IMAGINE that human life is a long hurdle race—a race in which runners jump over obstacles. All runners start the race together; but as they jump over and occasionally hit the obstacles, the runners slow down, and more and more drop out.
Similarly, human life has a starting point and high hurdles along the way. During his life man encounters one hurdle after another. Each jump makes him weaker, and in time, he gives up. The higher the hurdles, the sooner he drops out, or dies. If one lives in the developed world, the drop-out point comes at about 75 years of age. This time period is called the average human life span—comparable to the distance most runners actually go. (Compare Psalm 90:10.) Some people, though, run on longer, and a few even reach what is thought to be the maximum human life span, 115 to 120 years—a feat rare enough to make world headline news.
Identifying the Hurdles
People can now stay in the race almost twice as long as they could at the beginning of this century. Why? Basically because man has been able to lower the hurdles. What, though, are these hurdles? And can they be pushed even lower?
A public-health expert of the World Health Organization (WHO) explained that some of the main hurdles, or factors, affecting man’s life expectancy are habits, environment, and medical care. Thus, the sounder your habits, the healthier your environment, and the better your medical care, the lower those hurdles are and the longer your life may last. Although people’s circumstances vary greatly, virtually everyone—from a bank director in Sydney to a street vendor in São Paulo—can do something to lower the hurdles in his or her life. How?
Habits That Affect Your Track Record
“Not only do persons with better health habits survive longer, but in such persons, disability is postponed and compressed into fewer years at the end of life,” reports The New England Journal of Medicine. Indeed, the first hurdle can be lowered by changing such habits as eating, drinking, sleeping, smoking, and exercise. Consider, for example, exercise habits.
Physical-exercise habits. Moderate physical exercise goes a long way. (See the box “How Much and What Kind of Exercise?”) Studies show that simple exercises in and around the home help the elderly, including the ‘oldest old,’ to regain strength and vitality. For instance, one group of older people ranging from 72 to 98 years of age found that they could walk faster and climb stairs more easily after doing some weight-lifting exercises for just ten weeks. And no wonder! Tests taken after the exercise program showed that the participants’ muscle strength had more than doubled. Another group, made up of mostly sedentary women up to 70 years of age, exercised twice a week. After a year, they had gained in muscle mass, as well as in strength, balance, and bone density. “When we started, we were afraid we’d rip ligaments, pop tendons, tear muscles,” said physiologist Miriam Nelson, who conducted the studies. “But all we got was stronger, healthier people.”
Summarizing the results of several scientific studies on aging and exercise, one textbook states: “Exercise slows the process of aging, prolongs life, and reduces the period of dependency that most often precedes death.”
Mental-exercise habits. The adage “Use it or lose it” seems to apply not merely to the muscles but also to the mind. Although aging is accompanied by some forgetfulness, studies conducted by the U.S. National Institute on Aging show that an older brain remains flexible enough to handle the effects of aging. Hence, professor of neurology Dr. Antonio R. Damasio concludes: “Older people can continue to have extremely rich and healthy mental lives.” What accounts for the continuing flexibility of older brains?
The brain consists of 100 billion brain cells, or neurons, and trillions of connections between them. These connections act like telephone lines enabling neurons to “talk” to one another to create, among other things, memory. As the brain ages, neurons die. (See the box “A New Look at Brain Cells.”) Yet, older brains are able to compensate for neuron losses. Whenever a neuron falls silent, its neighbors respond by making new connections to other neurons and taking on the work load of the lost neuron. That way, the brain actually shifts responsibility for a given task from one region to another.
Therefore, many older people accomplish the same mental tasks as younger people, but they may use different parts of the brain to do so. In some respects, an older brain acts a bit like an older tennis player who compensates for his dwindling speed by resorting to skills that younger players may lack. Yet, despite using techniques different from those of his juniors, the older player still scores.
