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Chapter – 16


There are six components of wellness: proper weight and diet, proper exercise, breaking the smoking habit, control of alcohol, stress management and periodic exams.           -Dr. Kenneth Cooper

This chapter is a brief summation of the proceeding 15 chapters.  If you don’t have time to read the preceding 15, at least read this one.

Preventive health care (preventive medicines) consists of measures taken for disease prevention as opposed to disease treatments.  Health includes a variety of physical and mental state.  Like health, disease and disability, are affected by a multiple of factors – genetic, environment, disease agents and lifestyle choices.  Health, disease and disability are dynamic process.  Everyday our knowledge about them is changing mostly for the better.

Each year millions of people die from preventable causes. Smoking is the leading cause of preventable death.  Smoking leads to disease and disability and harms nearly every organ in the body. The leading causes of death in 2015 worldwide were heart disease, stroke, lower respiratory diseases, and diabetes, Alzheimer, tuberculosis and road injuries. Indoor and outdoor air pollution, unsafe drinking water and poor sanitation, smoking and drinking, obesity, lack of physical activity, under nutrition and lack of proper vaccination are major contributing factors for most of these diseases.

Chronic diseases like heart disease, diabetes and cancer are responsible for large number of deaths worldwide.  Many of these deaths can be prevented by lifestyle changes, early screening and early treatment.  Eating healthy, exercising regularly, avoiding tobacco and alcohol, getting vaccination, getting cancer screening are just a few examples of ways people can stay healthy.  The right preventive care at any stage of life helps us to stay healthy, delay or avoid the onset of disease and disability.  Followings are a brief summary of steps you can take to stay healthy.


  • Follow a healthy eating pattern from childhood to old age.
  • Limit your calories from added sugar, saturated fats and Trans fats.
  • Eat a variety of vegetables – dark green, red, orange, legumes (beans and peas), starchy and others.
  • Eat a variety of fruits – especially whole fruits.
  • Eat whole grains –brown rice, whole wheat flour.
  • Eat fat – free or low – fat diary, including milk, yogurt, cheese and / or fortified soy drinks.
  • Eat variety of protein foods, including fish, poultry, eggs, lean meat, legumes (beans and peas), nuts, seeds and soy –products.
  • Limit saturated fats, Trans fats, added sugar and salt.
  • Don’t smoke or drink.


Any form of physical activity can improve health, including daily activities that wouldn’t be called exercise – walking, gardening, and dancing.  Physical activity provides health benefits for every part of the body.  Exercise reduces the risk of developing heart disease, high blood pressure, stroke, type-2 diabetes, depression and some cancers.

There are 3 main types of exercises – Aerobic – Activity, Muscle-strengthening and Bone-Strengthening.  Do some exercise from each group.

Children and Adolescents (6-17 years old)

Children and adolescents should get 60 minutes of physical activity daily.

Aerobic Activity – Get 60 minutes of moderate to vigorous physical activity – daily.  As a part of the 60 minutes a day-should include muscle – strength activities like – using playground equipment, climbing, and weight lifting or jumping ropes at least 3 days a week.

Adults (18-64 years old)

  • 150 minutes (2 ½ hours) of moderate – intensity each week or
  • 75 minutes of vigorous physical activity each week.
  • For even greater health benefits you can increase the moderate – intensity physical activity to 300 minutes a week or vigorous – intensity physical activity to 150 minutes a week.
  • Include muscle – strengthening and bone-strengthening activities at least 3 times a week (like-lifting weight, resistance bands, push-ups, pull-ups).

Older Adults (Age 65 and Older)

  • For older adults who are fit and have no limiting chronic diseases, the guidelines are same as those for all adults (18-64).

Guideline Just for Older Adults

  • Be as active as possible.
  • Do some activities to improve your balance – walks on heels or toes, walk forward and backward, stand on one leg.
  • Do some activities to improve your flexibility – stretching exercises.

Ideal Body Weight

                                    BMI                                                    Status

Below 18.5                                        Under weight

18.5 to 24.5                            Normal weights

25 to 29.9                                          Overweight

30 or higher                                      Obese


Newer studies show that normal BMI for Asians is up to 23 instead of 24.5.  Know your BMI.

