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Opportunities to prevent diseases: stress reduction OPPORTUNITIES TO PREVENT DISEASES: STRESS REDUCTION
Most people know that if they stopped smoking, drank very moderately, ate the right food, exercised regularly and got enough sleep they would live longer and be healthier. Yet most of us continue to do all or most of the things we know we shouldn't. True, mortality rates for heart disease and strokes have been falling in the US (heart attack deaths have fallen by 30 per cent over the last 10 years), but the number of people having heart attacks has not fallen as dramatically. Clearly at least some of these improved statistics are the result of better medical care, once a heart condition is apparent.
In the face of unhealthy pressures all around us it would be surprising if self-help methods unfailingly succeeded in improving the health of the individual. But how reasonable is it to place the burden on the individual when cigarette and alcohol advertising continue to bombard him or her from all sides? Can children be brought up to take control of or responsibility for their health when they learn so soon that what they try to do has so little impact? And supposing our man described above did cut out all his vices, what would he do instead - and might it not be even more hazardous?
So if individuals often cannot help themselves, how about the State lending a hand? This only works if the public is ready for the legal restrictions. Prohibition in the US did not work because people weren't ready for it, yet penalties for driving when under the influence of drink and for not wearing seat-belts are apparently acceptable in the UK and elsewhere. Increased taxation on illness-producing habits works at least to some extent but research shows that real devotees simply give up other things (a healthy diet perhaps) to fund their addictions. Anyway, how far does a government have the right to impose its will on the masses? In other words there is a considerable ethical dilemma involved in preventive medicine. Should 1 be allowed to behave in any way I want, even if it affects others adversely? We all want to see laws such as those that prevent drunken driving, but a balance must be struck between measures like this, which benefit us all, and the reasonable liberty of the individual And then there is the question of individual freedom to act in ways that don't directly affect others. It could be argued that the man who smokes heavily in private is doing society a favour in several ways. First, he is relieving the society of the cost of the drugs that might otherwise be consumed if he were not smoking and being tranquillized by his cigarettes. Second, his habit will kill him younger, and relatively quickly, by lung cancer (the average lung cancer victim lives only eight months from the discovery of the tumour) or heart attacks-the other major smoking disease. Both kill very quickly, so reducing his capacity to be a burden on society and its medical facilities. Lastly, he will probably not live long enough to collect his old age pension-another saving to society.
Looked at coldly, then, a case could be made for allowing people to do what they want if it kills them quickly and prematurely, if only because we have so many old people and too large a burden of chronically ill already.
My approach to prevention, then, is not a dictatorial one, mainly because after fifteen years of preventive medical experience I know that forcing it on people does not work. In the last analysis everyone must be free to choose his or her way of death-and most of us will do so whatever governments or health educators do. Some kill themselves with overwork, some on the road, some through their hobbies, while others smoke themselves to death, and so on. What I as a health educator can do is to make them aware of the dangers of these harmful pursuits so that they have a choice. I never tell a patient to stop smoking. That's his or her choice. I don't expect patients to tell me to stop driving my car-and that could kill me. What I do is to lay before them the facts as they are currently understood about the harmful effects of smoking. The choice is then theirs.
The difficulties come when another person's behaviour affects my life and health adversely, and most of us agree that the State should step in here. But here again the problems are formidable. Should the State, for example, pass laws to prevent any form of extramarital sexual activity on the basis that it harms innocent third parties? Such a suggestion seems preposterous yet we happily go along with similar laws that stop people polluting the air of innocent third parties with cigarette smoke on far flimsier evidence.
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