Thursday, 15 September 2011

3rd world folk, health, fitness—reality and myth

It is widely regarded as a truism that people in the 3rd world lead a healthy life—that they rarely if ever suffer 'western' lifestyle diseases. This perception is based upon the belief that 3rd worlders eat simple, natural foods, and lead an inherently healthy lifestyle. This belief is a myth—the reality is the opposite—people in the third world, or at least the population of south east Asia (SEA), have a poor and unhealthy diet and lifestyle, and, as a consequence, suffer form a wide variety of diseases.

This poor lifestyle manifests in many different forms, but the most obvious: the large majority of people in these countries smoke excessively, drink too much alcohol, eat too much fatty food, conversely, they do not eat enough of the more healthier foods, and avoid exercise as they would the plague. All of which results in, or or at least exacerbates, a wide variety of illnesses. For example, the number of Thai women who suffer from osteoporosis is astounding. Few women over fifty in Thailand seem to be free of the disease.

This abusive life style is readily apparent, in many guises. For example, one major cause of ill-health is sugar. It is an addiction found throughout the region, and is the cheapest and perhaps the most deadly of drugs. In a hotel buffet breakfast Thais will line up at the sugar bowl, spoon three or four spoonfuls of sugar into their morning tea or coffee, and then add one spoonful of salt. The reason: they are addicted to sugar, but even with this addiction they find this quantity of sweetness repellent, so they mask it with salt. A different take on this is found in Cambodia where there are 'sugar drink machines'. Essentially, a few lengths of sugar cane are run through a squeezer, the resulting liquid drops into a glass, which is then drunk. This is too sweet for me to contemplate, but quaffed without reservation by Cambodians. These machines are found everywhere, and are usually busy. In the more prosperous Thailand it is the mis-named 'energy' drinks that are the norm. Did I mention diabetes?

Another example of an abusive lifestyle is eyesight. If you were to ask someone over 30 or 35 to read, they will likely refuse—shack their head, turn away with a smile—not because they are illiterate, but because their eyesight is poor. Their eyesight is poor because of their harsh environment, and a corresponding lack of eye care. Tropical countries have a hot, dusty, and sun rich environment.  People's eyesight suffers badly from this combination. The simple use of sunglasses would go a long way to tackle this problem, but few take the trouble to do so.

Much of this ill health and its effects are not readily visible. This is because people do not like to 'air their dirty linen in public', and Buddhists are doubly compelled to show their best face to guests and outsiders. However, if you talk to people, watch closely, and observe, this sad state of health will be all to readily apparent. Take a look down town alleyways during and after public holidays. These will contain drunks, 'sleeping off' their alcohol binges.

The flip side of this lifestyle is exercise, and here again 3rd world folk fail. Exercise for the vast majority of the population is something to be avoided. The dream of most SEAs is to get a job in a bank, with a comfortable chair, lots of cold aircon, and to sit all days shuffling papers. Physical exertion is for farmers and labourers—not successful people. There are gyms and public exercise gear available, and some, a handful of locals make use, but these people are the exception. There are many myths about exercise, some women believe that it will make them too masculine, some young people believe that only older people need to exercise as younger people are 'naturally fit'. Even the simple act of a short walk, 5 or 10 minutes, is regarded as something to avoid.

One cause in all of this are the long work hours most locals experience. Twelve hour shifts are the norm. People finish work tired and drained, with little energy for exercise. A desire to relax, eat and drink with friends, to find some joy in the day, before sleep, is understandable.

This leads to another factor, a lack of sufficient and good sleep. Most locals do not sleep well. This is due to a number of factors. A hot and humid sleep environment, and small and crowded rooms are the most obvious, however, another factor, though hard to be certain of, is a belief and apprehensiveness of 'ghosts'. People are concerned that ghosts/spirits will appear in their dreams or while they sleep. I realise that this last point sounds insane to most westerners, but it is something which is truly there in the social makeup of many people in SEA.

There is one other area of illness that receives even less discussion, psychological. In SEA there are many people with psychological problems. Again, this is something which is hidden from common view, there is little social acceptance of this form of illness, and it is widely hidden and ignored, with little medical assistance available.

I will add one more factor into this equation: intellectual exercise. There is little. Most education is poor, with an emphasis on memorisation and rote learning. After graduation, few people seem to read books, rather, television viewing is a near universally popular, almost compulsive activity. Even when talking with friends a tv will most likely be on in the background, and these shows never revolve around an intellectual theme. The vast majority of tv is a love story, a ghost story, or an historical epic. Docos are few and far between.

The picture I have painted here is a sad one, but one I believe to be true. Personal health in the third world is poor. Smoking, drinking, a poor diet and lifestyle are the culprits. It is a problem that many local health care individuals and institutions are aware of, but few take action. The populations of countries such as Malaysia and Thailand are ageing. With better public health, such as immunisation, better post-natal care, and a safer work environment, people are living longer—long enough to begin experiencing the deleterious effects of the lifestyle described above. Over the next generation this problem will gradually emerge into the public arena, individuals will show greater personal responsibility and institutions great public responsibility, one hopes.

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