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Controllable Factors
There are a number of things which can be done to control the risk of developing certain chronic health conditions. The relationship between controllable risk factors and certain chronic diseases are highlighted in table 2.0. Note that high blood pressure and high cholesterol are often a result of the other controllable risk factors (drinking, smoking, poor diet and physical inactivity).
Table 2.0 Controllable risk factors and their relationship with chronic diseases (9).
Depressed / Stressed / Anxious States of Mind
If your mental wellbeing is being affected by depressive/stressed/anxious states you are more likely to make bad decisions. But this doesn’t have to be the case! There are a number of support networks, family members and friends willing to help you through ‘hard times’. Don’t hesitate to speak out and contact a support network to point you in the right direction. Depression affects one in six men. You are not alone, so get help (83).
Lifeline: 13 11 14
The chances of suicide increase if a condition such as depression, bi-polar, post traumatic stress, anxiety and stress go untreated. Each year, approximately 2,100 Australians die by their own hand (5), with nearly 80% of them being males (5). During 1995 to 2005 the male suicide death rate was approximately four times higher than the female rate (5). The average age of these men when they committed suicide was 41.4 years (5). Suicide is entirely preventable, and is claiming the lives of far too many men.
See your doctor as soon as possible if you believe you have an undiagnosed mental disorder.
Overweight / Obesity
- How to identify if you are overweight or obese:
- Waist to Hip Ratio
- Overweight and Obesity in Men
- Cardiovascular Disease
- Diseases of the Circulatory System
- Heart disease
- Hypertension (High blood pressure)
- High blood cholesterol
- Musculoskeletal and Connective tissue diseases/disorders
- Mental / Behavioural Problems & Psychological Distress
- Respiratory disease/disorders
In a follow-up of the Australian Diabetes, Obesity and Lifestyle Study, more than 600 adults cross the line from being overweight to obesity every day, that’s more than 200,000 people per year (21). For the first time in Australia, overweight and obesity has overtaken tobacco as the number one risk factor responsible for disease: 8.6% compared with 7.8% for tobacco (8).
Body Mass Index (BMI):
Being obese (where your BMI is more than 30 kg per metre of height squared) is linked with increased risk of developing cancers of the colon, kidney, oesophagus and gall bladder (68). Being overweight (where your BMI is between 25 and 30 kg per metre of height squared) is also linked with these cancers, however the risk is less (33, 68, 114).
How to use the Body Mass Index (BMI) table:
1. Find your height (cm) at the top & weight (kg) on the left side (use closest measure if exact is not listed)
2. Follow the two lines until they intersect
3. The number in the intersecting square is your BMI
4. Look below to see where you score
Waist Circumference
Men who have waist circumferences over 94cm are more likely to develop chronic health conditions. Men who have a waist circumference greater than 102 cm (marker of central obesity) are considered to have even greater risk of developing chronic health conditions. The waist circumference measurement is considered a better predictor of cancer risk than BMI (79).
Overweight = greater than or equal to 94cm (Increased risk of developing chronic health condition)
Obese = greater than or equal to 102cm (Substantially increased risk of developing chronic health condition)
Waist to Hip Ratio
Waist to hip ratio = Waist circumference (cm) divided by hip circumference (cm)
A ratio greater than 0.9 for males indicates that the person may be at greater risk of chronic disease, including obesity.
Download a Measuring Tape
Overweight and Obesity in Men
In 2005, overweight or obesity cost taxpayers a staggering $21 billion in 2005 (6). According to the National Health Survey, 54% of Australian adults in 2004-05 were either overweight or obese (4). Only fifteen years ago (1989-90) 38% were as overweight or obese (4). Men are more likely to be overweight or obese than women (62% to 45%) (8). The average self reported weight of Australian men increased by 6.2kgs from 77.4 kg in 1989-90 to 83.6 kg in 2004-05, while the percentage of men who reported a normal weight decreased from 52% to 37% (8). The scary fact is 63% of those men considered themselves to be at a healthy weight (8), leaving a 26% gap between perception and the reality. Some men need to take a good look in the mirror and honestly reassess their health.