What can older persons do to keep up the score? After studying more than 1,000 people between 70 and 80 years of age, gerontology researcher Dr. Marilyn Albert found that mental exercise is one of the factors that determines which older people hang on to their intellectual prowess. (See the box “Keeping the Mind Flexible.”) Mental exercise keeps the brain’s ‘telephone lines’ alive. On the other hand, say experts, mental decline starts “when people retire, decide to take things easy, and say they don’t have to keep up with the world anymore.”—Inside the Brain.
So the good news is, explains gerontologist Dr. Jack Rowe, that “factors under our control or which we can modify should enhance our capacity to have a successful old age.” Moreover, it is never too late to start forming good habits. “Even if you have had bad health habits most of your life and you change in the later years,” says a researcher, “you should still reap at least some of the rewards of a healthy lifestyle.”
Environment Makes a Difference
If a girl born today in London were to be transported back to London of the Middle Ages, her life expectancy would be less than half what it is today. That difference would be caused, not by a sudden change in the physical condition of the girl, but rather by an abrupt change in the height of two more hurdles—environment and medical care. First, consider environment.
Physical environment. In the past, man’s physical environment—his home, for instance—was a towering health hazard. During recent decades, however, the dangers caused by physical environment have been lessened. Better sanitation, safer water, and a reduction in vermin in the home have improved man’s environment, bolstered his health, and extended his life. As a result, in many parts of the world, man is now able to go a longer distance. Yet, lowering this hurdle involves more than installing indoor plumbing. It also calls for maintaining a healthy social and religious environment.
Social environment. Your social environment is made up of people—the ones with whom you live, work, eat, worship, and play. Your physical environment improves when you have access to safe water; similarly, your social environment may improve when you have access to valued companions, to name one prime factor. Being able to share your joys and sorrows, dreams and frustrations, with other people lowers the height of the environmental hurdle and helps you to run a longer course.
The reverse, however, is also true. A lack of companionship may cause loneliness and social death. You tend to wither if you exist without receiving expressions of care from the people around you. One woman living in a home for the elderly wrote to an acquaintance: “I am 82 years old and I have been here at the home for 16 long years. They treat us well, but the loneliness is sometimes hard to bear.” Sadly, this woman’s condition is typical of that of many older ones, especially in the Western world. They often live in a social environment that tolerates but hardly appreciates them. As a consequence, “loneliness is one of the major conditions that constantly threaten the well-being of the elderly in the developed world,” says James Calleja, of the International Institute on Ageing.
True, you may not be able to remove the circumstances that make you vulnerable to loneliness—such as forced retirement, declining mobility, the loss of longtime friends, or the death of a spouse—but you can still take some steps to lower this hurdle to a manageable height. For starters, keep in mind that feeling lonely is not caused by old age; some young people feel lonely as well. Being old is not the cause of the problem—being socially isolated is. What can you do to fight slipping into isolation?
“Make it pleasant for people to be with you,” advises an older widow. “Few people enjoy associating with a grouchy person. You need to put forth the effort to be cheerful. That takes energy, it’s true, but the energy you invest gives returns. Kindness begets kindness.” She adds: “To make sure that I have some topics of conversation in common with the people I meet, young or old, I try to keep up with the present by reading informative magazines and following the news.”
Here are some other suggestions: Learn to be interested in what other people like. Ask questions. To the extent possible, be generous. If you lack material goods, you can give of yourself; there is happiness in giving. Write letters. Take up a hobby. Accept invitations to visit other people or to go out with them. Keep your home cheerful and inviting for visitors. Reach out to people in need and offer help.
Religious environment. A growing body of evidence suggests that religious activities help older people to find “meaningfulness and significance in life” and to experience “happiness,” “a sense of usefulness,” “greater life satisfaction,” and “a sense of community and well-being.” Why? The book Later Life—The Realities of Aging explains: “Religious faith provides people with a philosophy of life as well as a series of attitudes, values, and beliefs that help them interpret and understand the world around them.” In addition, religious activities bring older people in contact with other people and thus “reduce the possibility of social isolation and loneliness.”
