More than 12 prominent Bulgarian and international scientists discussed health risk factors and rallied in support of urgently applying new harm reduction approaches during a conference held in Sofia
Cigarettes, alcohol, unhealthy diet, air pollution, insufficient physical activity, excessive use of electronic devices – they are all frequently overlooked risk factors that in fact kill 7 in 10 people globally. The population's health is deteriorating at breakneck pace and there is urgent need to come up with harm reduction guidelines and approaches to address the "invisible pandemics". Many diseases such as cancer, diabetes, COPD, asthma and obesity can be prevented by implementing timely measures and adequate health policies that encourage behavioural change.
Scientists, medical doctors, and business associations drew attention to this at an International Conference entitled "Science in action: Rethinking facts on harm reduction for health resilience" organized by Arbilis in Sofia, Bulgaria. The conference took place mere days after the Ministry of Health and 11 scientific societies and patients' organisations signed a consensus document for incorporating the scientific approach and applying advanced policies aimed at reducing the harm associated with tobacco use, harmful alcohol consumption, obesity and excessive use of electronic devices combined with insufficient physical activity.
The Bulgarian nation is rapidly dying and grows old with diseases. People live in poor health even if longer.
• Bulgaria has the highest mortality rate in the EU.
• The average life expectancy in Bulgaria is 73.6 years which is the lowest in the EU – EU average of 80.1 years.
• Almost 55 % of the adults in Bulgaria (19 to 75+) are overweight and 21.4% are obese. 32.0% of the children (5 to 19) are overweight and 12.8% are obese.
• Bulgaria tops the list in terms of physical inactivity - 82% report insufficient physical activity.
• The consumption of fruits and vegetables is low.
• The smoking rates for adults and adolescents are the highest in the EU – close to 40% smoke, some even after suffering a heart attack or stroke.
Strokes, ischemic heart disease and lung cancer are the leading causes of death and the reason for one third of all deaths. Smoking, unhealthy diet, alcohol consumption and insufficient physical activity contribute to almost half of all deaths in Bulgaria.
Overweight and obesity pandemic
Obesity is one of the greatest health challenges worldwide and is among the leading causes of disability and death - 813 million people in the world live with obesity and their number is expected to reach 1.5 billion by 2035. Almost 60% of the adults in the EU and one in three school children are overweight or obese. In some countries obesity may replace smoking as a leading factor for developing cancer in the next decades.
Obesity is a chronic, progressive, relapsing disease – the scourge of our times and a predictor of more than 230 diseases. One third of the people do not even realise that they have this condition, Prof. Tsvetalina Tankova, Deputy Rector and Head of the Endocrinology Department of the Medical University in Sofia, Head of the Dietology Clinic of the Academician Ivan Penchev Hospital, pointed out. Only 5% weight reduction results in lower blood pressure and 15% reduction leads to a remission of diabetes Type 2 without medication, she added.
Maintaining a healthy weight should be made the highest priority in the national policies, Doctor Esther Halmy, , President, Hungarian Society for Study of Obesity, noted and added that obesity is the cause of many diseases leading to lower quality of life and shorter life expectancy.
We implement measures to raise awareness, and encourage healthy eating habits as early as in kindergarten and school, said Prof. Veselka Duleva, Head of Food and Nutrition Department of the National Center for public health and analysis. The lower level of food processing and the lower content of harmful substances, the lower the health risk, was the advice of Prof. Milena Georgieva, Molecular Biology and Epigenetics, Bulgarian Academy of Science.
Modern perspective on tobacco harm reduction
On the eve of the World No Tobacco Day on 31 May the scientists reiterated that the countries should strive to achieve a smoke-free environment. Despite the decades-long campaigning against smoking, there are about 1 billion smokers in the world, Prof. Reuven Zimlichman, Chief of Department of Medicine and Head of Hypertension Institute at the E. Wolfson Medical Center, Israel, Director of Cardiovascular Research Institute, Sackler Faculty of Medicine, Tel-Aviv University noted. He then presented striking data according to which almost 50% of the smokers who have suffered an infarction and 57% of those who have suffered a stroke continue to smoke. "It is very difficult to persuade these people to quit, they are staunch smokers. As doctors we failed in our efforts to curb smoking given that the number of smokers globally remains unchanged. 1 billion smokers are a testament to our failure. It is now clear that we need to find another solution. There are different smokefree alternatives with reduced harm already available – snus, e-cigarettes, heated tobacco products.", he remarked.
The toxic substances are reduced by 95% because tobacco is heated and not burnt. "Do you realize how many of the lives of the 1 billion smokers we can save?", the professor asked rhetorically. He gave as an example Sweden where on account of snus the smoking rates are at a record low – about 5%. "How many more deaths were avoided in Sweden and how many more lives could be saved if the snus ban in Europe were lifted?", the professor added.