Being overweight or obese brings an increased risk of developing medical conditions such as:
- Cardiovascular Disease
- Osteoarthritis
- Certain Cancers
- High Blood Pressure
- High Cholesterol (114).
Long Term Health Conditions
People who are obese are slightly more likely to have a long term health condition (a condition which lasts longer than exceeds six months) than those who are overweight or average (4). However, more overweight or obese adults are much more like to have multiple long term health conditions (4). The average number of long term health conditions reported by adults was three (4), with the obese reporting an average of four (4). Of the adults who reported five or more long term health conditions, 61% were overweight or obese (4).
Cardiovascular Disease
Diseases of the Circulatory System
Those who are overweight or obese are at major risk for developing diseases of the circulatory system (4). In 2004-05 it was found that 23% of Australian adults (approx 3.2 million) had a disease of the circulatory system, with 28% of those being overweight or obese (4).
Heart Disease
Forms of heart disease include hypertension (high blood pressure) and ischemic heart disease (narrowing of the arteries) (4). Being overweight or obese is a major risk factor for heart disease (8). In 2004-05 it was established that 15% of Australian adults (approx 2.1 million) had heart disease, with 20% being either overweight or obese (4). 26% of adults who were obese reported having heart disease, along with 18% of those that were overweight (4). However, three quarters of the men who were found to have heart disease were overweight or obese (4). If you can decrease your weight into the ‘normal’ bodyweight zone the relationship between the two conditions drops to just 10% (4).
Hypertension (High blood pressure)
Hypertension is the most common form of heart disease, and is a known risk factor for other health conditions of the circulatory system such as coronary heart disease and stroke (7). Overweight and obesity are linked to detrimental effects on blood pressure (114). The national health survey in 2004-05, found that 14% of Australian adults (approx 1.9 million) had hypertension (4). As the population’s body mass index (BMI) increased so too did the rate of hypertension (4). Hypertension was found in 16% of those who were classified as overweight and 24% of those who were obese (4).
High Blood Cholesterol
High blood cholesterol is strongly related to heart disease and stroke. Cholesterol can be deposited onto artery walls narrowing their diameter and increasing the risk of clots forming, which can obstruct blood flow (8). Having high blood pressure, teamed with being overweight or obese can affect the body’s ability to metabolise cholesterol (114). In 2004-05 it was found that 9% of Australian adults (approx 1.3 million) had high blood cholesterol. Like hypertension, those who had a higher BMI were likely to have high blood cholesterol. The proportion of people with high blood cholesterol doubled if they were overweight or obese (4).
Musculoskeletal and Connective tissue diseases / disorders
Musculoskeletal and connective tissue diseases include arthritis, osteoporosis, rheumatism, back pain and disc disorders (4). Chronic musculoskeletal conditions are among the most debilitating health problems associated with obesity (114). In 2004-05 an alarming 44% of Australian adults who were overweight or obese (approx 5.5 million) had a condition of the musculoskeletal system (4).
Arthritis
Of those who were overweight or obese, 23% suffered from arthritis, including osteoarthritis (19% of men). The proportion of overweight or obese adults with arthritis increased with age, with the highest proportion of sufferers in the 75 years or more age group (54%). Osteoarthritis is a degenerative, and often painful, condition, where the cartilage wears down over a long period of time (4). The disease often affects the hands, spine and weight bearing joints such as the hips, knees and ankles (4). Excess body weight can place extra pressure on cartilage and joints, therefore increasing the risk of developing osteoarthritis (7). In 2004-05 it was estimated 10% of Australian adults (approx 1.4 million) had osteoarthritis with 63% of those classified as overweight or obese (4).
Respiratory disease / disorders
Obesity is also linked to respiratory difficulties (114), such as chronic obstructive pulmonary disease, asthma, obstructive sleep apnea and obesity hyperventilation syndrome (4). In 2004-05 it was found that 32% of Australian adults (approx 4.4 million) who had a respiratory condition were overweight or obese (4). By being overweight or obese, extra pressure is placed on the chest through gravity, often making it much harder to breathe.
