The biopsychosocial model

In recent years there has come about an increasing dissatisfaction with the biomedical model, which has been caused by a growing awareness about the noxious side-effects of modern medicine, especially antibiotics, the prohibitive costs of health care in Western countries, the inadequacy of modern medicine in the treatment of chronic and psychosomatic illnesses, and the growing evidence about the linkage between environmental, social, cultural and behavioural factors and disease.

The emergence of certain new health-related disciplines, such as neuroendocrinology, psychoneuroimmunology, behavioural neurology, biofeedback and behavioural medicine, have reinforced the rethinking about the aims and claims of the biomedical model. Neuroendocrinology and psychoneuroimmunology deal with the interaction between psychological processes and the nervous and immune systems, especially with the complex ways in which the human brain modulates the functioning of the immune system. Biofeedback aims at exercising voluntary control over processes that are supposed to be automatic and self-regulatory in nature, such as heart rate and blood pressure. Behavioural medicine and cognitive therapy emphasize that one’s perception and appraisal of a situation, which is influenced by one’s beliefs, values and convictions, has an important bearing on health and illness.

These developments have paved the way for the emergence of an alternative way of looking at health and illness, known as the biopsychosocial model. This model holds that health and illness are multi-dimensional, multi-factorial phenomena which involve not only genetic, biological and physiological processes but also environmental, social, cultural, behavioural and psychological factors. This view is reflected in the World Health Organization’s definition of health: “Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity.”

These developments have paved the way for the emergence of an alternative way of looking at health and illness, known as the biopsychosocial model. This model holds that health and illness are multi-dimensional, multi-factorial phenomena which involve not only genetic, biological and physiological processes but also environmental, social, cultural, behavioural and psychological factors.

Sociology of health and illness

Broadly defined, sociology of health and illness—also known as medical sociology or sociology of medicine—deals with the social basis of health and disease. Specifically, it studies the culturally conditioned perceptions of illness, the bearing of environmental, social, cultural and behavioural factors, such as dietary habits, occupation and lifestyle, on health and illness. It also deals with the interplay between disease and human development, the social dimensions of the medical profession, the linkage between medicine and globalisation, and indigenous systems of medicine. There are significant variations in the perception and interpretation of illness and disease, which are generally determined by cultural values. Among the Madi of Uganda, for example, illness is often seen as a result of failure to deal properly with inter-personal relations.

Social epidemiology

Social epidemiology deals with the frequency, distribution and magnitude of diseases in human populations. A basic principle of social epidemiology is that diseases are not uniformly distributed in human populations and that the distribution of diseases occurs in patterns in a community. Seen from the perspective of social epidemiology, diseases could be classified in terms of rural and urban patterns, occupation, gender, ethnicity and social class. The frequency, distribution and magnitude of diseases are significantly linked to overcrowding, unhygienic living conditions, illiteracy, poor sanitation and inadequate health care facilities.

Diseases such as brucellosis, neonatal tetanus and various infectious diseases are predominantly found in rural areas. On the other hand, diseases such as diabetes, hypertension and heart disease, respiratory disease and various forms of cancer have a far greater prevalence in cities.

There is a close linkage between occupation and certain types of disease. Silicosis, which is a major cause of disability and mortality, is caused by inhalation of dust containing silicon dioxide. Workers employed in mines, construction work, pottery and ceramic industry and iron and steel industry, who are constantly exposed to dust particles, are at greater risk of respiratory diseases. Similarly, workers in asbestos factories run the risk of respiratory disorders and certain types of cancer. It is estimated that approximately four percent of cancer deaths are attributable to occupational hazards. The desk-top culture, which involves long hours of work at the computer, has given rise to diseases like the Carpal-tunnel syndrome, which is manifested in tingling, numbness of fingers and joints, and abnormal sensations.

There is a certain correlation between disease and gender. Women, for example, are at greater risk of slipped disc, rheumatoid arthritis and osteoarthritis and migraine. Collagen vascular diseases, which affect the liver and joints, are more common among women. In India, the number of women suffering from osteoarthritis is four times that of men. Although genetics is the strongest reason for the high prevalence of the disease in women, rising obesity, a sedentary lifestyle, poor diet and the traditional style of squatting are important risk factors. On the other hand, men are at greater risk of hypertension and heart attacks as compared to women. Haemophilia occurs only among boys.

There appears to be some correlation between disease and ethnicity. There is, for example, a preponderance of the incidence of breast cancer in Parsi (Zoroastrian) women in India. Thalassemia, a gene-linked disease which causes severe, sometimes fatal, anaemia, is more common among certain ethnic groups in India, such as Sindhis, Gujaratis and Punjabis. Women from Jewish, Muslim and Amish backgrounds are at much lower risk of cancer of the cervix. African Americans have more severe high blood pressure and are at greater risk of heart disease than Caucasians. The incidence of heart disease is much higher among Indian Americans and Mexican Americans.

Social class has a significant bearing on the distribution of disease. Some researchers speak of diseases of affluence and diseases of poverty. Diseases of affluence include Type-2 diabetes, coronary heart disease, cerebrovascular disease, certain types of cancer and alcoholism. The diseases of affluence are generally caused by reduced physical activity, fatty food, obesity, greater use of alcohol and tobacco and greater use of antibiotics (which weaken the immune system). Diseases of poverty, on the other hand, include malaria, tuberculosis, measles, pneumonia, diarrhoea and AIDS.

Disease and environment

A great deal of attention is now focused on the linkage between environmental factors—both natural and man-made--and the aetiology of disease. In some areas, as in the sub-Himalayan region, the soil is deficient in iodine, which affects water as well as vegetables. Iodine deficiency is the leading cause of endemic goitre. Similarly, in some regions in India, water contains excessive chlorine, which causes skeletal and dental fluorosis. Vernal conjunctivitis in children and adolescents is caused by pollen in the atmosphere. Prolonged exposure to harsh sunlight causes pterygium, which affects vision.

