hazardous healthcare wastes which can harbour dangerous infectious organisms that are drug resistant. The related problem of antimicrobial resistance can then be reduced by good antimicrobial stewardship.

Global Health Security is defined as actions required to reduce the health hazards and impacts of acute public health events that endanger the health of populations living across geographical regions. GHSA pursues a multi-sectoral approach to strengthen global and national capacity to prevent, detect, and respond to human and animal infectious disease threats, whether occurring naturally, accidentally or deliberately spread. Global health security emphasizes the current framework for global preparedness and response to emerging infectious diseases. The Global Health Security Agenda (GHSA) which is a partnership between governments was launched in 2014 with the aim to make the world safe from infectious disease threats. The governments involved in the Global Health Security Agenda focused on strengthening their countries’ capacities for the detection, response and prevention of health problems and threats. More than 70% of the world remains underprepared to prevent, detect, and respond to a public health emergency.

Through the GHSA, the Center for Disease Control and Prevention (CDC) works with countries to strengthen public health systems and contain outbreaks at their source, before they evolve into regional epidemics or global pandemics. Public health threats, health emergencies, and infectious diseases do not recognize or respect boundaries; therefore, effective and functional public health systems in all countries reduce the risk of health threats. Protecting the world from infectious disease threats requires that national governments share the responsibility of serving those most in need, regardless of where they live. All countries have a responsibility to keep their people safe because collective international public health action can build a safer future for humanity. In the context of public health emergencies, GHSA has received both financial and political support from several international organizations and about 50 countries. Unfortunately, global health security is mostly focused on protecting high-income countries from pandemics originating from low- and middle-income countries such as Ebola virus, Marburg, Zika virus, dengue, chikungunya, Rift Valley and Lassa fevers.

Values such as respect for human rights and solidarity, as well as focus on the prevention of future outbreaks rather than emphasis on disease containment to protect national security, must be incorporated by GHSA. Such values are consistent with the motives of many people who provide health services in public health emergencies. Health security agendas should aim to build resilience to future outbreaks of infectious diseases, and require a long-term systems approach based on surveillance and national health system strengthening. To ensure that GHSA is a fundamental part of the national policy of every country, political attention, financial support and coordination between national ministries is necessary. Additionally, all countries need to have the laboratory, trained workforce, surveillance, and emergency response team to prevent, detect, and respond to disease threats. Only when these accomplishments are realized can we truly be on the road to global health security for infectious diseases.

Heavy metals are dense metals that are found naturally in the earth. The major heavy metals of public health concern are lead, mercury, cadmium and arsenic which are all included in World Health Organization’s list of 10 chemicals of public health concern. These metals are quite toxic to the human body as there are no known safe levels in humans or other species. This propensity to harm not just humans, but to accumulate in plants, fishes and soil poses great risks to potentially compromise the ecosystem. Despite being harmful, these chemicals have been found to be useful in several ways which include:

  • Lead-As an additive in petrol which has been phased out by most countries, use in certain folk medicines, lead based paints and lead solder for canning
  • Mercury-use in electrical equipment, thermometers, pharmaceuticals, thimerosal which has been removed from most vaccines, dental amalgam and use in artisan gold mining which has drawn recent attention of the UN
  • Arsenic-widespread use as components of pharmaceuticals and semiconductors
  • Cadmium-used in batteries and fertilizers

Cigarette smoking is an important source of exposure to some chemicals thus leading to ease of exposure. In addition, poor disposal of these substances either by dumping on land or rivers- especially ones used by communities can result in devastating effects to a population. Take the Minamata disease catastrophe that happened in japan in the 1950s as an example: more than 600 people died (not including the thousands with disabilities) from dumping of mercury wastes in Minamata bay by a chemical factory. It is sad that despite the disasters that have been caused by heavy metal exposures, it is still a largely neglected public health problem. It is worthy to mention that there are dangerous and life threatening levels of these metals in Tasmanian lakes of Australia, Kurang river in Pakistan, Shur river in Iran, Ganges delta in India and Bangladesh and many others.