Diabetes
Type 2 diabetes is a condition where the body builds up a resistance to the effects of insulin, or produces too little insulin, so that a person becomes incapable to control blood glucose levels (4). It has been reported that 75% of adults with type 2 diabetes are overweight or obese (4). There is a link between a high Body Mass Index (BMI) and an increased risk of developing type 2 diabetes (4).
Mental / Behavioural Problems & Psychological Distress
Data collected in 2004-05 showed that 12% of Australian adults (approx 1.6 million) reported suffering from a mental or behavioural problem. Of the men classified as overweight or obese, 12% reported a mental or behavioural problem. Both high and very high levels of psychological distress were more common among adults who were obese (24%) (4).
High Cholesterol
Health Risks
High cholesterol is associated with an increased risk of coronary heart disease and stroke (5). Diets that are high in saturated fat and salt and low in fibre are the most likely to blame. Total blood cholesterol levels above 5.5 mmol/L are considered to increase the risk of developing coronary heart disease and levels above 6.5 mmol/L are considered a high risk category (10, 11).
The rates of high blood cholesterol seem to increase with age. 3% of those aged 35–44 had high cholesterol compared with 9% of the 45–54 year age group. High cholesterol was highest in the 65–74 age group (21%) but declined among those aged 75 years and over (17%). Of those who had high blood cholesterol, 7% also reported having ischemic heart disease, compared with only 2% of those without high cholesterol. 9% of those with high cholesterol also reported having diabetes compared with 3% of adults without high cholesterol. Almost 30% of adults with high cholesterol also had high blood pressure, compared to 11% of adults without high cholesterol. Interestingly, 56% of adults with high cholesterol said they didn’t consume the recommended amounts of fruit and vegetables. Being overweight also increases the risk with 55% of overweight men recording high cholesterol levels (5).
High Blood Pressure
The World Health Organisation (116), considers people to have high blood pressure (hypertension) if their systolic blood pressure is greater than or equal to 140mmHg and/or their diastolic blood pressure is greater than or equal to 90mmHg. High blood pressure is a risk factor for a number of conditions including coronary heart disease, stroke and heart attack. To reduce high blood pressure, lower your body weight (if necessary), exercise, limit alcohol, eat more fibre and reduce the amount of sodium (salt) in your diet (10;11).
Physical Inactivity
Physical inactivity is believed to account for 6% of total disease burden (23). Physical activity can help improve health and wellbeing, especially if you suffer a chronic health condition. It may also help relieve some of the side effects (48;64). The Federal Government has recognised the importance of physical activity in reducing the strain on the health system, developing the National Physical Activity Guidelines for Adults. It recommends at least 30 minutes of moderate intensity exercise at least five days per week (24, 41, 59, 114). Unfortunately, less than half of Australian adults meet the recommendations (35). Physical inactivity tends to increase with age, especially in those over 75 years old (1). It was established that in 2005-2006, only 29% of Australians regularly (more than twice a week) engaged in sport and physical recreation activities, including walking (1). Please note, walking is only deemed moderate intensity if at a brisk pace.
Those who regularly exercise at a moderate to high levels are less likely to suffer long-term conditions:
- Only 11% identified as having high blood pressure, compared to 14% of those who are physically inactive (1).
- 15% of moderate to high exercisers reported arthritis compared with 19% of physically inactive people (1).
- Adults who exercised at moderate to high levels were least likely to be obese (11%) compared to 17% in the physically inactive category and 16% of those who did little exercise (1).
Those who regularly do moderate to high intensity exercise often enjoy many benefits:
- Good dietary habits - Those who were physically inactive have the poorest dietary habits, with 65% consuming inadequate fruit servings per day (one serve or less per day) compared to the 45% of men that exercised at moderate to high levels (1).
- Smoking - Men who were moderate to high exercisers were less likely to smoke when compared to physically inactive men (22% compared with 36%) (1).
To perform moderate exercise for at least 150 minutes per week is not only in your best interest but can also save taxpayer dollars. In 2006-07 it was estimated that health expenses related to physical inactivity in Australia amounted to an astonishing $1.5 billion (81).