For Louise and Evelyn, both widows 80 years of age and members of a congregation of Jehovah’s Witnesses, these studies merely confirm what they have known for decades. “At our Kingdom Hall, I enjoy talking to others, old and young,” says Louise. “The meetings are educational. When associating after the meetings, we have some good laughs too. It’s a cheerful time.” Evelyn also benefits from her religious activities. “Going out to talk with the people in my neighborhood about the Bible,” she says, “keeps me from becoming isolated. But more than that, it makes me happy. Helping others to get to know the real meaning of life is satisfying work.”
Clearly, Louise and Evelyn have a purpose in life. The resulting feelings of well-being they experience lower the second hurdle—environment—and help them to stay on course.—Compare Psalm 92:13, 14.
Available—Low-Cost Medical Care With High Cure Rates
Advances in medical science in this century have lowered the third hurdle, medical care, dramatically—but not globally. In several poor countries, notes The World Health Report 1998, “life expectancy actually decreased between 1975-1995.” The director-general of WHO commented that “3 out of 4 people in the least developed countries today are dying before the age of 50—the global life expectancy figure of half a century ago.”
Even so, a growing number of older and younger people in poor countries are lowering this hurdle by making use of health care that is available and affordable. Take, as an example, a new approach in the treatment of tuberculosis (TB).
Worldwide, TB kills more people than AIDS, malaria, and tropical diseases combined—8,000 each day. Of every 100 TB patients, 95 live in the world’s developing countries. Some 20 million people now suffer from active TB, and some 30 million could die from it in the next ten years, a number equal to the combined populations of Bolivia, Cambodia, and Malawi.
No wonder WHO was pleased to announce in 1997 that it had developed a strategy to cure TB in six months without the need of hospitalization or high-tech medical care. “For the first time,” noted The TB Treatment Observer, a WHO publication, “the world has proven tools and strategies to reverse the TB epidemic not only in wealthy countries, but in the world’s poorest countries as well.” This strategy—described by some as “the biggest health breakthrough of this decade”—is called DOTS.
Although the cost of this strategy is much less than that of conventional TB treatments, the results are promising, especially for those living in developing countries. “No other TB control strategy has consistently demonstrated such high cure rates,” says Dr. Arata Kochi, director of WHO’s Global TB Programme. “DOTS produce cure rates as high as 95 percent, even in the poorest of countries.” By the end of 1997, the DOTS strategy had been adopted in 89 countries. Today that number has risen to 96. WHO hopes this strategy will reach many more millions of poor people in the least developed countries, thus enabling them to lower the third hurdle in the race of life.
By changing his habits, enhancing his environment, and improving his medical care, man has indeed been able to extend his average life span and life expectancy. The question is, Will it be possible one day for man to extend the maximum human life span as well—perhaps even to live without a finish line?
Although the terms “life expectancy” and “average life span” are often used interchangeably, there is a difference between the two. “Life expectancy” refers to the number of years an individual can expect to live, while “average life span” refers to the average number of years that member of a population actually live. Thus, life-expectancy estimates are based on average life spans.
In addition to these malleable factors, man’s fixed, inherited genetic makeup obviously affects his health and the length of his life. This will be discussed in the next article.
For more information on how to improve the home environment by simple measures, see the articles “Meeting the Challenge of Cleanliness” and “What Shapes Your Health—What You Can Do,” in Awake! issues of September 22, 1988, and April 8, 1995.
The location where Jehovah’s Witnesses hold their weekly meetings is called a Kingdom Hall. These meetings are open to the public, and no collections are taken.
DOTS is an acronym for directly observed treatment, short-course. For more information about the DOTS strategy, see the article “A New Defense in the Fight against Tuberculosis,” in the Awake! of May 22, 1999.
HOW MUCH AND WHAT KIND OF EXERCISE?
“Thirty minutes of moderate activity each day is a good goal,” says the National Institute on Aging (NIA). But you don’t have to exercise for 30 minutes all at once. Doing exercises for three short sessions of 10 minutes each is said to have the same benefits as doing the same type of exercises in one session of 30 minutes. What kind of exercise can you do? The NIA booklet Don’t Take It Easy: Exercise! Recommends: “Short bursts of activity, like taking the stairs instead of the elevator, or walking instead of driving, can add up to 30 minutes of exercise a day.