The growing pace of urbanization and industrialisation in large parts of the world has resulted in overcrowding and congestion, air pollution and water contamination. Environmental degradation and atmospheric pollution have brought about an alarming increase in respiratory diseases, especially asthma, bronchitis and lung cancer. Atmospheric pollution adversely affects the immune system and results in easy susceptibility to infectious diseases. Children are more vulnerable to respiratory diseases caused by environmental pollution. Smog aggravates cold and cough and respiratory diseases such as asthma, bronchitis and allergies. The consumption of mercury-contaminated fish causes visual distortions, dysphasia and even mental retardation.

Global warming caused by the burning of fossil fuel and deforestation has resulted in drastic climate changes, including floods, unprecedented heat waves, gales and tsunami, in many parts of the world. Climate changes could create a favourable climate for disease-causing organisms and food-plant pests and provide potential for epidemics such as malaria and Dengue fever. Experts fear climate changes could cause an extra 5,000 deaths from skin cancer every year and 2,000 from heat waves. Climate changes in some countries have resulted in new epidemics of viral infections caused by Ebola and Hanta viruses.

The World Health Organization reported in June 2006 that as much as 24 percent of all global diseases—including respiratory infections and cancer--are caused by environmental factors and can be averted. More than 33 percent of diseases in children—including malaria, diarrhoeal diseases--are caused by environmental exposures. More than 13 million deaths worldwide are due to preventable environmental causes. Preventive environmental risks could save as many as four million lives a year, mostly in developing countries.

The World Health Organization reported in June 2006 that as much as 24 percent of all global diseases—including respiratory infections and cancer--are caused by environmental factors and can be averted.

Social and cultural factors

There is a correlation between certain cultural patterns and social practices and disease. Consanguinous marriages or marriage between close relatives—such as cross-cousin or parallel cousin marriages—over several generations predispose the offspring to certain genetic abnormalities. The average risk of genetic defects, including albinism, congenital deafness, alkaptonuria (a kind of enzyme deficiency), mental retardation and haemophilia, is approximately doubled in the offspring of cross-cousin marriages as compared with the offspring of unrelated mates. An increased risk of premature death and high infant mortality are also reported in such offspring. In one Japanese city, a death rate of 116 per 1000 was found during the first 8 years of life amongst the offspring of first cousins, against 55 in the rest of the population.

The average risk of genetic defects, including albinism, congenital deafness, alkaptonuria (a kind of enzyme deficiency), mental retardation and haemophilia, is approximately doubled in the offspring of cross-cousin marriages as compared with the offspring of unrelated mates. An increased risk of premature death and high infant mortality are also reported in such offspring.

Dr Muhsin al-Hazmy, head of the Cooperative Centre of World Health Organization, says that 20 percent people in Saudi Arabia are suffering from hereditary diseases which are linked to inbreeding or consanguineous marriages.

Dr Muhsin al-Hazmy, head of the Cooperative Centre of World Health Organization, says that 20 percent people in Saudi Arabia are suffering from hereditary diseases which are linked to inbreeding or consanguineous marriages.

It is reported that British Pakistanis are 13 times more likely to have children with genetic disorders than the general population. British Pakistanis account for 3.4% of all births in the country but have 30% of all children in Britain with recessive disorders. The high incidence of genetic disorders among British Pakistanis is attributed to the widely prevalent practice of cousin marriages. About 55% of British Pakistanis are married to first cousins.

In the general population, the likelihood of a couple having recessive genes—which cause recessive genetic disorders—is one in a hundred. In cousin marriages, the likelihood is one in eight. One in ten of all children born to first-cousin marriages in Birmingham’s large Pakistani community either dies in infancy or goes on to suffer serious disability as a result of recessive genetic disorders.

The use of kohl (surma) and kajal is very common in South Asia and the Middle East. Most kohl substances contain a high level of lead which is injurious to the eye. In rural India it is very common to apply kajal to a child’s eyes with a thin wooden or metal stick, which is often unclean and may result in the spread of eye infection.

In the Indian countryside it is a common practice to apply a paste of cow dung on the umbilical stump after cutting the umbilical cord, which is believed to have healing properties. This, however, puts infants at the risk of neonatal tetanus.

In Kashmir (India), which experiences extreme cold in winter, there is the practice of hanging a wooden basket filled with burning coal close to one’s chest and neck, which provides warmth. This practice puts people at greater risk of skin cancer.

The Western habit of sitting on chairs and sofas—and on the toilet seat--and not on the floor makes women more susceptible to osteoarthritis of the hips. On the other hand, Asian women who are accustomed to squatting on the floor are at much less risk of osteoarthritis of the hips.

There is a positive correlation between dietary habits—which are often culturally conditioned--and disease. The consumption of high-cholesterol and processed foods, for example, is linked to colon cancer. The incidence of colon cancer is increasing worldwide by about two percent annually. North America, western Europe and Australia have the highest rates of colon cancer while the lowest rates are found in Africa, Asia and Latin America. Western diet with its high animal fat and low fibre content plays a significant role in increasing the risk of colon cancer. Dried, smoked and salted foods carry a higher risk of gastric cancer. The consumption of junk food results in excessive free radicals which cause tissue damage. Colas and other aerated drinks reduce the bone mass, putting people, especially young children and adolescents, at greater risk of osteoporosis in old age. The consumption of milk of cows and buffalos that are injected with synthetic oestrogen or female hormone (in order to increase the yield) disturbs the body’s hormonal system and may result in infertility.

Certain culinary and dietary practices among some communities are correlated with disease. Members of the Bantu tribe in South Africa cook their food in copper vessels. In the process of cooking some copper gets mixed with food, which causes pancreatic damage, leading to diabetes and discolouration (bronzing) of skin. The consumption of a type of red lentil, lathyrus sativus (known as kesri dal in parts of India), is very common among people belonging to the lower socio-economic strata in the eastern, central and northern parts of India and in parts of Algeria and Spain. The regular consumption of this lentil, which contains a toxin called BOAA, puts people at the risk of lathyrism, a form of neurological paralysis. The extensive use of chemicals and pesticides in modern farming methods has raised concerns about the health risks of chemical and pesticide residues in food items and fruits. One of the risk factors in Parkinson’s disease, which affects one million people in the US, is the consumption of food containing chemical and pesticide residues.