Unfortunately socioeconomic and employment status seems to have an impact on physical activity levels. 40% of adults from the most disadvantaged socioeconomic areas were physically inactive compared with 25% of adults from the least disadvantaged socioeconomic areas. Physical inactivity was highest among those not in the labour force (34%) and lowest among the unemployed (24% for men) (1).
Cancer and Physical Activity Relationship
Regular physical activity can also help protect against cancer – and not just by helping you maintain a healthy weight. There have been strong relationships established between physical activity and cancer, such as colon cancer. Despite this, only one third of Australians achieve the higher level of 60 minutes a day estimated to reduce colon cancer risk (35).
Diet Choices
The national diet guidelines (90) recommend Australians enjoy a wide variety of nutritious foods. To do this, you should consume:
- Plenty of fruit, vegetables and legumes (go for 2 fruit & 5 vegetables everyday) = Great sources of fibre, water, vitamins, minerals and phytochemicals
- Plenty of wholegrain/low GI cereals (including breads, rice, pasta and noodles) = Provides energy that lasts longer and can be great source of fibre
- Lean meat, fish and poultry options = Lower in saturated fat, can be a great source of protein, calcium, omega 3 and iron
- Reduced fat milks, yoghurts, cheeses = Lower in saturated fat and can be a great source of protein and calcium
- Plenty of water = Makes body systems work effectively and efficiently
You should also consider:
- Limiting saturated fat and moderate total fat intake
- Choosing foods low in salt
- Limiting alcohol (if you choose to drink at all)
- Consuming only moderate amounts of sugars and foods containing added sugars
It has been reported only 7% males consume the recommended five vegetables servings per day (1), with only 46% of males consuming the two fruit servings per day (1). The low commitment from Australian males to get their two fruit and five vegetables in every day is a concern as it can increases the risk of developing chronic disease. For those who do meet the recommendations of fruit, vegetables and legumes, you have a significantly lower risk of developing coronary heart disease, stroke, certain cancers, hypertension and type 2 diabetes (90).
There is a significant proportion of Australians that only manage to have one fruit serving or less per day (47%). The majority (70%) reported a vegetable intake of three serves or less daily (1). 42% of males had a fruit intake of one serve or less and a vegetable intake of three serves or less per day, compared to 32% of females reporting these intake levels (1).
Interestingly, those who said they didn’t eat the recommended amounts of fruits and vegetables were also more likely to make other unwise lifestyle choices:
- Only 22% of those who were physically inactive ate enough fruits and vegetables compared to 39% of those who are physically active (1).
- 33% of those who were physically inactive added salt to their food compared with 22% of those who were physically active (1).
- 31% of those who were physically inactive smoked cigarettes compared to 18% who were physically active (1).
Socioeconomic and employment status also had an impact on dietary habits. 41% of people from the most disadvantaged socioeconomic areas said they didn’t eat the recommended servings of fruits and vegetables, compared with 35% of adults living in “well-off” areas(1). It was the ‘bachelors’ (men living alone) who were most likely to have inadequate intake of fruit and vegetables (52%) (1).
Smoking
By the end of the Second World War, in the mid 1940’s, 72% of men and 26% of women were smokers (38). Unfortunately these people were not clearly aware of the health risks associated with cigarette smoking. Now, there is no excuse. A significant amount of people smoke these days, even though they are well aware of the risks. Unfortunately, many of these people are addicted. Among other conditions, smoking has now been associated with increased risks of cancer, coronary heart disease, stroke, lung cancer, bronchitis and emphysema (10;11).
Worldwide, smoking is estimated to cause almost five million premature deaths each year (115). One in five Australian adults (20%) called themselves smokers during 2007-08 (1). More males (22%) are smokers than females (18%). Every day, around 43 Australians die from smoking-related illnesses, equaling more than 15,500 deaths every year(106). In 2004 the US Surgeon General said there is evidence to link smoking and cancers of the bladder, cervix, kidney, larynx, lung, oesophagus, mouth and pharynx, pancreas and stomach (110). In 1992, the US Environmental Protection Agency classified cigarette smoke as a Class A carcinogen, warning that passive smoking causes lung cancer (10).