Raking leaves, playing actively with children, gardening, and even doing household chores can all be done in a way that count toward your daily total.” Of course, it is wise to consult your doctor before starting an exercise program.
Moderate physical activity can help the elderly to regain strength and vitality
KEEPING THE MIND FLEXIBLE
Scientific studies involving thousands of older people found several factors that help to keep an older mind flexible. They include “active engagement in reading, travel, cultural events, education, clubs, and professional associations.” “Do as many different things as possible.” “Keep your job. Don’t retire.” “Turn off the TV.” “Take a course in something.” It is believed that such activities not only lift the spirit but also rewire the brain.
Mental exercise helps keep the mind flexible
HEALTH TIPS FOR THE AGING
The National Institute on Aging, a division of the U.S. Department of Health and Human Services, says that “the chances of staying healthy and living a long time can be improved” by following levelheaded advice, such as the following:
- Eat a balanced diet, including fruits and vegetables.
- If you drink alcoholic beverages, do so in moderation.
- Don’t smoke. It’s never too late to quit.
- Exercise regularly. Check with a doctor before starting an exercise program.
- Stay in contact with family and friends.
- Stay active through work, play, and community.
- Keep a positive attitude toward life.
- Do things that make you happy.
- Get regular health checkups.
A NEW LOOK AT BRAIN CELLS
“We used to think that you lost brain cells every day of your life everywhere in the brain,” says Dr. Marilyn Albert, a professor of psychiatry and neurology. “That’s just not so—you do have some loss with healthy aging, but not so dramatic, and in very selective brain areas.” Moreover, recent findings suggest that even the long-held conviction that humans cannot grow new brain cells is, at the very least, “far too sweeping,” reports Scientific American of November 1998. Neuroscientists say that they have now collected evidence that even elderly people “do create additional neurons by the hundreds.”
OLDER AND WISER?
“Is there not wisdom among the aged and understanding in length of days?” the Bible asks. (Job 12:12) What is the answer? Researchers studied older people to measure such qualities as “insight, sound judgment, perspective and the ability to weigh conflicting values and generate good problem-solving strategies.” According to U.S.News & World Report, the study showed that “older people consistently outshine younger people on all measures of wisdom, offering more-thoughtful, sophisticated advice.” Studies also show that “although it often takes older people longer than youngsters to make a decision, it is usually a better one.” Thus, as the Bible book of Job suggests, age is, indeed, sage.
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A New Defense in the Fight Against Tuberculosis
TUBERCULOSIS (TB) is man’s oldest infectious killer, and it remains such a serious health threat that the World Health Organization (WHO) compares it to a time bomb. “We are in a race against time,” warns a WHO report on TB. If man fails to defuse this bomb, he may one day face a drug-resistant disease that “spreads through the air, yet is virtually as incurable as AIDS.” The time has come, urges WHO, to wake up to TB’s devastating potential. “Everyone who breathes air, from Wall Street to the Great Wall . . . , needs to worry about this risk.”
An overstatement? Hardly. Just imagine how wide-awake the world would be if a disease threatened to rage out of control and erase the entire population of, say, Canada in ten years! Though this sounds like fiction, the threat is real. Worldwide, TB kills more people than AIDS, malaria, and tropical diseases combined: 8,000 persons each day. Some 20 million people now suffer from active TB, and some 30 million could die from it in the next ten years—a number larger than the population of Canada.—See the box “TB’s Global Grip,” on page 22.
Now the Good News
Today, however, there is hope. After ten years of testing, researchers have come up with a strategy that may reduce TB from being a killer on the loose to being a criminal under siege. Dr. Hiroshi Nakajima, former director-general of WHO, called this new strategy “one of the most important public health breakthroughs of this decade.” And Dr. Arata Kochi, director of the WHO Global TB Programme, says that it offers the first-ever chance to “reverse the TB epidemic.” The cause of all this excitement? A method called DOTS.
DOTS is an acronym for directly observed treatment, short-course. It is a health management system that can cure most TB patients in six to eight months without their spending a single day in the hospital. DOTS depends on five elements for its success. If any of the elements are missing, notes WHO, the ability to cure TB victims “slips through our fingers.” What are these elements?
