How many of you can remember when cigarette-vending machines could be found in hospital corridors, and when doctor’s fingers were stained with tobacco smoke while they told you to stop smoking?
I remember only 35 years ago washing half the windows and walls in the nurses’ or doctors’ tea room at Mowbray Maternity Hospital down, to demonstrate visually the amount of smoke pollution that had accumulated. Nobody noticed until I pointed it out. But I doubt it made any difference in the smoking practices of the staff.
Thankfully, Dr Nkosazana Zuma left us a lasting legacy by challenging the might of tobacco companies through legislation to ban smoking in public places and to remove cigarette-vending machines. The prevalence of smoking has diminished worldwide, but there is still work to do.
However, another more challenging issue these days is the rapidly expanding pandemic of non-communicable diseases (NCDs). Up to 80% of doctors’ consultations are for NCDs – obesity, diabetes, high blood pressure, heart disease, auto-immune diseases, cancer and dementia. These are all strongly linked to lifestyle factors – poor diet, stress, physical inactivity, poor sleeping habits, addictions and insufficient social connections. How can we address these underlying causes to prevent and manage NCDs effectively? It will need enormous energy and work to turn the “ship” around. We need people with the strength and will of Dr Nkosazana Zuma to legislate needed laws preventing the rampant marketing of harmful and addictive foods, especially to our children. Much robust scientific evidence shows that ultra- and highly processed foods are the major cause of NCDs.
To that end, just as hospitals stopped selling cigarettes in their corridors, isn’t it time now that hospitals set the standard for nutrition? How about banning the vending machines that sell ultra-processed foods, like sugar-sweetened beverages, snacks loaded with saturated fats, salt and sugar, and other sugar-rich foods? How about mandating that the kiosks and hospital kitchens stop selling processed meats (like sausages, polonies, and cold meats), that are recognised carcinogens?
How about if catering companies servicing the hospitals (both private and state) provide whole food plant-rich options as the default diets? There is more than adequate evidence that plant-rich diets (like the Mediterranean, DASH and whole-food plant-based diets) are powerful in preventing, managing, and even reversing NCDs.
In 2017, both the American Medical Association and the American College of Cardiology passed a recommendation that hospitals throughout the USA should incorporate more plant-rich diets. Many hospitals have done that. New York City led the way. All hospitals, schools and prisons there now provide plant-based as the standard diet, and patients have to specifically request fast foods or ultra-processed foods if they want them. Fast-food outlets have been removed from hospitals. Statistics show that the policy is making a difference, with 95% of patients accepting and 90% satisfied with the diets. Interestingly, with more than 500 000 meals served, there was a 17% cost saving. That should make hospital managers happy!
Hospitals in Somerset West, how about leading the way in South Africa?
V This health column is written by Dr Dave Glass, a retired obstetrician/gynaecologist living in Somerset West. He is chairperson of the South African Lifestyle Medicine Association (SALMA).