It is important to understand that there is no safe level of second hand smoke (106). Research estimates cigarette smoking to be the second highest risk factor for disease accounting for 7.8% of the total burden in Australia (22, 23). Only being overweight/obese creates a greater burden of disease in Australia estimated to be at 8.6% (22, 23). One in two lifetime smokers die from diseases caused by smoking, with approximately 22% of these deaths people under 65 years old (12). Tobacco smoking is recognised as the leading cause of cancer, and was estimated to cause 10,592 new cases of cancer (12% of all new cases of cancer) and 7,820 deaths (21.5% of cancer deaths) in Australia in 2001 (106). There is also a higher proportion of current smokers reported to have mental or behavioural problems, 14% compared to 10% of ex-smokers and 9% of adults who had never smoked (5).
Smokers were also more likely to adopt other poor lifestyle choices which further increased their chance of developing a chronic health condition. A significant proportion (63%) of smokers consumed inadequate amounts of fruit and vegetables daily, compared to 47% of smokers who had quit and 41% of adults who had never smoked (5).
Smoking was more evident amongst those from lower socioeconomic groups, 34% smoked compared with 17% of adults from the least disadvantaged socioeconomic areas (5). Adults living alone or in sole parent families with dependent children were more likely to smoke (33% and 34% respectively) (5). Those that are unemployed (40%) are more likely to smoke compared to those employed (32%) (5). <85% of the health expenses related to lung cancer in Australia are a result of cigarette smoking. In Australia in 2001–02, smoking accounted for more than 291,000 hospital stays, costing $682 million (67). Therefore, it’s easy to understand why governments all over the world are spending money trying to prevent people from smoking. The most recent WA Department of Health and Ageing analysis on this issue found that every $1 spent on tobacco control results in a $2 saving (14).
It is positive to see a lot of smokers ‘wake up’ to their bad habit, with 29% reporting they were ex-smokers (5). As these people grow older, it seems they become wiser with 87% of smokers aged over 75 giving up the habit (5).
Alcohol Consumption
- Potential Health Benefits
- Burden of Alcohol Related Disease and Injury
Australians generally consume alcohol for enjoyment, to relax and improve their social confidence (89). People can achieve this without too many adverse effects (89). A substantial proportion of alcohol drinkers consume levels that increase their risk of alcohol-related harm (89). When used excessively, alcohol can be responsible for a considerable loss of life, disease and injuries (89). The effects of alcohol don’t necessarily just affect the drinkers but also those around them. Alcohol is a known risk factor for cancer (106). There is no evidence to suggest that alcohol can protect against any form of cancer (106). In fact, in 1988 the International Agency for Research on Cancer classed alcohol as a Group 1 carcinogen (106). The financial cost of disease, injury and crime caused by alcohol in Australia is estimated to be a figure in excess of $7.6 billion. The exact proportion attributable to cancer is not clear (38, 39). Alcohol effects each person in a different way. Gender, body weight and type, age, drinking experience, genetics, nutrition and metabolism should all be considered (89). As these variables do exist, there is no amount of alcohol which can be guaranteed safe for everyone (89). Unfortunately, people often don’t realise the capabilities of their own body, drinking far more then they can handle (89).
Risk Factors that increase risk of alcohol related incident or disease include:
- Being male, as men are more likely to perform risk taking behaviour (89).
- Being of smaller frame, meaning there is less body tissue to counter the alcohol effects (89).
- Age - in your later years, tolerance to alcohol decreases, the risk of falls and driving incidents increases and having adverse reactions with medications are more likely (89). Since chronic alcohol-related illness tends to develop over a lifetime of drinking, they occur most frequently among people over 45 years of age (91).
- Mental health, if you have a history of conditions such as anxiety, depression, schizophrenia and/or bipolar you are more likely to experience heightened symptoms after drinking alcohol (89).