- 1. Directly: The most dangerous TB case is the undiagnosed case. WHO thus stresses that first of all, health-care workers should direct their efforts to identifying the people in their community who suffer from contagious TB.
- 2. Observed: The second element of DOTS makes the health system—not the patient—responsible for achieving a cure. Health-care workers or trained volunteers, such as shopkeepers, teachers, or former TB patients, observe patients swallowing each dose of anti-TB medicines. “Patient observers” are crucial for success because a main reason why TB persists till today is that patients stop taking their medicines too soon. (See the box “Why on the Rise—Again?” on page 22.) After just a few weeks of medication, they start feeling better and stop taking their pills. Yet, the medication must be taken for six to eight months in order to rid the body of all TB bacilli.
- 3. Treatment: During these six to eight months, health workers monitor the results of the treatment and document the patients’ progress. In that way, they make sure that patients are fully cured and cannot pass the infection on to others.
- 4. Short-Course: Using the right combination and the right amount of anti-TB drugs, known as short-course chemotherapy, for the right length of time is the fourth element of the DOTS strategy. These combined drugs give a knockout punch to kill the TB bacilli. The drugs must always be in supply so that treatment is never interrupted.
- 5. !: WHO expresses this fifth element of the DOTS strategy by means of an exclamation mark at the end of DOTS! It represents funding and sound policies. WHO urges health systems to secure financial commitment from governments and nongovernmental organizations and to make TB treatment part of the country’s existing health system.
Speaking of funding, the DOTS method appeals to policymakers holding the purse strings. The World Bank has ranked DOTS as “one of the most cost-effective interventions available in fighting . . . disease.” The total cost of using the strategy in poor countries, calculates WHO, is about $100 per patient. “This seldom amounts to more than 10 cents (U.S.) per capita in developing countries, which is affordable even in the worst economic conditions.” Low costs, however, do not rule out high payoffs.
How Well Does It Work?
WHO representatives announced in March 1997 that the limited use of the DOTS strategy was “causing the global TB epidemic to level off for the first time in decades.” “Where DOTS is used, cure rates nearly double.” DOTS pilot projects carried out in areas rife with TB already show that the strategy is working. Consider a few success stories cited by WHO.
In India “DOTS has been applied in demonstration areas covering over 12 million people. . . . Tuberculosis is now cured in 4 out of every 5 patients.” In a pilot program covering one million people in Bangladesh, “87 percent [of the TB patients] were cured.” On an Indonesian island, a DOTS project “is curing 9 out of 10 infectious patients.” In China, pilot projects were “a stunning success,” with a cure rate of 94 percent. In one South African city, “more than 80 percent [of the TB patients] are being successfully treated.” Recently, DOTS was also instituted in New York City, with impressive results.
The findings of field tests in several dozen countries, concludes Dr. Kochi, show that the strategy “can be used everywhere and can produce cure rates of 85 percent and more.”
No Boom—But Progress
With a treatment that can practically defeat one of man’s deadliest infectious killers easily and inexpensively, you would expect the DOTS strategy to be booming. “Yet,” says a WHO official, “surprisingly few countries are implementing WHO’s proven and cost-effective TB control strategy.” Indeed, at the beginning of 1996, only 34 countries had implemented the strategy nationwide.
Even so, there is progress. Prior to 1993, when WHO declared a global TB emergency, only 1 out of every 50 TB patients received DOTS. Today that ratio is 1 out of every 10. Reportedly, in 1998 some 96 countries were using the DOTS strategy. If more countries rally around DOTS, the annual number of TB cases ‘will be cut in half in just a decade.’ Says Dr. Kochi: “We have a proven health care package which only needs to be used more widely.”
Since man has the knowledge and the tools to fight against TB successfully, the only thing that is lacking is the ‘people who will see that these medicines are put to use throughout the world.’ No wonder that in a publication directed to physicians and other health workers worldwide, WHO asks: “What are we all waiting for?”