Several studies in recent years have suggested that social isolation and loneliness are often linked to high blood pressure, depression and dementia. Dementia is emerging as an increasingly worrisome ailment in large parts of the world, especially in Western countries and in China. It is defined as an acquired deterioration in cognitive abilities that impairs the successful performance of daily activities. Loss of memory is the most common cognitive dysfunction in dementia. In addition to memory, other mental faculties, such as language, calculation, visuospatial ability, judgement and problem solving, are also affected.

Dementia affects four million people in the United States and involves a staggering health care cost of $ 100 billion annually. In the US, approximately 10 percent of all persons over the age of 70 experience significant memory loss, and in more than half of the cases the cause is Alzheimer’s disease. In the US, the annual cost of caring for a single Alzheimer’s patient in an advanced age of the disease is estimated at $50,000. In India about 3 percent of people in the age-group of 65-75 suffer from dementia. A recent study of more than 800 elderly patients in the US, who were followed over a four-year period, has suggested that people who lead lonely lives are twice as likely to develop Alzheimer’s disease.

The leader of the study, Professor Robert Wilson, Professor of Neuropsychology at Rush University Medical Centre in the US, points out that loneliness may affect systems in the brain dealing with cognition and memory, making lonely people more vulnerable to the effects of age-related decline in neural pathways. Professor Wilson adds that we need to be aware that loneliness has not only an emotional impact on old people but also a physical impact.

The National Institute on Aging at the University of Chicago sponsored a study in 2006, which found that men and women between 50 and 68 years of age who scored the highest on measures of loneliness also had high blood pressure, which is a major risk factor for heart disease, the number one killer in the US. Lonely people, according to the study, are also susceptible to depression, alcoholism, weak immune system, impaired sleep and suicidal tendencies.

In China, six million people suffer from Alzheimer’s disease, a third of all Alzheimer’s patients in the world, and the number of diagnosed cases is rising. The increase in the incidence of Alzheimer’s disease in China is linked to the erosion of the country’s traditional support networks. Residential patterns in large cities in China, as in other cities around the world, are undergoing a radical transformation. Living in high-rise buildings and apartment houses breeds individualism and social isolation. This new urban ecology affects old people the most, and results in loneliness and depression. And depression is a risk factor for Alzheimer’s disease.

The leader of the study, Professor Robert Wilson, Professor of Neuropsychology at Rush University Medical Centre in the US, points out that loneliness may affect systems in the brain dealing with cognition and memory, making lonely people more vulnerable to the effects of age-related decline in neural pathways. Professor Wilson adds that we need to be aware that loneliness has not only an emotional impact on old people but also a physical impact.

Behavioural and lifestyle factors

A great deal of research is being carried out on the bearing of behavioural and lifestyle factors on the aetiology of disease. Lifestyle-related diseases, such as cardiovascular diseases, diabetes, lung disease and some cancers account for nearly 44 percent of premature deaths around the world. According to WHO, some 388 million people—most of them in poorer countries—are likely to die over the next decade from non-communicable and lifestyle-related diseases.

An invariable result of a high-cholesterol diet, processed and junk food, smoking, drinking and lack of physical activity is obesity. Obesity has major adverse effects on health. Morbidly obese individuals have as much as a twelve-fold increase in mortality. Obesity is a major risk factor for diabetes, and nearly 80 percent of patients with Type-2 diabetes are obese. In the U.S., an estimated 65 million adults are overweight or obese, leading to 300,000 deaths annually and more than $ 100 million in annual health costs. Obesity has a positive bearing on reproductive disorders, pulmonary disease, joint and connectivity tissue disorders and menstrual abnormalities. It is an independent risk factor for cardiovascular disease in men and women (including coronary hear disease, stroke and congestive heart failure).

Lifestyle-related diseases, such as cardiovascular diseases, diabetes, lung disease and some cancers account for nearly 44 percent of premature deaths around the world. According to WHO, some 388 million people—most of them in poorer countries—are likely to die over the next decade from non-communicable and lifestyle-related diseases.

The World Cancer Research Fund warns that being obese or overweight increases the risk of cancer. According to a study funded by Cancer Research UK, being overweight or obese accounts for around 6,000 out of a total of 120,000 new cases of cancer each year among middle-aged and older women in the UK. The study, which examined 45,000 cases of cancer in one million women in the UK over seven years, says this figure comprises about 5% of such cases.

A Harvard study suggests that a diet rich in red meat, high-fat diary products and baked goods made from refined flour is 60 percent more likely to result in diabetes after the age of 40. Currently, 246 million people worldwide are affected by diabetes. India has 44 million diebetics, nearly one-fifth of the global diabetic population. Diabetes is a chronic, debilitating and costly disease. It is responsible for close to 4 million deaths worldwide each year. It is a leading cause of heart attack, stroke, kidney failure, amputation and blindness. When diabetes exists with high blood pressure, obesity, high cholesterol levels and smoking, the risk of heart attack increases several times.

A Harvard study suggests that a diet rich in red meat, high-fat diary products and baked goods made from refined flour is 60 percent more likely to result in diabetes after the age of 40. Currently, 246 million people worldwide are affected by diabetes. India has 44 million diebetics, nearly one-fifth of the global diabetic population.

What is extremely worrying is that an increasing number of young children and adolescents in the United States and some European countries are developing Type-2 diabetes. Experts believe that fast food, too much time spent in front of TV and computer and lack of exercise are causing a rise in diabetes among children and adolescents.

Habitual alcohol consumption increases the risk of alcoholic hepatitis as well as the inflammation and destruction of liver cells, which may result in cirrhosis or cancer of the liver. Alcohol abuse increases the risk for cancers of the mouth, lungs, pancreas and intestine. It also affects the central nervous system.

Drinking in excess—called binge drinking—is rapidly spreading among young girls and boys in Britain and many other European countries. In the UK, nearly six million people are believed to be binge drinkers. Latest reports indicate that young women are out-drinking men. More than 20,000 die each year in Britain from alcohol-related causes. Studies show that one in five heavy drinkers develops cirrhosis of the liver.

