Equity in health is an achievable goal - SLMA President

by Nilma DOLE

With the dawn of peace, Sri Lanka is poised for a quantum leap in development. In this context, achieving equity in health has become a priority. Health is the fundamental right of any human being. As the Buddha preached, 'Health is the greatest gain, contentment the greatest wealth'. Since independence, every consecutive government in Sri Lanka, irrespective of political ideology, have placed emphasis on providing its people access to good quality health care.

Taking over the reins of the Sri Lanka Medical Association (SLMA) from Prof Rezvi Sheriff, Dr. Narada Warnasuriya, former Senior Professor of Paediatrics at the University of Sri Jayewardenepura is championing the importance of Sri Lanka maintaining its momentum as one of the few developing countries with a reasonable chance of achieving health equity on a relatively modest health budget.

"An inequality becomes an inequity when it is preventable and unjust. There are many such disparities in health based on gender, ethnicity, social class and economic status which are easily preventable with relatively modest inputs," commented the doctor who is a former Dean of the Sri Jayewardenepura University's Medical Faculty and who was its Vice Chancellor from 2005 until 2008. Counting over 34 years as a paediatrician and a medical lecturer, Dr. Warnasuriya is the 123rd President of the distinguished association. He was recently honoured as an 'Outstanding Asian Paediatrician' at the Asia Pacific Congress of Paediatrics held in Shanghai, China. At his induction as SLMA President on the 16th of January, Dr. Warnasuriya's presidential address was on "Equity in Health: The role of the medical profession". Sri Lanka's outlier status in social indicators pertaining to health and education has been recognized and acclaimed by outstanding economists like Nobel laureate Amartya Sen in the eighties. In 2005, a UNDP placed Sri Lanka 17 places ahead in its Human Development Index (HDI) compared to its rank based on GDP per capita.

India, in comparison was 9 places below its GDP rank. Sri Lanka is among the few low and middle income countries which are well on track towards achieving the Millennium Development Goals (MDGs) in respect of health and education. According to him, Sri Lanka's success is at least partly due to the technical efficiency in healthcare delivery to which the medical and other health professionals in this country have contributed. Quoting from an Institute of Health Policy (IHP) monograph entitled 'Sri Lanka: good practice in expanding healthcare coverage, he said "Efficiency in health service delivery is more important than resource mobilization in overcoming resource constraints."

Dr. Warnasuriya was of the view that even though we lack so-called hotel amenities, Sri Lanka's public sector offers healthcare of a quality comparable to and at times, superior to that available in the private sector. He identified some recent negative trends in healthcare delivery which could have a negative impact on health equity. A shift towards a more cost intensive model in the private sector, lack of regulation in the private sector, a recent loss of confidence in the public sector due to a some sensationalised media reporting and a poor public image of the medical profession were some of the issues highlighted by him.

In this context, he emphasized that the medical profession as stakeholders in Sri Lanka's relative success in achieving health equity had a role to play in sustaining and further improving it. He advocated a four-fold role for the doctor in this respect. Ethical clinical practice with due regard to the patient's economic status, advocacy for equity and social justice, patient empowerment by education and training of medical and other health staff were the keyroles identified.

He also highlighted the need for public awareness on health equity and the social determinants of health. All social sectors including education, housing, transport and communication had a role to play in achieving health equity.

The Sri Lanka Medical Association (SLMA) is the oldest professional association in this part of the world. It started as the 'Ceylon branch of the British Medical Association' in 1887. Later, it evolved into the 'Ceylon Medical Association' in 1951. After Sri Lanka became a Republic in 1972, it became the 'Sri Lanka Medical Association'. The 123rd Anniversary academic session of the SLMA due to commence on the 1st of June will have as its theme seminar 'Achieving Equity in Health: the Sri Lankan experience'. Sir Michael Marmot, Chairman of the WHO Commission on Social Determinants of Health and President elect of the British Medical Association, will be the keynote speaker. Several distinguished researchers in this field including Dr. Ravi Rannan-Eliya of the IHP, Dr. Godfrey Gunatilleke of the Marga Institute and Professor Zulficar Bhutta of the Aga Khan University have been invited to participate. The SLMA will also have a series of meetings at district level in collaboration with the district medical societies with a view to continue professional development of doctors at which the doctor's role in achieving health equity will be discussed.

Childhood obesity may delay onset of male puberty

by Drucilla DYESS

Obesity in young boys can cause delays in mental and physical growth and development, which is quite the opposite of their female counterparts. These setbacks can lead to low self-esteem issues and make matters worse for severely overweight males, since obese children are often the subject of ridicule among their peers. According to a study recently published in the Archives of Paediatric and Adolescent Medicine, obese boys are 50 percent less likely to enter puberty by age 111/2 than boys who are of normal weight. These findings directly contradict the outcome of previous studies involving young girls that have shown obese girls to be much more likely to enter puberty earlier than girls of normal weight.

The study was led by researchers at the University of Michigan Health System. Paediatric endocrinologist Joyce M. Lee, M.D., M.P.H., and colleagues, followed 401 boys born in 1991 who had diverse socioeconomic backgrounds and came from 10 different regions of the U.S. The height and weight of the boys were measured beginning at age 2 and continuing through age 12. Tanner genitalia staging was used to measure puberty. According to this scale, boys in stage one lacked genital development by the age of 11.5 years and were considered to have a late onset of puberty. Results of the analysis revealed that 14 percent of obese boys had a later onset of puberty, as did 13.3 percent of boys who were considered overweight. This was in comparison to just 7 percent of boys of normal weight who experienced a late onset of puberty.