Waist Circumference (WC)

Excessive abdominal fat (belly fat), in spite of being of normal weight puts a person at greater risk for developing type -2 diabetes, high blood pressure and heart disease.  The normal waist circumference for an Indian man is less than 78 cm and Indian women is less than 72 cm.  (For Americans men less than 40 inches women less than 35”).  Overweight and obese people are at higher risk of developing – type-2 diabetes, high blood pressure, stroke, heart disease, arthritis, gallstone, mental illness and some cancer.

Losing Weight

To lose weight, you must use up more calories than you take.  To lose one pound (.45Kg), you have to reduce your caloric intake by 3,500 calories or use 3,500 calories more.  1 gram of carbohydrate and protein has 4 calories each and 1 gram of fat has 9 calories.  Reduce your caloric intake by 600 – 1000 calories a day to lose about 1 to 2 pounds (.45 Kg to 0.9 Kg) a week.

Losing weight is not easy, and it takes commitment.  Even modest weight loss has big health benefits. 

Tips For Losing Weight

  • Eat a healthy meal.
  • Eat slowly
  • Use smaller plates
  • Don’t skip meal – eat 3-4 small means a day. East low caloric snacks.
  • Eat more fiber.
  • Get at least 30 minutes – 60 minutes of exercise a day.

Preventing Infections

There are many different kinds of infection – bacterial, viral, fungal and parasites.  The steps you need to take to prevent an infection depend on how the infection is spread.

Food Borne Illnesses

  • Drink safe water,
  • Wash your hands with soap and water before handling food
  • Drink only pasteurized milk and juices.
  • Wash fruits and vegetables well before cooking. Avoid raw vegetables.
  • Cook all the foods well – special meat and poultry.
  • Refrigerate leftover food promptly.

Common Cold and Flu

  • Wash your hands often with soap and water or sanitizer.
  • Avoid getting close to people with cold and flu.
  • Cover your mouth and nose when coughing and sneezing and wash your hands.
  • Take flu vaccine every year.


  • Spray indoor and outdoor with insecticide.
  • Use insecticide treated mosquito nets.
  • If you are travelling to a malaria endemic area take prophylactic medicine.

Sexually Transmitted Diseases and HIV/AIDS/Hepatitis-B

  • Don’t have multiple sex-partners.
  • Use condom (male & females from start to finish of sexual act.
  • Don’t have sex with IV drug users.
  • Don’t share contaminated needles. If in doubt get tested for STDs and HIV, Hepatitis – B treatment will save your life.
  • Get vaccinated for hepatitis-B and hepatitis-A.

Preventing Children Sickness and Death

In 2015, 5.9 million children under the age 5 died from preventable diseases (WHO) worldwide.  About 45% of all children’s death are somewhat related to malnutrition.  A child’s risk of dying is highest in the first month of life.  Under-5 children deaths can be reduced by-

  • Safe and clean delivery of all babies.
  • Breast feeding of all babies.
  • Providing adequate nutrition to all children.
  • Providing safe drinking water.
  • Providing adequate sanitation and hygiene.
  • Use of mosquito nets by all families in malaria endemic area.
  • Provision of Oral Rehydration Solution (ORS) for diarrhea.
  • Vaccination of children for multiple diseases.

Preventing Maternal Deaths

Every day, 830 women die worldwide from child birth and pregnancy related causes.  Most of these deaths are preventable.  Here are some steps women can take before, during and after pregnancy.

  • Eat a healthy diet with whole grains, cereals, fruits, vegetables, fish and poultry and milk products legumes and beans.
  • Take 400 microgram of folic acid and extra iron (a prenatal Vitamin tablet) during pregnancy.
  • Stop smoking and drinking during pregnancy.
  • Get regular prenatal care.
  • Deliver your baby in a hospital or clinic.

Children Health

Some of the steps you can take to keep your children healthy are:

  • Like adults children should eat a variety of nutritious foods. Their diet should include whole grain cereals, vegetables, fruits, milk products, legumes, eggs, fish, poultry and meal. A protein rich vegetarian diet is also appropriate.  Avoid junk foods.
  • Exercise or play 60-90 minutes a day.
  • Limit screen time (TV, Computer, Cell phone) to 2 hours or less a day.
  • All children should get a good night sleep.
  • Immunize them against all the infections for which there is a vaccine available.
  • Discourage them strongly not to smoke, or drink alcohol or do drugs. Set an example yourself.
  • Involve them with extra-curricular activities – sports, music, dance etc.
  • Use mosquito nets – in mosquito prone areas.