It has been established beyond doubt that smoking increases the risk of lung cancer. The risk of developing coronary heart disease in smokers is two to four times that of non-smokers. Smoking is the biggest cause of cancer in the US and accounts for nearly 30 percent of all cancer deaths. It is reported that the sperm count of healthy men has dropped more than forty percent during the last 50 years, resulting in a decline in male fertility. This is said to be associated with smoking, heavy drinking and the increased use of antibiotics.

There is a significant linkage between marriage, pregnancy and breast-feeding and certain diseases. Remaining single, voluntary childlessness, delayed pregnancy and avoidance of breast feeding have adverse consequences for women’s health. Researches reveal that upper middle class and wealthier women are at greater risk of breast cancer because they tend to delay marriage and motherhood, prefer not to have a child and if they have one, do not like to breastfeed it, and are likely to have hormone replacement therapy. All these factors have a positive bearing on breast cancer. In Western countries the rate of breast cancer is 90-100 per 100,000 women. In the UK, there are 44,000 cases of breast cancer annually. Women who marry after the age of 35 run a greater risk of giving birth to children with Down’s syndrome.

Researches reveal that upper middle class and wealthier women are at greater risk of breast cancer because they tend to delay marriage and motherhood, prefer not to have a child and if they have one, do not like to breastfeed it, and are likely to have hormone replacement therapy. All these factors have a positive bearing on breast cancer.

In recent years there has come about a radical shift in the perception about children in Western countries. There is a growing feeling among young women and men that not having children is the ideal way of life. Their increasing preoccupation with unbounded freedom, self-fulfilment and career advancement, coupled with work and financial pressures, keep them away from having children.

A recent study conducted by the Federal Institute for Demographic Research in Germany shows that 26 percent of men and 15 percent of women aged between 20 and 39 do not want to start a family. Fifty percent of university-educated women of child-bearing age in Germany prefer not to have children. In the 1990s nearly 60 percent of women aged between 25 and 29 in Germany had a baby. The figure plunged to 29 percent in 2005. In Britain, a recent report of the Office of Population Censuses and Surveys predicted that 20 percent of women born between 1960 and 1990 will remain without a child. In the US, 20 percent of women in their 30s are expected to remain without a child.

A culture of voluntary childlessness is emerging in many Western countries and in Australia. In Britain, there is a growing market for books such as Child-Free and Loving It. Honda is now designing cars that will replace child seats with dog crates. In Australia, childless couples constitute the fastest growing type of household. In some restaurants in Rome children are not welcome.

Osteoarthritis is closely associated with lifestyle factors. A sedentary lifestyle, junk food and colas, excessive drinking, frequent and long travel by car and plane, use of steroids and high heels are risk factors in the development of osteoarthritis.

Women are five to 11 times more likely to develop cervical cancer if their husbands frequent prostitutes or have multiple sexual partners. Cervical cancer is directly linked to human papillomavirus or HPV, a virus that is commonly spread through sexual intercourse. Up to 97 percent cases of cervical cancer are infected with this virus. Women who have many sexual partners are also at the risk being infected by this virus.

A recent report released by the World Bank and the Harvard School of Public Health predicts that in the next 25 years most people are likely to suffer from “behavioural pathogens” or lifestyle-related diseases, caused by fatty diet, junk food, smoking, drinking, lack of exercise and increased stress levels.

Women are five to 11 times more likely to develop cervical cancer if their husbands frequent prostitutes or have multiple sexual partners. Cervical cancer is directly linked to human papillomavirus or HPV, a virus that is commonly spread through sexual intercourse. Up to 97 percent cases of cervical cancer are infected with this virus. Women who have many sexual partners are also at the risk being infected by this virus.

Epigenetics

It is generally believed that genetic information passed on from parents to the child not only determines the child’s physical appearance but also predisposes him or her to certain hereditary conditions, including certain diseases. Conditions such as obesity, diabetes, breast cancer, heart disease and poor eye sight have a strong genetic predisposition. But scientists are puzzled by a strange genetic phenomenon. There are about 10 million identical twins in the world. In some pairs of identical twins, one of the twins develops a genetic disorder, while the other remains healthy. They also have different medical histories. In some cases, one of the twins has diabetes while the other is free from the disease. This should not happen because monozygotic or identical twins share the same DNA structure.

Some scientists began to ponder whether external influences—diet, lifestyle and environment—have a significant bearing on modifying the genetic blueprint of twins. An important research conducted in Spain in 2005 showed that the twins in the study often had very different personalities and suffered from different ailments. It was found that those twins who had spent more time apart and had different lifestyles showed the greatest differences in genetic activity. The scientists were inclined to believe that lifestyle factors can cause genes to be switched on or off. The study of how genes are activated and deactivated by external, environmental factors has come to be known as epigenetics.

Genes provide a blueprint or potentialities. But the unfolding or actualisation of these potentialities significantly depends on external factors, including diet and lifestyle, habits and cultural practices. External, environmental factors can cause changes in gene activity which in turn results in physiological changes. An organism is able to pass on to its offspring a blueprint—genetic profile—telling it which genes should be active and which should be silent. The manner in which this blueprint takes a concrete shape is significantly influenced by external, especially lifestyle, factors. Thus, though Hyperactive Airway Disease (HAD) or asthma has a genetic basis, the genes responsible for the disease are likely to be activated by certain social and lifestyle factors such as house dust, carpets and upholstery in which termites breed (if not regularly cleaned), hair and feathers of pets, and passive smoking. A strong immune system, influenced by a healthy lifestyle, can keep some cancers dormant for years.

There is a positive correlation between a certain type of temperament or personality structure and cardiovascular disease. Health psychologists speak of Type-A personality, which is associated with a set of characteristics. A person with Type-A personality tends to be impatient, has a low threshold of tolerance, is excessively time-conscious, ambitious and competitive, nurses hostility and aggression and suffers from a deep-seated sense of insecurity. People with Type-A personality are generally the high achieving workaholics. Such people are prone to hypertension.