Some of the oldest diseases of human can be traced to heavy metal poisoning associated with mining, refining and use. They cause disease primarily by inhibiting important enzymes in the body. It can either be acute due to eating or inhalation of high levels of these metals usually leading to death or a chronic accumulation from continuous exposure resulting in disabilities. This leads to neurological problems as in the Minamata disease discussed and other clinical manifestations. Importantly, they are associated with increased carcinogenic and teratogenic risk.

The clinical treatment of giving chelators is obviously not sufficient to address this problem (as clinical solutions are not public health solutions).Even though clinicians have an important role as part of the surveillance system, what is needed is remove the source of exposure just like the great Doctor, John snow. Many organisations like the EPA, WHO, UN and others have to work with governments and health agencies to ensure minimal exposure to these chemical by regulating their use and enforcing proper disposal. There should be continuous research in the use of associated products by the general public to monitor and report any adverse effects.

Whether conscious of it or not, everyone is faced with the important health choice of good or bad diet daily unless you decide not to eat for one reason or the other. Diet is a significant modifiable risk factor in the development of NCDs such as diabetes, cancer, heart disease and high blood pressure which are the leading causes of death in developed nations. According to a study published in the prestigious lancet journal in 2017,11 million deaths (95% uncertainty interval [UI] 10–12) and 255 million (234–274) DALYs were attributable to dietary risk factors:

  • High intake of sodium (3 million [1–5] deaths and 70 million [34–118] DALYs)
  • Low intake of whole grains (3 million [2–4] deaths and 82 million [59–109] DALYs)
  • Low intake of fruits (2 million [1–4] deaths and 65 million [41–92] DALYs)

These figures represented the negative effects of the leading dietary risk factors for deaths and DALYs globally and in many countries. As scary and authoritative as this is, it doesn’t make much public influence due to the widespread use of media by the nutraceutical industry to throw out health claims here and there. This along with constant churning out of facts by pseudoscientists and others with personal interests have somewhat made the public numb to health facts. It is difficult to make a positive health choice when one is overloaded with false information.

In addition to the prevention of NCDs, a healthy diet also protects against protein energy malnutrition. Generally, a healthy diet involves the intake of fruits, vegetables, legumes, whole grains, less salt, sugar, and unsaturated fat (found in fish, olive oils). The healthy diet is exemplified in the Mediterranean diet, indigenous to the people of the Mediterranean region (modern day France and Italy) which attracted worldwide attention in the 1960s when high adult life expectancy and low rates of chronic diseases (coronary heart disease, certain cancers and diabetes) were reported across the region. It is the most studied of all diets and have been clearly shown to control diabetes and hypertension. It is not a ‘diet’ in the strict sense as the Mediterranean countries eat very differently but an eating pattern which involves high fruits, vegetables, legumes, monounsaturated rather than saturated fat or trans-fat, moderate ethanol, milk, dairy products and low meat and meat products.

The case with an unhealthy, poor or bad diet is the complete opposite of a healthy diet with increased risk of nutritional deficiencies, NCDs, obesity and cardiac arrest. The prototype bad diet is the western diet which is high in total energy, saturated fats, salt, sugar and low fibre. The most convincing evidence of the association of western diet to NCDs comes from the observation of higher incidence of colorectal cancer in Asian immigrants in the US who adopt western diets. Also, there is increasing frequency of this cancer in Africans- who are also adopting the western style of diet. Worse still, the Africans who less able to handle salt are more predisposed to hypertension and it’s complications.

The list of other types of diet is endless; popular ones include the DASH diet, MIND diet, Nordic diet, Atkins diet, Asian diet, Weight watchers diet, Vegetarian or Vegan diet etc. The diet you adopt must be supplemented where applicable if it is deficient in an important nutrient for example if you adopt the vegan diet, you should receive iron and vitamin B12 supplements as they are lacking in these diet. The point is, irrespective of the diet choice, a good, healthy balanced diet should be the goal.

The choice of diet is not necessarily based on health benefits, other factors like cost, availability, culture, beliefs, geographical and environmental factors affect what individuals choose and eat. The government can promote healthy diet by increasing incentives for healthy products and taxation of unhealthy food products.