Adolescence is a time of raid change – both physical and mental.  This is when adolescents experiment with smoking, alcohol, drugs and sex.  Teenage pregnancy is a main health issue.  Self-injuries are a main health issue.  Self-injuries and suicides are also problem at this age.

  • Watch for signs of depression.
  • Pay attention to their friends.
  • Listen to your child. Find time.
  • Strongly discourage tobacco, marijuana, alcohol and drug use.
  • Set clear limits and enforce them.
  • Be a role model.

High Blood Pressure, Stroke, Heart Disease and Diabetes (Type-2)

These four chronic diseases are interrelated.  Their risks and preventive measures are similar.  They are also the most common cause of death and disability worldwide.

Risk Factors

  • Family history – parents, brothers and sisters with the diseases.
  • Age – above 45
  • Smoking
  • Overweight and obesity
  • Lack of physical activity
  • Excess alcohol use


  • Stop smoking
  • Loss weight if overweight or obese.
  • Get regular exercise
  • Eat a healthy diet – vegetables, fruits, whole grain, legumes low fat diary product, fish and poultry.
  • Get regular checkup.
  • Control your blood pressure, blood sugar (if diabetic) and blood cholesterol.
  • Get appropriate immunization for your age.


Cancer can start almost anywhere in the human body.  All cancers are not fatal.  Early diagnosis is the key.  Most common killer cancers are – lung, colon and rectum, breast, prostate, pancreas and non-Hodgkin lymphoma, leukemia, ovarian and stomach.

Risk Factors Are

  • Cigarette smoking and tobacco use in any form.
  • Infections
  • Radiation
  • Immune suppressive drugs

Tobacco use is strongly linked to lung, bladder, kidney, and pancreas and stomach cancer.  Chewing tobacco products of all kinds are strongly linked to mouth cancer.  30% of all cancer deaths are related to tobacco.

Preventing Cancer

You can reduce (not eliminate), your risk of getting cancer by making healthy choices.

  • Do not smoke
  • Don’t use tobacco products of any kind.
  • Protect your skin from UV rays of the sun – cover your skin with clothe and hat use sun block, sunglasses.
  • Avoid alcohol (excessive)
  • Get hepatitis B, hepatitis – C and HPV (Human Papilloma Virus) vaccinations.
  • Get age – appropriate cancer screening- mammogram, colonoscopy, and Hepatitis screening and genetic tests.

Chronic Obstructive Pulmonary Disease (COPD)

Risk Factors:

  • Tobacco smoke.
  • Indoor and outdoor air pollution – especially cooking smoke.
  • Occupational dust – coal, sand, chemicals.


  • Do not smoke. If you are a smoker quit – now.
  • Cook near a open window.
  • Use face mask – if your work involves dust particles.
  • If you are breathless, get it checked.

Bones and Joints Health

  • Osteoporosis

Risk Factors

  • Being female, of Asian origin.
  • Being older than 50.
  • Being thin.
  • Being a smoker or drinker
  • Being inactive.


  • Eat a well-balanced diet.
  • Use Vitamin and Calcium supplement.
  • Be physically active.
  • Avoid smoking and drinking alcohol.
  • Get screen for osteoporosis.
  • Osteoarthritis (Joint Disease)

Osteoarthritis is also known as degenerative arthritis – where there is wear and tear of joints.

Risk Factors

  • Obesity
  • On the job over – use
  • Hereditary
  • Older age
  • Weak muscles
  • Sort injuries


  • Keep your weight down
  • Perform strength – training exercises
  • Work smart – especially heavy lifting.

Health Aging

People can often control the age – related disability by certain lifestyle changes.

  • Eat healthy diet, with extra calcium and Vitamin – D.
  • Stay Active.
  • Pay attention to our weight.
  • Get regular health screening.
  • Get age – appropriate vaccination – flu, herpes, zoster, pneumonia.

Oral Health

Oral health is essential to general health.

Prevention tooth loss and gum disease

  • Brush your teeth twice daily and floss at least once a day.
  • Use fluorinated water and tooth paste.
  • Get your teeth and gum checked by a dentist at least twice a year.
  • Do not smoke.
  • Do not use smokeless tobacco products of any kind.

There are some evidence to suggest that gum disease may be contributing to heart disease and stroke.  Oral health is beneficial to your overall health and for a good smile.


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