Stress and disease

Some amount of stress is unavoidable and is in fact beneficial in certain situations. But too much of anxiety, tension and depression takes a heavy toll of one’s health, peace of mind and inter-personal relationships. Growing medical evidence indicates that stress has a critical bearing on a wide range of illnesses, including coronary heart disease, diabetes, stroke, arthritis, allergies, skin diseases, fatigue, insomnia, and gastro-intestinal problems. Stress has long been associated with ulcer. It also suppresses the reproductive system. It is estimated that nearly half of the ten causes of disability worldwide are psychogenic and are linked to stress.

Stress weakens the immune system by switching off white blood cells which fight disease. Stressful situations and stimuli—called stressors—accelerate the secretion of a hormone, cortisol, which makes one susceptible to infectious and other kinds of disease. Stress causes loss of appetite and sleep, rapid heart beat, high blood pressure and loss of libido. Stress in the work environment—job stress, night shifts, unpleasant relations with colleagues—engender negative emotions such as resentment, anger, hostility, anxiety and depression, which lead to the release of stress hormones. Studies suggest that stress in the work place is a major factor in the development of heart disease and diabetes. Stress causes blood pressure to rise and sustained high blood pressure leads to the thickening and stiffening of the artery wall, which reduces blood flow and thereby contributes to hypertension.

An increasing number of people, especially young professionals, suffer from insomnia and sleep disorders in Western countries as well as in other parts of the world. In the UK, about one million people regularly take sleeping pills. It is estimated that 8 to 12 percent of the adult population in the country have sleep disorders and 20 to 25 percent people have a complaint about their sleep. Women are more prone to insomnia than men, since their anxiety levels tend to be higher. Insomnia is associated with stress, irregular food intake and long working hours.

Prolonged stress may accelerate puberty by altering the balance of growth hormones and other chemicals in the body. This is happening in Britain and many other European countries where the onset of puberty is heading towards the age of 12. But the earlier onset of physical maturity is not being accompanied by emotional development, which could leave youngsters at a greater risk of teen pregnancy, sexually transmitted diseases and drug abuse.

Depression is becoming increasingly common in large parts of the world. In the US, nearly 4 percent of the population suffer from major depression, with a lifetime risk of 5 to 10 percent for men and 20 to 25 percent for women. A study sponsored by the World Bank and the World Health Organization on the Global Burden of Disease and Injury estimates that 15 percent of men and 25 percent of women across the world suffer from depression. It also predicts that unipolar disorder will be the second largest cause of disability and death worldwide by the year 2020. Cognitive symptoms of depression include diminished interest in work and other activities, feelings of sadness, worthlessness, guilt and difficulty in concentration. Acute or clinical depression is often manifested in fatigue, insomnia, significant weight loss and restlessness. Depression always causes significant morbidity. The pathogenesis of depression depends on several factors, including genetic predisposition, physical illness and psychosocial factors such as stress, alcoholism and drug abuse.

What is extremely worrying is that an increasing number of adolescents and teenagers in Western countries are suffering from depression and are under medication. In 2002, nearly 11 million children and teenagers in the US were prescribed antidepressants. Some researches suggest that the use of antidepressants may predispose some of them to suicidal behaviour.

What is extremely worrying is that an increasing number of adolescents and teenagers in Western countries are suffering from depression and are under medication. In 2002, nearly 11 million children and teenagers in the US were prescribed antidepressants. Some researches suggest that the use of antidepressants may predispose some of them to suicidal behaviour.

Disease and human development

There is a significant correlation between disease and human development, as measured in terms of literacy and education, health and longevity, income and quality of life. A mention was made in the foregoing of diseases of poverty such as malaria, tuberculosis, measles, pneumonia, diarrhoea and AIDS. Poor people are more vulnerable to infectious diseases as a result of malnutrition, overcrowded and unhygienic living conditions, inadequate sanitation, unclean water, illiteracy and superstition and poor health care facilities. Malnutrition is linked to nearly 54 percent of childhood deaths. Diseases of poverty kill approximately 14 million people annually. Developing countries account for nearly 98 percent of the global incidence of tuberculosis and 95 percent of the global AIDS prevalence. About 10 percent of global mortality is linked to tuberculosis, malaria and AIDS. Some 33 million people in the world are infected with the HIV virus, of which 22.5 million are in sub-Saharan Africa and 4.9 million in Asia. The number of people with the HIV virus in Europe has gone up from 1.25 million in 2001 to about 2.4 million now.

Diseases of poverty kill approximately 14 million people annually. Developing countries account for nearly 98 percent of the global incidence of tuberculosis and 95 percent of the global AIDS prevalence. About 10 percent of global mortality is linked to tuberculosis, malaria and AIDS.

South Asia has the highest incidence of annual maternal deaths in the world. Every year around 188,000 women die from complications in pregnancy and child birth. The majority of births in the region occur at home in rural areas without qualified medical help or adequate health care facilities. The region’s high maternal mortality rates account for almost half of all maternal deaths worldwide. In South Asia, India has the largest number of annual maternal deaths (117,000 or 540 per 100,000 live births), followed by Afghanistan (26,000), Bangladesh (21,000) and Pakistan (15,000). Some studies suggest that children who are left motherless are 10 times more likely than their peers to die within two years of their mothers’ death.

In South Asia, India has the largest number of annual maternal deaths (117,000 or 540 per 100,000 live births), followed by Afghanistan (26,000), Bangladesh (21,000) and Pakistan (15,000). Some studies suggest that children who are left motherless are 10 times more likely than their peers to die within two years of their mothers’ death.

A Unesco report points out that throughout South Asia there is a huge disparity between impressive economic growth and dismal performance in respect of human development indices. A recently released report by the UN and Asian Development Bank points out that India is lagging behind in eradicating extreme poverty and hunger, in achieving universal primary education, in promoting gender equality, in reducing maternal and infant mortality and in combating malaria and other diseases.