"Patients awake after a major surgery and ask for a cigarette.", shared Prof. Borislav Georgiev, Head of Cardiology clinic at National Cardiology Hospital Sofia. "The heavy smokers "quit" 50 times and thus we are trying to find an alternative and a modern approach - a smoke-free environment.", he added.
A harm reduction approach should be applied to all addictions. Tobacco harm reduction is defined as "minimising the harm and reducing overall mortality and morbidity without fully eliminating tobacco and nicotine use", explained Prof. Hristo Kozhuharov, Head of Second Psychiatric Clinic in Varna, Chairman of the Bulgarian Psychiatry Association.
Smoking kills half of the smokers plus 600 000 people exposed to second-hand smoke annually. Thus, smoking is a preventable cause of death globally, said Doctor Rada Prokopieva, Cardiologist, Head of Cardiology Department, St. Anna hospital, Sofia. Cigarette smoke causes 40% of the cardiac diseases, increases cholesterol by 24% and raises arterial pressure by 31%. The first step is for the smokers to reduce the number of cigarettes smoked per day and if they are not even able to do that to switch to a smokefree alternative which eliminates passive smoking – in this way they will help themselves and their relatives, concluded Dr. Prokopova.
Harmful alcohol consumption – every step back is a success
We drink 13 l of spirits per year which is more than what the Russians drink. 86% of the Bulgarians admit that they drink alcohol. Another 14% say that they do not drink alcohol, but according to them beer is not considered alcohol. This data was presented by Ralitsa Skorcheva, Chair of Spirits Bulgaria – Association of Producers, Importers and Traders of Spirits. 500 ml of beer, 160 ml of wine and 50 ml of whiskey or brandy contain the same amount of alcohol.
According to surveys the concentrations of methanol, 1-propanol, 1-butanol, 2-butanol, isobutanol and isoamyl alcohol in the home-made alcoholic beverages are significantly higher than those in the respective manufactured beverages, explained Prof. Georgi Momekov, Head of Department on Pharmacology, Pharmacotherapy and Toxicology with the Medical University in Sofia, Chairman of the Bulgarian Pharmaceutical Scientific Society. Most people do not even know how calorie-rich alcohol is. A chronic drinker gets almost 50% of his/her daily calorie intake from alcohol and even stops eating, he added.
There is now a "Consume responsibly" text on the labels of alcoholic beverages, and everyone can access more detailed information on the webpage konsumirai-otgovorno.bg. A digital calculator is being developed that everyone can use to calculate the alcohol content, the calories, and the alcohol degradation rate, explained Ralitsa Skorcheva.
The scientific consensus today is that any alcohol consumption increases the health risks and is not safe, Prof. Lyudmila Mateva, Head of Gastroenterology Clinic with St. Ivan Rilski hospital pointed out. In her opinion to prohibit alcohol is not feasible, but any step back is a success – any reduction in alcohol consumption brings benefits.
Digital dependencies and digital detox
7 in 10 deaths are directly associated with our lifestyles, behaviour and choices, were the opening words of the psychotherapist Detelina Stamenova during the panel on excessive use of digital devices and screens. People spent 5 hours in front of their laptops and more than 2 hours in social networks. Long screen time is not the worst, what is worse is that we do not spend time with our friends and loved ones and when we do not interact face-to-face, we lose our social skills. Humans have the ability to read facial expressions. Only when we see the face, can we tell the emotions the person is feeling. When using screens we lose this ability, Prof. Manuela Grazina, University of Coimbra, Faculty of Medicine, Biochemical Genetics Laboratory, shared. It is not about prohibiting the devices, it is about spending less time with them and starting to use them later in life, urged Grazina.
We are now talking about technostress, techno-fatigue and techno-addiction. There are such things as Nomophobia – fear of losing one's device and FOMO syndrome – fear of being expelled from the online world. There is also such a thing as cyber disease – excessive 24-hour exposure to electronic devices. We do not take decisions anymore; we are used to finding ready-made decisions online. Our attention span is shorter, and the immersion in video games raises blood pressure, accelerates the heart rate and increases the breathing rate. It all comes down to the dose – from salt to stress. We need to identify the risks and reduce the harm. These "invisible pandemics" can be prevented – concluded the experts taking part in the International Conference entitled "SCIENCE IN ACTION: RETHINKING FACTS ON HARM REDUCTION FOR HEALTH RESILIENCE" organized by Arbilis. They issued a call to the policymakers to use science and not take political decisions that are not based on scientific evidence.
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