Greetings to all my readers for this first blog on lifestyle medicine for 2020.  Our family spent the holiday season together in wintry Norway – for the first time in our lives.  Our son is working with a large non-governmental international aid agency, based now in the Norwegian office – being the reason to visit that country.

ALSO READ : Turning the Tide – Lifestyle Medicine and Emotional Health (part 2)

I was fascinated to see the differences in lifestyle in Norway compared to back home.  A couple of things struck me:

• Inclement weather does not seem to dampen people’s enthusiasm for exercise. Even when it is snowing, or the temperature is -5’C you still see people jogging with headlights in the morning dark (in mid winter the sun rises at 9:30 am and sets at 3:30 pm), or walking their dogs on icy roads, where the dogs have little warming socks for their feet.
• There is appropriate clothing and equipment for any weather. Even bicycles can be equipped with studded tyres for the ice on the roads and you can get running shoes with studs.
• The incidence of obesity is much lower in Norway according to my general observation compared to S Africa. (South Africa is ranked number 40 in the world, and Norway number 92).
• An amazing common practice is to put your child outside in their pram to sleep during the day at nap time, even in the middle of winter. Of course they are warmly wrapped up.  Even at the Day Care facilities this practice is implemented across the board.  I can’t imagine that being allowed in S Africa – apart from the risk of your child being kidnapped.  But this practice makes children comfortable in the outdoors as they grow up.
• Children as young as 2 years old start learning to ski – which is a good idea, because when you fall you have a lot shorter distance to fall. (And I did learn from personal experience that skiing is a lot harder than it looks!)
• The consumption of berries is high. Evidently blueberries and many other berries grow wild everywhere, and can readily be picked and frozen to use all year long.  We know that berries are very rich in health-promoting anti-oxidants and phytochemicals.
• A very high sugar tax is being implemented. Soft drinks cost almost 3 times the equivalent in S Africa and water is abundant and clean.

What do the official statistics say:

The health status of the population of Norway in 2018 was generally good. In 2017, life expectancy was 84.3 years for women and 80.9 years for men. (In S Africa in 2018 males 61,1 and 67,3 years for females).

The two main causes of death are cardiovascular disease and cancer. The mortality rate for cardiovascular disease has fallen significantly over the last 50 years and deaths have largely shifted to the over-80 age groups.

This decrease in incidence seems to be related to increased exercise and better control of blood cholesterol levels.

The incidence of obesity is rising steadily (but not nearly as much as S Africa), and possibly contributing to the rising incidence of diabetes, although there seems to be a levelling off of the incidence of diabetes lately.  One in 4 men and 1 in 5 women are obese.  (In S Africa the incidence amongst women far outnumbers that in men.)

Only about 10% of the population smokes.

In the last 200 years public health in the country has come a long way.  Leprosy (also called Hansen’s disease) was prevalent along the west coast in the 1800’s.  Gerhard Hansen was a Norwegian doctor in Bergen who was the first to identify and describe the leprosy bacillus, and was able to show scientifically that isolation of leprosy patients reduced the spread. (Of course isolation of leprosy patients was prescribed in Mosaic health laws already thousands of years ago). Tuberculosis was the next major disease to ravage the country.  Other infectious diseases like cholera and typhoid, smallpox, polio and diphtheria have been eliminated through immunisation and through better public hygiene.

Norway is a fairly wealthy country thanks to vast oil wells in the North Atlantic, and good, responsible governance.  The national resources are used to subsidies socialised health care and free education and maintain efficient and well-working infrastructure.  Of course “free” education and subsidised health care has to be paid for and that means very high personal taxation.  The incidence of unemployment is low, even with increasing numbers of immigrants from Eastern Europe, the Middle East and Africa.  However your chance of getting employment unless you speak Norwegian is very limited.  Norway is the 5th largest country in Europe – even larger than Germany, yet only has a population of 5,6 million people.  One must acknowledge that vast areas in the north above the arctic circle have very harsh environments, so most of the population is concentrated in the south.

What can we learn from the Norwegians?  I think the take home message is that activity, especially in the open air, is a very important component of healthy living.  In South Africa crime is a very real deterrent, especially for women, children and the elderly, but we could do more in so-called safe areas.

Another good take home message is that healthy living is our own personal responsibility – we have choices we can make – we can’t rely on governments to make those decisions for us, neither can we rely on public health systems to fix the problems.

ALSO READ : Turning the Tide – Lifestyle Medicine and Emotional Health (part 1)

As we begin 2020 it is good to set small reachable goals – start to implement short-term changes in your diet, and with exercise, setting new priorities in your life in terms of family time and social interactions, spending more time in personal devotions and meditation/prayer.  Too many people set unreachable targets, and then get discouraged and give up.

May 2020 be a turning point for the better in your health journey.

Next week we will talk about a famous project in Finland that has seen a dramatic reduction of heart disease in North Karelian men by 73% from the highest incidence in the world.  There is much we can learn from that project both in terms of what changes to make and how to implement these changes in the general population.

Dave Glass

Dr David Glass graduated from UCT in 1975.  He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital. 

He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world.  He no longer delivers babies but is still very clinically active in gynaecology.

An old passion, preventive health care, has now replaced the obstetrics side of his work.  He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle – obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.

He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing.  He is active in community health outreach and deeply involved in church activities.  He enjoys teaching and sharing information.

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