According to Lee, "With the epidemic of childhood obesity, there's concern this is going to have a negative effect on growth and development." Regarding the study outcome, Lee said, "It confirms that obesity has effects on children's growth and development for both genders." However, Lee pointed out that although the study suggests that puberty works differently among boys and girls, it also reveals how little is known about the possible impact of obesity on boys, or what the impact will be if obesity trends continue. She noted that girls are already ahead of boys in regards to puberty, but could move even further ahead of boys in the same age group.

The exact cause for the development delay remains unknown. Although the hormone lepin was once believed to affect the early onset of puberty in girls, since elevated levels are found in both males and females who have more fat, it is a less likely explanation for changes in time of puberty onset. One possibility for boys is the theory that fat converts male hormones into estrogen, which slows male development.

Long-term effects of obesity on pre-adolescent boys will require further studies, however, researchers agree that one benefit of the study results is that the new knowledge will make parents aware of the negative effects obesity can have on their sons. With early intervention, obesity and its ill effects may be prevented. In addition to eliminating developmental delays, conditions such as hypertension and diabetes may be avoided.What can parents do? A great start would be to have their children follow a healthy diet in conjunction with a proper exercise program.

For helpful information in choosing a healthy diet plan, you can read reviews on popular, proven weight loss programs.

Green tea may reduce lung cancer risk - even for smokers

by Madeline ELLIS

For thousands of years, the people of China, Japan, India, and Thailand have consumed green tea and used it medicinally to treat everything from headaches to flatulence. In fact, the ancient Chinese proverb, "better to be deprived of food for three days, than tea for one," gives us an idea of how much they believed in its curative abilities. Over the past few decades, however, research in both Asia and the West has begun providing scientific evidence of green tea's numerous health benefits.

As a whole, studies indicate that regular consumption of green tea may slow or prevent conditions including high cholesterol, heart disease, rheumatoid arthritis, impaired immune disease and liver disease. In addition, some studies have indicated green tea may have cancer-fighting properties, lowering the rate of gastric, esophageal, and mouth cancers. And in a conference this week sponsored by the American Association for Cancer Research (AACR) and the International Association for the Study of Lung Cancer (IASLC), researchers reported that Taiwanese smokers who consumed one cup of green tea each day significantly reduced their chances of developing lung cancer.

For their study, Dr. I-Hsin Lin, of Chung Shan Medical University in Taiwan, and her colleagues recruited 170 people with lung cancer and 340 healthy patients as controls. The participants completed questionnaires regarding their lifestyle habits, including how much they smoked, how much green tea they drank, their dietary intake of fruits and vegetables, cooking practices and family history of lung cancer. They also underwent genotyping on insulin-like growth factors: IGF1, IGF2, and IGFBP3, all of which have been reported to be associated with cancer risk.

The results showed that both smokers and non-smokers who did not drink green tea were 5 times more likely to develop lung cancer compared to those who drank at least one cup of green tea per day. Smokers who did not drink green tea at all were more than 12 times more likely to be diagnosed with lung cancer than those who drank at least one cup of green tea per day. However, the protection was greatest for those carrying certain genes. Green tea drinkers, whether smokers or non-smokers, with non-susceptible IGF1 (CA)19/(CA)19 and (CA)19/X genotypes reported a 66 percent reduction in lung cancer risk compared with green tea drinkers carrying the IGF1 X/X genotype.

Health News

Doctors discover 'red flags' for serious childhood infections

Rapid breathing, a bluish tinge to the skin, and a rash that doesn't fade when pressed are all warning signs that could indicate serious infections in children, a new study shows. Parents and doctors are also justified in relying on their instincts, according to the research, as parental concern or a doctor's hunch are reliable indicators of a more serious illness.

What do we know already?

Serious infections, such as meningitis, can be life-threatening, but are often difficult to distinguish from common, milder illnesses. The average UK child will see a doctor four times before the age of 1 with an infection, but most of the time there won't be anything seriously wrong.

Severe infections can have dangerous consequences, so it's important for doctors to be able to tell them apart from the more minor illnesses that children pick up. By analysing 30 previous studies on the topic, researchers have come up with a list of 'red flag' symptoms that are warning signs of a severe infection.

What does the new study say?

In children, warning signs of a serious infection include:

* A blue or purplish tinge to the child's skin, often around the fingernails or the mouth

* Rapid breathing

* Poor blood flow to the hands and feet.

Your child's hands or feet might feel much colder than usual. You can also test blood flow by pressing one of the child's fingernails until it turns white, and seeing how long it takes to turn pink again. The exact time will depend on lots of things, like the temperature of the room, but under 2 seconds is usually considered normal.

* A rash caused by broken blood vessels under the skin. Some rashes will go away if you press them, but this kind won't. You can check by rolling a drinking glass over the rash.

* Drowsiness or loss of consciousness

* Having seizures (fits)

* A temperature of over 40°C. (Normal body temperature is around 37°C.)

Research also shows that if parents are very worried, or a doctor has a hunch that something is seriously wrong, it's a good idea to trust these instincts. One study found that concern from parents or a doctor was linked to a higher chance of the child's illness being serious.

How reliable are the findings?

The new study is a round-up of all the research that's been done so far. A slight problem is that most studies have looked at children in emergency departments, where children are more likely to be seriously ill than in a GP surgery.

Where does the study come from?

The study was done by researchers from the University of Oxford and the University of Leuven in Belgium. It appeared in The Lancet medical journal.

What does this mean for me?

The studies give you some guidelines about warning signs to be aware of. The individual studies the researchers relied on had all been done in developed countries, including the UK, the US, and Canada. So, these warning signs are likely to apply to typical children in the UK.

What should I do now?

If you're ever worried about your child's health, it's always safest to get medical advice.

Some children may have serious infections without any of the warning signs above, so don't put off getting help just because your child doesn't have these signs.