- Health conditions such as epilepsy, diabetes, alcohol dependence, cirrhosis of the liver, alcoholic hepatitis or pancreatitis, can develop or be exacerbated if alcohol is consumed (89).
- Medication and drug use, alcohol may interact with medications, herbal preparations and illegal drugs. This can potentially cause serious harm to the drinker and/or others (89).
- Family history of alcohol means the drinker is at an increased risk of developing the dependence themselves (89).
- Combining alcohol consumption with smoking, as they can increase the risk of cancers of the upper aero-digestive tract even further (27). The risk of developing mouth and throat cancer is seven times greater for those who use tobacco, six times greater for those who use alcohol, and 38 times greater for those who use both tobacco and alcohol (27).
Metabolising Alcohol
Alcohol has a fast impact, affecting the brain within five minutes of consumption (89). Your blood alcohol concentration (BAC) reaches its peak 30-45 minutes after the consumption of a standard drink (89). Your liver can only process alcohol at a certain rate (89). If multiple drinks are consumed in a short period of time, your BAC elevates faster because the alcohol cannot be processed (89). On average it takes about an hour for the body to clear one standard drink from the system, and that’s not allowing for the individual effect alcohol has on your body (89). Metabolism rates are affected by the size of the liver, body weight and type, and alcohol tolerance (42). Genes that control the expression of alcohol-metabolising enzymes in the liver can also alter alcohol metabolic rates (42; 75; 111). To reduce the effect of alcohol, you should consider eating while drinking alcohol as it slows the increase in BAC (89). Drinking coffee, having a cold shower, vomiting or exercising does not reduce your BAC (89). If you consume a number of alcoholic drinks, it can take several hours for the BAC to return to zero (89).
Standard Alcoholic Drink
It is recommended that no more than two standard drinks are consumed per day to reduce the lifetime risk of harm from alcohol (89). If this advice is followed, the lifetime risk of death from alcohol related disease or injury remains below 1 in 100 (89). If you are able to drink less often (eg. weekly rather than daily), and drinking less on each occasion, you will reduce the life time risk of alcohol related harm (89). Healthy men should try to limit their alcohol consumption to no more than four standard drinks per drinking session (89). As it stands, drinking four standard drinks on a single occasion more than doubles the risk of injury in the six hours afterwards (89).
A standard drink contains only 10g of alcohol (12.5mL of pure alcohol) (89). A serving of alcohol (such as in a premixed can, or poured into a wine glass) is usually more than one standard drink (89). A standard drink of table wine is approximately 100ml, whereas it’s normally served in a glass of 150ml. You can identify how many standard drinks are in the alcoholic beverage by reading the label. You’ll probably be surprised. Refer to figure 3.0 below to get a clearer picture of what a standard drink is. Identifying how many standard drinks you have had can be harder if you aren’t using glasses with standard drink markers, pouring spirits without standard drink measurers, if drinking from jugs and if glasses are topped up rather than completely finished before refilling (89). If the potency of the beverage is not known (for example fruit punch) it becomes virtually impossible to keep track of your consumption (89).
Figure 3.0 Number of Standard Drinks
For more detailed information click here
Short Term Effects
When people consume alcohol they often feel relaxed, but excess consumption can have less pleasant effects. Drowsiness, loss of balance, nausea and vomiting are common (89). Alcohol has the capability to reduce reaction times and can affect coordination, speech, cognition and the senses (89). Alcohol can also inhibit the release of anti-diuretic hormones, resulting in the kidney not re-absorbing enough water. This may make the drinker urinate more frequently (“breaking the seal”) and can ultimately result in dehydration. Alcohol can also affect decision-making (89), leading to embarrassment or worse. In more serious cases, the BAC can elevate to life threatening levels leaving the drinker unconscious, and perhaps not breathing normally, which could potentially lead to death (89). There have been many cases where drinkers have suffocated on their own vomit (89). Drinkers must be aware that every alcoholic drink consumed significantly increases the risk of injury and death for the drinker and/or others (89).