The drugs include isoniazid, rifampin, pyrazinamide, streptomycin, and ethambutol.
Every second, someone on earth is infected with tuberculosis ‘Lifesaving medicines sit on the shelf while millions die.’
—Dr. Arata Kochi
“The DOTS strategy will represent the most important public health breakthrough of this decade.”—WHO press release
Why on the Rise—AGAIN?
The cure for tuberculosis (TB) was discovered more than four decades ago. Since then, over 120 million people have died of TB, and nearly 3 million more people will die this year. Why are so many people still dying from TB when there is a cure? For three main reasons: neglect, HIV/AIDS, and multidrug-resistant TB.
Neglect. The eyes of the world are focused on such infectious diseases as AIDS and Ebola. In 1995, however, for every person who died of Ebola, 12,000 died of TB. In fact, TB is so common in developing countries that people there have come to view the disease as a fact of life. Meanwhile, in the richer countries, TB has been allowed to spread even while effective medicines to cure it sit on the shelves. This global neglect has proved to be a fatal mistake. While the world’s concern about TB was weakening, the TB bacilli were growing stronger. Today they attack more people in more countries than ever before in human history.
HIV⁄AIDS. TB is a traveling companion of HIV and AIDS. When people become infected with HIV—which lowers their immunity—they are 30 times more likely to develop TB. No wonder that the current worldwide HIV epidemic has caused an increase in the number of TB patients as well! It is estimated that 266,000 HIV-positive people died from TB in 1997. “These are the men and women,” says Peter Piot, director of the Joint United Nations Programme on HIV/AIDS, “who didn’t benefit from the inexpensive anti-TB medicines they needed to cure their tuberculosis.”
Multidrug-Resistant TB. “Superbugs,” immune to man’s antibiotic arsenal, are the stuff of science fiction, but in the case of TB, they are rapidly becoming a fact. More than 50 million people may already be infected with multidrug-resistant (MDR) TB. Patients who stop taking their medicines after a few weeks because they feel better, because the drug supplies run out, or because the disease carries a social stigma do not kill all TB bacilli in their body. In one Asian country, for instance, 2 out of every 3 TB patients drop out of treatment early. When they become sick again, the disease may be harder to treat because the surviving bacteria fight back and triumph over every available anti-TB medicine. As a result, the patients end up with a type of TB that is incurable—for them and for whomever they may infect. And once this deadly MDR genie is out of the bottle , we are left with the grim question, Will man be able to put it back?
TB’s Global Grip
The tuberculosis (TB) epidemic is growing more sizable, more expensive, and more deadly by the year. Reports gathered by the World Health Organization trace the spread of this silent killer. Here are some examples: “Pakistan has been losing the war against tuberculosis.” “Tuberculosis has returned to Thailand with a vengeance.” “Today, tuberculosis ranks among the leading causes of illness and death in Brazil.” “Tuberculosis has maintained a tenacious grip on Mexico’s people.” In Russia “the incidence of TB is rising sharply.” In Ethiopia “tuberculosis rages throughout the country.” “South Africa has one of the highest recorded incidence rates of TB in the world.”
Although 95 out of every 100 TB patients live in the world’s poorer countries, TB is tightening its grip on rich countries as well. The United States saw a sharp rise in reported TB cases during the early 1990’s. U.S. journalist Valery Gartseff notes that TB “has once more returned to haunt Americans.” Likewise, Dr. Jaap Broekmans, director of the Royal Netherlands TB Association, said recently that the TB epidemic has “begun to worsen in Eastern Europe and parts of Western Europe.” Not surprisingly, the journal Science, of August 22, 1997, states that “tuberculosis continues to be a major health threat.”
TB Blueprint Discovered
Researchers recently succeeded in documenting the entire genetic blueprint of the tuberculosis (TB) bacterium. This feat marks “a new phase in the battle against one of mankind’s most successful predators,” says Dr. Douglas Young, of the Imperial College School of Medicine in London. The World Health Organization reports that this discovery “could prove invaluable to future research on anti-TB drugs and vaccines.”—The TB Treatment Observer, September 15, 1998.
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