MEDICAL MATTERS: There has been a profound cultural change in attitudes to smoking, after a public health campaign lasting 40 years or more. Without such a cultural change, success could not have been achieved.
While smoking may be on the wane, we now have a new and serious increase of obesity in the population. It is described by the WHO as the metabolic syndrome. This pervasive syndrome describes a pattern of biological markers which is associated with obesity and an increased risk of heart disease, stroke, sudden death, high blood pressure, diabetes, and high blood sugar and blood fats.
A public health strategy aimed at reversing the current trend is likely to be much more difficult than the campaign against cigarettes. To succeed we must understand the fundamental reasons at the basis of the metabolic syndrome. These are changing eating and physical exercise habits.
Vigorous exercise was part of the daily life of most workers in Ireland 50 years ago. Transport was by foot or on the bike. Physical work was an inherent part of the job. Many domestic chores involved physical effort. Workers were lean, strong and flexible.
All has changed over the past 50 years. Most adults have cars; the bicycle is little used; and walking as part of daily life is discouraged by poor urban, suburban and rural planning and by safety and security considerations. Children are particularly disadvantaged by poor walking and cycling facilities in our new suburbs, despite the recommendation in the 1995 report of the Lord Mayor's Commission on Cycling that all new suburbs should be provided with safe cycling tracks. Our suburban sprawl and long commuting distances are serious disincentives to an active life.
There has been no corresponding increase in leisure exercise. Television popularity, commercial pressures and public policies tend to encourage a sedentary life and the viewing of sport rather than participation. The use of many exercise facilities are discouraged by an increasingly litigious society.
Little can be done to increase work exercise. A cultural change, valuing activity, fitness and leanness, is mandatory to achieve widespread adoption of aerobic exercise in all age groups. In Ireland we have always had an eclectic interest and involvement in sport but currently active aerobic leisure exercise tends to be enjoyed more by the young, the better educated and men rather than women.
Encouraging an aerobically active population will need enlightened town planning, pedestrian and cycling facilities on country roads and a network of paths, lanes and tracks in rural areas, including mountains, forests, open country and farmlands.
My last walking holiday was in France in 2003. Walking 15-18km a day, we never encountered traffic because of the rich network of tracks and pathways in Burgundy, mostly through farmland and vineyards where it was traditional never to leave the recognised rights of way and where, therefore, there was no conflict with farmers.
We need easy access to gyms and health centres through prescription or tax inducements and extended pedestrian areas in cities and towns; less emphasis on Bertie Bowls and more on sports teachers and sports facilities in schools and colleges. And we need legal reform to counteract opportunistic litigation.
It is unlikely that the metabolic syndrome can be counteracted, even by enlightened public policies, unless there is a profound cultural change where we all take a positive pride in health, fitness and leanness, and where adults, both teachers and parents, encourage children to adopt healthy lifestyles by mutual family participation.
Such a cultural change will bring happiness as well as health but it can only be achieved by a comprehensive programme of public education, appropriate legislation and media support.
Dealing with changing eating habits is just as challenging. We are eating more calories than we require, a situation aggravated by our sedentary habits. Excessive eating is inevitable in a prosperous and sedentary society, constantly exposed to advertising and commercial pressures, with the easy availability of food at retail outlets, at work and in the home.
Can we restore the disciplined family eating habits of the past? Can we conceive a physically active population with disciplined eating and drinking habits? Dieting cannot succeed without a holistic approach to the metabolic syndrome.
Can we learn to treasure the lean, the fit and the active? Is it possible to adopt appropriate lifestyle changes encompassing vigorous leisure exercise and a degree of calorie intake commensurate with the maintenance of normal weight in a prosperous, secular and acquisitive society which is increasingly devoted to self-gratification?
The Obesity Task Force has a challenging task on its hands.
• Risteárd Mulcahy, professor of preventive cardiology (emeritus) at St Vincent's University Hospital, Dublin, has been an advocate of smoking control, healthy eating and exercise during his professional life. He recently published Improving with Age (Liberties Press, Dublin).