Globalisation, illness and medicine

The worldwide diffusion of Western culture—the so-called “globalised lifestyle”—seems to be bringing about similar patterns of morbidity and mortality in large parts of the world, with the predominance of coronary heart disease, diabetes, strokes and cancer. The consumption of colas, burgers, junk food and ketchups, which supply empty calories with no nutritional value, leads to the accumulation of saturated fats, cholesterol and salt in the body. This, combined with a sedentary lifestyle, smoking and drinking, results in obesity and puts people at greater risk of cardiovascular diseases. An increasing number of career-obsessed upwardly mobile executives with a faulty lifestyle and stressful jobs in multinational companies in large parts of the world are suffering from hypertension, diabetes and heart disease.

There is a significant relationship between changes in diet and lifestyle as a result of transnational migration and disease. It has been observed that people who migrate from one country to another generally acquire the cancer rates of the host country. It was found that Japanese-Americans have a higher rate of coronary heart disease than the native Japanese, due to the adoption of an Americanised lifestyle and diet.

Western pharmaceutical companies have a monopoly over certain drugs. The prices these companies charge are many times higher than the cost of production. Pharmaceutical companies often indulge in illegal and clandestine drug trials, unethical marketing and drug dumping.

Modern research has recognised that there is a wealth of potential cures in the world’s flora, particularly in tropical countries. Almost half of the 4000 plant patents granted in recent years by the US pertain to traditional knowledge obtained from developing countries. A number of traditional medicinal plants are taken from the developing countries by pharmaceutical companies and used to synthesize chemical substitutes with little or no compensation to these countries. This has been described as “bio-piracy.” One of the most notorious cases of bio-piracy was the attempt by the US to patent turmeric—extensively used in South Asia for culinary and medicinal purposes—in 1993. The patent was eventually overthrown but not without expensive litigation. The drug used for the treatment of childhood leukaemia, which was developed by the American-based company Eli Lilley, used the rare genetic trait of the rosy periwinkle plant found in Madagascar. Eli Lilley’s sales of these drugs amount to approximately $100 million per year worldwide. Ironically, Madagascar receives nothing for the use of this valuable resource.

Several drugs that are banned in Western countries are available over the counter in developing countries. Some children’s cough syrups that are classified as dangerous in the US are freely available in India.

Consumers International, a global federation of consumer organizations, has carried out a study “Drugs, Doctors and Dinners,” which found that pharmaceutical companies often bribe doctors in developing countries to needlessly prescribe their drugs—vitamin supplements, cough syrups, painkillers and antibiotics. Sometimes, these prescriptions lead to pathogens that develop resistance to drugs. An overuse of painkillers can cause liver disease. Such prescriptions, however, help boost sales and profit. In return, doctors get gifts such as cars, laptops, club memberships and foreign holidays.

Alternative and indigenous systems of medicine

The last two decades have witnessed a growing popularity of alternative systems of medicine—naturopathy, homeopathy, acupuncture, Chinese medicine, Tibetan medicine, Ayurveda and Unani—in Europe and the United States. In the UK alone, more than 11,000 registered and 17,000 unregistered medical practitioners follow alternative systems of medicine. The Council for Complementary and Alternative Medicine in the UK is a professional association of medical practitioners who espouse alternative systems of medicine. The American Holistic Medical Association is growing in its reach, membership and professional activities. An International Institute of Holistic Medicine has been established in Geneva.

Asian pharmacopoeia and therapeutic techniques are gaining increasing popularity in the US and Europe. Interestingly, Dr Roy Cyre has opened a biofarm in South Wales, where he is breeding 80,000 leeches and supplying them to laboratories and clinics all over Europe and North America. In India and Vietnam, leeches have been used for centuries for sucking out infectious blood, for the treatment of swellings and skin diseases. Dr Cyre has discovered an enzyme found in the secretion of leeches, which is efficacious in the treatment of coronary blockages, which otherwise requires angioplasty and bypass surgery.

Holistic medical paradigm

Behavioural medicine makes a distinction between health-enhancing lifestyle and health-depressing lifestyle and emphasizes that with appropriate modifications in attitude and habits, relationships, diet and lifestyle one can keep most diseases at bay. A balanced diet, consisting of vegetables and fibre-rich cereals, milk, fruits and fish, regular physical activity and avoidance of smoking and drinking act as a useful buffer to illness. Certain foods are not only a good source of nutrition but also contain substances which fight disease. Green tea, for example, contains a chemical, EGCG, which reactivates genes which regulate cell growth and division and thereby prevents cancer.

Scientists say that a fibre-rich diet can reduce the risk of bowel cancer by as much as 40%. This observation is based on The Epic (European Prospective Investigation of Cancer and Nutrition) study that was carried out in Cambridge in 2001. The study involved 400,000 people cross nine European countries.

In the Nuro province of Sardinia (in southern Italy), which has a population of 265,000, 60 persons are hundred years old or more. This is three times the average in the rest of the Western world. Nearly half of them are women. Many of them cook for themselves, walk after their sheep for long distances and even go hunting. The traditional Sardinian cuisine is rich in fish, vegetables, olive oil and fresh fruits. Dr Giusepe Pilia, a geneticist who has worked on a project funded by the US National Institute on Aging relating to longevity in this region, believes that though genetics undoubtedly plays a part, the balanced and healthy diet of the people, their stress-free life and their pragmatism are largely responsible for their exceptionally good health and longevity.

A balanced diet, consisting of vegetables and fibre-rich cereals, milk, fruits and fish, regular physical activity and avoidance of smoking and drinking act as a useful buffer to illness.

As indicated in the foregoing, obesity is a major risk factor for several diseases. This risk can be avoided by eating a balanced diet, reduced calorie intake and regular physical activity. Several studies suggest a positive link between calorie reduction and longevity. Calorie reduction appears to prolong the life of cells and dampens down parts of the immune system that can cause tissue damage.

According to a recent research conducted at the Pennington Biomedical Research Centre at Louisiana University in the US and published in the Journal of the American Medical Association, eating about 25% fewer calories for six months has a positive bearing on better health and longer life. The findings of the study—called the Comprehensive Assessment of the Long-Term Effects of Reducing Intake of Energy (CALERIE)—suggest that all subjects included in the study who dieted or increased their exercise lost body weight, but those who reduced their calorie intake registered lower fasting insulin levels and lower body temperature. They also had less oxidation damage to their DNA, which is a marker of ageing at the biochemical and cellular level. Low-calorie diets have been found to drive the body to replace and repair damaged cells.

