FR

Is it not feeling sick? Not having worries? Looking good? 

Is it a perception or an actual state?

This is a very troubling question as health encompasses our physical, emotional, mental, and future state of being;

But how about our belief and relationship with the environment in which we evolve , our socio-economic status?

That’s a lot of considerations.

WHO define health as a state of complete physical, mental and social well being and not merely the absence of disease or infirmity. 

What does this actually means? I am not really sure everyone gets it.

Maybe one way of understanding it is to look at what contributes to our overall health, as individual and or maybe as a population. This is what the experts call the determinants of health.

To further our understanding let's take a global look at human population evolution:

It is estimated that from 8000 BC to 1750 AD almost 10,000 years ago, human population grew approximately from 10 million to 750 million (roughly about 74,000 people a year) whereas today almost 300 years later we are more than 8 billions on the planet. In 2022 alone despite a pandemic almost 66 million people were added on this planet. 

What happened? did we become more fertile? Or people died less often? Or both?

In 1953 a UN report attributed this trend to 4 factors:

 1. Public health measures (better housing, clean water supply, sewage and sanitation, vaccination, health education……)

  2. Advances in medical knowledge and therapeutics

   3. Improved personal hygiene

   4. Improved standards of living

But Thomas McKeown British physician and epidemiologist exploring the influencing factors of population growth in the UK after 1842 came up with something entirely different.

The echo of the controversies and acrimonies that resulted from his work are still being felt today. The scientific community was in shock, to say the least.

Mckeown ascribed population growth to a fall in mortality rate due to improved prosperity and nutrition and not to public health measures and medicine. 

Imagine that: only nutrition was responsible for improvement in health and well being and as a consequence mortality rate fell.

Today of course it’s common knowledge, but in the mid 70s, this was anathema.

Remember we are talking about the early years of industrialization and all the social misery that came with it :overcrowded cities, poor housing, worsening of personal hygiene, foul drinking water, child labor and dangerous working conditions

And yet because there was sufficient and abundant food in better quality, population grew.

This is revolutionary!

What about doctors, hospitals, comfortable houses, clean environment?

Better and sufficient nutrition alone is credited for most of the decrease in mortality rate.

How is that possible?

The work of Robert Fogel, Noble Prize laureate is illuminating to that effect.

Indeed Fogel estimated that 50% of the economic growth in Britain since the industrial revolution has been due to better nutrition of the population.

In Population studies like these height and weight measurement is essential to understanding the relationship between nutritional status and mortality.

What the science explains is that an individual height in adulthood tells the history of his nutritional experience during the growing years including the fetal period. 

So, if in a chosen population we associate height and mortality rate, it won’t tell us the history of how the adults are fed, but instead the nutritional levels (and disease history) of these adults from conception to maturity. 

Height is not determined by genetic factors alone, but also by nutrition. We don’t know yet the relative importance of each, but we do know that individuals who are poorly nourished or over nourished in adult life show higher mortality rate than individuals who maintain an ideal weight for height. However, short men who maintain an ideal weight are at a greater risk of death than are taller men.

In western countries where records are available, better and sufficient nutrition during infancy and childhood is associated with a decline in mortality rate.

Poor development during early life as a result of a poor nutrition, not only increases the risk of dying from contagious diseases, it also increases the likelihood of chronic disorders in adult life. The cause being related to the development of the immune system and other organ system.

More recently the role of other factors determinants of health have emerged, but the role of nutrition specially during childhood remains dominant.

Among the other factors cited are:

   - better nurturing of children: 

   - social status, the higher the individual in the social structure the better the health

   - most importantly the individual’s sense of achievement, self esteem, and control over his/her work is correlated with better health and well being

   - socio economic conditions such as prosperity, income equity, the environment in which people live and work

In light of these emergents factors one admitted theory is that increase prosperity and people’s control over their lives associated with improved nutrition can boost people’s defense system and help fight diseases.

The relationship between the nervous system, the endocrine system and the immune system is well documented today and help explain this theory.

We’ll explore in details these systems and the interconnection amongst them in our next discussions.

Until then, how about we ask ourselves how does the information shared above apply to populations on the African continent? 

How does recent historical events (slave trade and the introduction of foreign diseases on the continent, colonial rule and its innumerable hardships, endemic famines, poverty and socio-economic inequality, to say a few) affect the health of people on the continent?

How can this knowledge help us improve our health and well being, and move forward on the path to prosperity?

FR