From scarcity to abundance: Changing life-styles and NCD epidemic in Sri Lanka

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Health scientists, policy makers and many others have focused attention on the rising epidemic of non-communicable diseases like heart disease, diabetes, chronic kidney disease and cancers. 
While many communicable diseases have been drastically reduced due to improving living conditions and spread of education, worsening environmental conditions have become a major source of illness as the persisting threat of dengue epidemic shows. On the other hand, rising non-communicable diseases mentioned above have been the direct result of life style changes that followed the social and economic transformation brought about by economic liberalisation since the late 1970’s.
As is well known, food habits of Sri Lankans have changed drastically since the late 1970’s. Severe restrictions on food imports in the early 1970’s persuaded most people to eat locally produced food. This situation changed significantly in the years that followed. Increased availability of food due to both the expansion of local production and increasing imports and increasing monetary incomes of a large segment of the population led to a rapid increase in food consumption among non- poor sections of the population. 




Much of this increase has happened within a generation. Many people who experienced food shortages during their early years of life could now consume a variety of food items, some of which are full of fat, sugar and starch. The general tendency under such conditions is to engage in unhealthy consumption. For instance, youth from poor rural families moving into urban centres for employment adopt consumption patterns that usually involved alcohol abuse and intake of unhealthy fast food items. 
Migrant workers who are on the move over many years of their lives have enough money to eat all kinds of food at their destinations and this can naturally affect their health. Rural and urban migration for work, education and other needs expose many people of all walks of life to new consumption patterns, in particular fast food. Spread of private transport in all parts of the country such as motorcycles and three-wheelers has encouraged most people to avoid walking even in rural areas and this has no doubt contributed to the spread of NCDs. 




On the other hand, walking along our roads has become such a risky way of getting around in urban areas as roads are often constructed without adequate pavements. I even wrote several newspaper articles about a decade ago about this insane and inhuman practice of authorities responsible for road building, but the dominant car culture has blinded themselves to this major social issue.
 They drive their cars on the roads and use newly built walking tracts for walking. But the hapless masses have no choice but walk all over the place exposing them to grave risks.
Our colossal failure to curtail private transport by introducing more efficient mass transit systems is perhaps the main reason for environmental pollution in urban areas today. 
While environmental pollution is a major factor in ill health, thousands of people who are killed or injured also add to the rising case load of NCDs. 
It is myopic State policies that are behind such tragedies. Political leaders have not only used hard earned public money to import obscenely expensive luxury cars for their own use but also turned a blind eye to public tragedies mentioned above.


 

"Our colossal failure to curtail private transport by introducing more efficient mass transit systems is perhaps the main reason for environmental pollution in urban areas today. While environmental pollution is a major factor in ill health, thousands of people who are killed or injured also add to the rising case load of NCD’s. It is myopic state policies that are behind such tragedies. Political leaders have not only used hard earned public money to import obscenely expensive luxury cars for their own use but also turned a blind eye to public tragedies mentioned above"

Schoolchildren are at particular risk of developing NCDs in their later lives due to both exposure to air pollution and unhealthy food habits. Many of them travel long distances and have to leave home early often without any breakfast. They are given money to buy junk food and sugary drinks. School tuck-shops and nearby boutiques sell food items that are full of sugar, fat and refined wheat flour. Sugary pop-drinks do the rest. 
About ten years ago, we from the University of Colombo experimented with the idea of establishing a fruit stall in each school. 
The experiment carried out in two schools in Hambantota was successful. We trained two unemployed youth, provided them with the modern equipment necessary to process local fruit. The newly established elegant fruit stall supplied children with a range of fruit products such as juices, milk shakes with fruits and fruit salads. But the authorities at the time did not extend their support to the project and it died a natural death.
 If this idea was pursued by educational authorities, we would have by now established fruit stalls in most schools in the country. 
Apart from obvious nutritional and health benefits, the massive demand for fruits that the project would have generated could have created many income opportunities for farmers and others involved.




The only way to effectively contain the NCD epidemic is to adopt appropriate policies in the relevant sectors such as employment, transport, education, agriculture, physical planning and health. In all these areas, public education is critically important. 
But, unfortunately all the effective means of public education are dominated by vested interests such as business firms, politicians, etc. and the masses are only occasionally exposed to saner voices and objective analyses. 
Until this situation changes, we will continue to make colossal mistakes and spend many years and billions of rupees to correct them, all at the expense of the well-being of ordinary masses.