The effects of reduced calorie intake on health and longevity were first observed in laboratory rodents in the 1930s when it was found that rodents fed on a severely reduced diet outlived their well-fed peers. These effects were later observed in other organisms such as yeast, flies, worms and dogs. More than a decade ago, John Holloszy, professor of medicine at Washington University in St Louis, Missouri, had demonstrated that a strict calorie-reduced diet in mice and rats increased their longevity by about 30%. Similar results have been obtained in the study of rhesus monkeys. Recently, Professor Stephen Spindler and his collaborators at the University of California have discovered that reducing calorie intake even later in life results in substantial health and longevity benefits.

Warm human relationships and social support have a positive bearing on health. Social networks, participation in social and cultural activities and social support networks greatly mitigate the effects of stress. Experiments with rats in the laboratory have shown that if the mother rat licks her young, the gene that produces the stress hormone cortisol is switched off in the baby. An unlicked rat will have an active stress-producing gene resulting in higher levels of cortisol and will remain timid and insecure its whole life. Scientists believe that the same could apply to humans.

Warm human relationships and social support have a positive bearing on health. Social networks, participation in social and cultural activities and social support networks greatly mitigate the effects of stress.

In his book Unhealthy Societies: The Afflictions of Inequality (1996), Richard Wilkinson argues that the healthiest societies in the world are not the richest countries but those in which income is distributed most evenly and levels of social integration are highest. He notes a clear relationship between mortality rates and patterns of income distribution. Wilkinson points out that the inhabitants of Japan and Sweden, which are regarded among the most egalitarian societies in the world, enjoy better standards of health than do citizens of countries where the gap between the rich and the poor is more pronounced, such as the US. He argues that social factors—the strength of social contacts, ties within communities, availability of social support, a sense of security—are the main determinants of the health of a society.

The normal aging process is associated with some mild cognitive losses and slowing of physical and mental functions, especially memory. However, cognitive decline is neither inevitable nor universal. The brain consists of millions of neurons, which are interconnected in highly complex and dynamic networks and patterns. These interconnections— called synaptic connections--are in an unending process of activation throughout one’s life. They may be activated or deactivated through the kind of mental activities we choose to follow. People who lead a physically, mentally and socially active life may not experience cognitive decline in old age. Furthermore, cognitive decline may be arrested or reduced by certain brain exercises—called brain gymnastics--such as solving puzzles, memorising lists and using the left hand.

It has been found that people who exercise regularly in middle age are one-third as likely to get Alzheimer’s disease in their 70s as compared to those who do not exercise. Exercise causes the release of proteins that facilitate and accelerate connections between neurons and the birth of new neurons in the hippocampus, a brain region important for memory.

People who lead a physically, mentally and socially active life may not experience cognitive decline in old age. Furthermore, cognitive decline may be arrested or reduced by certain brain exercises—called brain gymnastics--such as solving puzzles, memorising lists and using the left hand.

Uses of Medical Sociology

Sociology of health and illness is not just an academic field of study. It has valuable and useful suggestions to offer to medical practitioners and health specialists, planners and policy makers, NGOs and the educated public. A distinctive feature of sociology of health and illness is that it takes health and well-being as its starting point and views them in a holistic, integrated perspective. There is now an increasing awareness and cognizance of the areas and subjects covered in medical sociology, some of which have been incorporated in medical curriculum under the rubric of preventive and social medicine.

Medical sociology not only makes us aware of the significant linkages between disease and social, cultural, behavioural and lifestyle factors but also makes an important distinction between health-enhancing and health-depressing behaviour and urges us to take control of our own health by making appropriate modifications in our attitudes and temperament, diet, lifestyle and behaviour.

According to Cancer Research UK, certain behavioural and lifestyle changes in women could help prevent thousands of cases of breast cancer. These include a reduction in obesity, regular exercise, drinking less, an increase in breastfeeding rates, and cutting back on long-term use of hormone replacement therapy.

According to Cancer Research UK, certain behavioural and lifestyle changes in women could help prevent thousands of cases of breast cancer. These include a reduction in obesity, regular exercise, drinking less, an increase in breastfeeding rates, and cutting back on long-term use of hormone replacement therapy.

An eminent French sociologist Pierre Bourdieu speaks about symbolic capital, which refers to values, ideals, will power and convictions. These factors play a highly important role in coping with stress and stress-linked illnesses as well as in recovery from illness. One’s appraisal of a given situation, which is significantly influenced by the symbolic capital, has a critical bearing on coping with illness. Cognitive-behavioural medicine emphasizes the concept of coping, which represents positive, self-conscious and purposive behaviour, as opposed to defensive or passive behaviour. Coping resources include meditation, prayer, yoga, and social support networks. Dr Herbert Benson, a professor at Harvard Medical School, in his books The Relaxation Response (1975) and Timeless Healing (1997) focuses on the power of the mind and its positive role in the healing process and has brought out the bearing of belief systems as well as prayer and meditation on recovery from illness. Several researches suggest that meditation helps in lowering blood pressure and in reducing the need for medication.

Health and illness in Islamic perspective

Islam has a holistic perspective on health, illness and medication. It recognizes that illness and disease are the result of a set of factors and processes, including genetic and biological malfunctions, environment, faulty diet and unbalanced lifestyle. It eschews a fatalistic attitude to illness and emphasizes that treatment should include medication by a competent physician, modifications in the environment and lifestyle, cognitive and behavioural reorientation, prayer and meditation, and community support networks.

The Islamic perspective on illness is remarkably rational and free from rigid dogmas and blind superstitions. Similarly, Islam has a refreshingly open and inclusive view of medication. The Prophet advised the use of certain Indian substances and medicines. The Holy Quran and the Traditions of the Prophet mention several fruits and substances, such as honey, fig, dates, vinegar, olive oil, black seed (Nigella sativa) and costus, which are said to have healing properties. Once, Sa’ad ibn abi Waqqas, a Companion of the Prophet, complained of chest pain. When the Prophet was informed about this, he suggested that the patient be taken to Harith ibn Kaldah, who was a Jewish physician at Madinah.