Long Term Effects
- Cardiovascular disease: Alcohol can raise blood pressure and increase the risk of arrhythmias, shortness of breath, some types of cardiac failure, haemorrhagic stroke and other circulatory problems (89).
- Cancers: The International Agency for Cancer Research (17) has found links suggesting alcohol is a carcinogenic, resulting in cancers of the mouth, pharynx, larynx, oesophagus, liver and colorectal area (89).
- Diabetes: It is believed that alcohol has some effect on insulin sensitivity however it is still not clear (66). Diabetes sufferers may not be able to monitor their condition properly if drunk (89).
- Nutrition Related Conditions: Alcohol consumption has been associated with malnutrition, Wernicke-Korsakoff syndrome, folate deficiency, Vitamin A depletion and pellagra (91). The nutritional benefits from alcohol are minimal, so if drinking begins to replace eating, then drinkers may be more susceptible to these conditions.
- Overweight and Obesity: Alcohol is very energy rich, so when consumed it adds kilojoules to your normal diet. If these kilojoules are not used up as energy, it will be stored as body fat (90).
- Liver Diseases: Alcohol consumption is the most common cause of cirrhosis of the liver (91). Conditions such as hepatitis B or C can increase the effect of alcohol on the body and can increase the risk of developing cirrhosis (89).
- Mental Health Conditions: Those who consume alcohol may be more at risk of developing depression and anxiety (77). Alcohol can also decrease the effect of antidepressants (77) and can trigger acts of violence and suicidal behaviour (89).
- Tolerance & Dependency: If people drink alcohol on a regular basis, they develop a tolerance to the drug. This is because the body becomes more efficient at breaking down alcohol and begins to compensate for its effects (89). This can result in the drinker consuming more and more alcohol at a time, increasing their dependency for the drug. This dependency can lead to withdrawal symptoms, including tremors and anxiety if they do not drink for a couple hours (89).
- Long-term cognitive impairment: There is a strong link between excessive alcohol consumption and cognitive impairment (50, 58, 76, 99). Long term, excessive consumption can change the way the brain operates, and can increase the chances of developing dementia (54, 56).
- Self Harm: Excessive alcohol consumption is strongly associated with self harming and suicide (36, 72, 74, 101).
- Road Trauma: Road accidents caused by drink driving claim the lives of many Australians each year (77). The risk of hospitalisation for an alcohol related injury increases with the frequency of drinking (89). When drinking occasions become highly frequent (eg. 5-7 days a week) with 8 standard drinks at each sitting (roughly six 375ml full strength beers) the lifetime risk of hospitalisation for alcohol related injury is approximately 4 in 10. The risk of death is 1 in 10 (89). Simply increasing consumption from two to four standard drinks daily increases the lifetime risk of death from alcohol-related injury by more than four times for men (89). It increases the lifetime risk of death from alcohol related disease by five times for men (89).
Potential Health Benefits
The benefits of drinking are questionable. Some research suggests that alcohol consumption can reduce the risk of some cardiovascular diseases in men (73). How much the risk is reduced is not entirely clear. Moderate alcohol consumption may reduce the rate at which bone density is lost through the ageing process (20; 85). If consumption kept to moderate levels it may also protect against cognitive impairment and dementia (28, 29, 65, 84). Other studies suggest these benefits may be exaggerated (18, 51, 104). The World Health Organisation and others have reported half a standard drink per day is all that’s needed to achieve these benefits day (19; 113). However these benefits could be also achieved through exercise or by modifying the diet (89).
Burden of Alcohol Related Disease and Injury
Alcohol has caused 3.7% (2.1 million) of all deaths in the world and 4.4% of the total burden of disease in 2001 (113). Alcohol consumption in 2003 was accountable for 3.3% of the total burden of disease and injury in Australia (4.9% in males) (22, 23). Approximately one third of Australian men involved in motor vehicle deaths and one-quarter of motor vehicle injuries are alcohol-related (98). Alcohol accounted for 40% of male pedestrian deaths and 37% of male hospitalisations (98). In Australia, alcohol is second only to tobacco in the number of preventable death and hospitalisation cases (44, 63, 80, 98). It was found that 31,000 deaths were alcohol related between 1992 and 2001 (37). During that period, over half a million people were admitted to hospital because of alcohol (37). Its estimated alcohol costs the Australian community about $15.3 billion (2004–05), with factors such as including crime and violence, treatment costs, loss of productivity and premature death taken into account (38).