Once, Sa’ad ibn abi Waqqas, a Companion of the Prophet, complained of chest pain. When the Prophet was informed about this, he suggested that the patient be taken to Harith ibn Kaldah, who was a Jewish physician at Madinah.

While Islam allows the enjoyment of God’s bounties, which are said to have been created for the benefit of mankind, it emphasizes moderation and discourages wasteful consumption (Quran 7:31-32). The Prophet used to pray: “O Allah! Give subsistence to the family of Muhammad which just suffices its needs.” He is reported to have said that two persons’ food actually suffices for three and three persons’ food suffices for four. He advised people to leave the table before one is fully satiated. He is reported to have said: “A believer eats in one intestine while an unbeliever eats in seven intestines.” Once, someone belched with a sound in the presence of the Prophet. The Prophet expressed his displeasure and told him: “Keep your belch under check, for the most hungry person on the Day of Judgement will be the one whose stomach is filled with food in this world.”

Caliph Umar is reported to have said: “Refrain from filling your stomachs, for the food (that is over-eaten) is a burden in this world and a foul-smelling thing after death.” Imam Shafi’i is reported to have said: “One who desires God’s mercy and learning should seek solitude, eat less and avoid the company of fools and of scholars who are devoid of a sense of justice and etiquette.”

In the Sufi tradition, the most effective means of taming and gaining control over one’s base self (nafs) is reduced eating and fasting. The Sufis prescribe three “reductions” for the purpose of cleansing one’s heart and mind of undesirable qualities: reduced food, reduced conversation, and reduced sleep. The eminent Sufi poet Maulana Jalaluddin Rumi asked: Could the reedflute sing if its stomach were filled? Annemarie Schimmel, in her celebrated work Mystical Dimensions of Islam (1975), has remarked that “it would be worth investigating to what extent this restriction to extremely small quantities of food contributed to the longevity of the Sufis. It is astonishing how many of them lived to be so old” (p. 116).

Islam enjoins fasting on adult men and women during the month of Ramadan. The multiple benefits of fasting are now increasingly recognised by doctors. Fasting increases the body’s natural resistance power and enhances the functioning of disease-fighting white blood cells. Doctors prescribe fasting as a cure for a variety of chronic diseases, digestive disorders, rheumatism, and got.

The Islamic practice of circumcision, which is also followed by Jews and the Amish, has several health benefits. In December 2006, two major trials were carried out by the US National Institute of Health in Kenya and Uganda. The full data from the trials were published in a paper in The Lancet in February 2007. The paper says tat conclusive data shows that circumcision reduces omen’s chances of catching HIV by up to 60 percent.

The Islamic practice of circumcision, which is also followed by Jews and the Amish, has several health benefits. In December 2006, two major trials were carried out by the US National Institute of Health in Kenya and Uganda. The full data from the trials were published in a paper in The Lancet in February 2007. The paper says tat conclusive data shows that circumcision reduces omen’s chances of catching HIV by up to 60 percent.

A joint analysis by WHO in Geneva, UNAIDS and other experts around the world found that in sub-Saharan Africa, circumcision could avert 2 million new infections and 0.3 million deaths over the subsequent 10 years. These studies lead to the conclusion that “circumcision must now be deemed to be a proven intervention for reducing the risk of heterosexually acquired HIV infection in adult men.” South African AIDS experts have called for a mass circumcision programme to fight the HIV virus. Some 5.5 million South Africans are infected with AIDS.

Medical researches have found circumcision to be a highly effective intervention in respect of several diseases in men and women. There is a strong correlation between circumcision and the absence of cancer of male genitals. A number of studies have documented higher rates of cervical cancer in women who had uncircumcised partners. A recently concluded large international study has provided overwhelming evidence of the link between lack of male circumcision and cervical cancer in the female partner. Sexual relations with uncircumcised males puts women at greater risk of a variety of vaginal infections.

Islam greatly emphasizes community solidarity and social support networks based on mutual concern, sharing and fellow-feeling. These factors mitigate the effects in one’s personal life as well as in inter-personal relationships and act as a buffer to diseases like dementia and Alzheimer’s.

Muslim scientists and physicians made highly original and outstanding contributions to the health sciences. It is significant to note that some of them dwelt on the bearing of environmental, social, behavioural and psychological factors on disease. Al-Razi (d.925), who has been described by George Sarton as “the greatest clinician of all times,” had a great interest in the role of psychological factors in the aetiology of certain diseases and wrote a treatise Al-Tibb ar-Ruhani on psychiatric disorders and their treatment. Ibn Sina (d. 1037) was deeply interested in psychosomatic medicine and psychotherapy. In his book Al-Shifa, Ibn Sina offered a classification of mental illness in terms of biotypology, psychosomatic interactions and the pathogenic influence of the environment and dwelt on the bearing of traumatic events and memories on personality disorders. Ibn Sina noted that prolonged depression or anxiety is linked to stomach ulcer. He also dwelt on the positive effect of music on recovery from illness.

Ibn Khaldun (d. 1406) made a notable contribution to social epidemiology by classifying diseases in respect of their distribution in urban and desert-dwelling, nomadic populations. He also suggested links between the urban lifestyle, especially a rich diet, and disease. To quote him:

The inhabitants of cities lack exercise….Exercise has no part in their (life) and has no influence upon them. Thus, the incidence of illness is great in towns and cities, and the inhabitants’ need for medicines is correspondingly great. On the other hand, the inhabitants of the desert, as a rule, eat little. Hunger prevails among them, because they have little grain. (Hunger) eventually becomes a custom of theirs…..The preparation of food boiled with spices and fruits is caused by the luxury of sedentary culture with which they have nothing to do…..Too, they take exercise, and there is a lot of movement when they race horses, or go hunting, or search for things they need, or occupy themselves with their needs. For all these reasons, their digestion is very good….As a result their need for medicine is small. Therefore, physicians are nowhere to be found in the desert (The Muqaddimah, translated by Franz Rosenthal (1958). Vol. III, pp. 376-77)