Lack of Sun Protection
- Those of increased risk to skin cancer
By not protecting your skin from the sun (especially when the UV rating is 4 and above) you are increasing your risk of developing skin cancer. The most important time to protect your skin is in childhood, however adult sun exposure appears to contribute to skin cancer too (105). It’s not clear how much sun exposure leads to cancer, but it is likely that both short and long term exposure can increase the risk, particularly if it causes sunburn (105). Studies show the relative risk of melanoma with a history of childhood sunburn is 1.8, while for sunburn in adulthood it is 1.5 (112).
Skin cancer claims the lives of about 1600 Australians every year, which is unnecessary as it can be almost completely avoided with appropriate skin protection (105). You should consider using sunglasses, UV protective clothing, sunscreens, hats and shelters (105). Unfortunately Australians (especially men) are not very good at applying sun protection methods and for that reason:
- Australia has one of the highest rates of skin cancer in the world, four times that in Canada, US or the UK (105).
- Skin Cancers account for 80% of all newly diagnosed cancers (105).
- Two in three Australians will be diagnosed with skin cancer by the time they are 70 (105).
- General Practitioners in Australia have over 1 million patient consultations per year for skin cancer (105).
- Around 434,000 people are treated for non-melanoma skin cancers, of which more than 400 die (105).
- More than 10,000 people are treated for melanoma, of which more than 1200 die (105).
- Melanoma is the most common cancer in people aged 15-44 years (105).
- Melanoma is the third most common cancer in men (105).
- Skin cancer is the most expensive cancer (105).
- Twice as many men have twice the skin cancer than women (106). Note that men tend to get skin cancer on their backs where it is hard to see, so get someone to check your back for you (34).
The five year survival rate for men with a melanoma stands at 90%, which is quite promising (105). However, skin cancer is becoming more prevalent in Australians. The rate of men developing skin cancer is increasing by around by 1.7% each year (105). General Practitioner consultations to treat non-melanoma skin cancer have increased by 14% between 1998-2000 and 2005-2007 (105). Treatment of skin cancer is also costing taxpayers a significant sum, with non melanoma skin cancer costing approximately $264 million and melanoma $30 million, totaling close to $300 million (105).
Those of increased risk to skin cancer
- Adults that have intermittent sun exposure
- Have had high volumes of lifetime sun exposure
- Have occupations that require them to be exposed to UV rays on a regular basis
- Have fair skin, which tends to burn easily (15, 43).
- Geographical location, as skin cancer (BCC & SCC) rates are around three times higher closer to the equator (87, 103), where UV radiation is higher.
- Artificial UV radiation sources are also hazardous and for this reason solarium use should be avoided (106).
Some sun is beneficial
Evidence suggests that vitamin D is absorbed via sun exposure (106). There is also increasing evidence that vitamin D may protect against certain types of cancers (30, 52, 53, 57) and can be beneficial in reducing the risk of osteoporosis (106). We need to achieve a balance so that our bodies absorb enough Vitamin D, yet avoid excessive exposure that leads to skin cancer.
Adequate sun exposure
- It is estimated that fair skinned people can get enough vitamin D (>50 Mmol/l) in summer by simply exposing the face, arms and hands (or similar) for as little as 10 to 15 minutes, either side of the peak UV periods, on most days of the week(100).
- In winter, in the southern states of Australia, where UV radiation levels are less intense, longer exposure is required to obtain sufficient vitamin D levels. Approximately two to three hours of sunlight exposure accumulated over a week to the face, arms and hands (or similar) may be required (107).
- In northern states, the amount of sunlight exposure required to maintain adequate vitamin D levels is significantly less. Most people would achieve sufficient levels of sunlight exposure with normal outdoor activities without needing to deliberately seek additional sun exposure (107).
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