Cardiologist Dr Geoff Evans talks preventative health

Dr Geoff Evans: In the North-West Coast and North East, rates of cardiac disease are very similar to what you see in the Northern Territory and that’s what the statistics show. We die in more numbers and at a younger age than everywhere else in Australia apart from the territory.

CD: Does it appear to be trending upwards or downwards?

GE: Rates of cardiac disease and death across Australia is falling but I’m actually very concerned here in Tasmania we’re going to buck the trend and start to go the other way. Our rates of cardiac mortality haven’t fallen much at all and a lot of other disease states are the same.

I see that we are now the fattest state in Australia, our rates of smoking might actually be going up, our rates of diabetes are rocketing. I can actually see the potential for Tasmania to start going back up again, which is a disastrous outcome.

CD: So what can we do to stop that from happening?

GE: There have been a number of different approaches. We do know that mass media campaigns are effective. We’ve had a number of things over the years that have really made people alert and attentive to issues, like the ‘slip, slop, slap’ ads.

I think we need to be getting into schools and educating kids more and I think by the time a child leaves secondary school, they should be so indoctrinated about healthy living that there is little choice. They could buck against it, but ultimately they’d come back to it.

CD: What should we be doing in schools?

GE: I have an idea about feeding kids in school. There are a lot of kids who go to school, particularly some of the lower socio-economic schools, where they turn up and have had nothing to eat or something that’s just pure sugar. They have behavioural problems in class very commonly, and I wonder how much of that’s related to the lack of proper nutrition.

Countries like France actually feed their kids at school. If kids came to school every morning and actually got fed, and then went and did an exercise program, an education program, and then they sat down for a meal again at lunch time, at least those kids would get fed properly in the morning, they could concentrate better and learn more in the morning, then they’d get fed properly at lunch time and they can learn better in the afternoon. And then when they go home, well, it doesn’t matter as much - they’ve been fed twice.

CD: How important is that early intervention? If a child is raised in an unhealthy environment, how difficult is it for them to turn that around when they reach adulthood?

GE: It’s almost impossible. Because they’ve had problems with attention, food, behaviour, and inevitably, they are poorly educated. Their fate is set once they’ve left secondary school. For many of them, they’re not interested in study because they’re not doing very well.

If you look at the last 50 years, what’s really changed in our diet is the amount of simple carbohydrate and that’s what’s making people fat. It’s really clear the amount of sugar in our diet, because we know that sugar increases insulin levels, and when your insulin level increases, you store the sugar away as fat and then your sugar level plummets and you want to eat more so sugar tends to make you eat more and more.

North and North-West Tasmania is the most successful place to run a fast food outlet in Australia. These are not big communities, yet they sustain these big fast food outlets.

CD: What can be done to stop people eating from those places – should there be stricter legislation about advertising?

GE: Possibly. I know there’s a whole lot of freedom of communication and people are entitled to communicate but we have banned some things, like cigarettes in sport.

CD: What about things like kids’ hours on TV?

GE: We shouldn’t be advertising junk food. We know there are a whole lot of other rules and laws around this. But there’s a very powerful food lobby.

CD: What is your advice to patients if they come in and are eating fast food everyday and drinking bucket loads of sugar?

GE: Firstly, fast food usually contains large amounts of sugar, and the sugar in itself has some addictive qualities to it. It tends to make people want to eat more sugar so my advice is they should cut out the fast food, they need to be careful with their fat intake and consume healthy fats and not excessive simple animal fats.

The secret to it all, I firmly believe, is exercise. If you’re someone who exercises regularly, there’s a whole lot of consequences from that. That’s one of those things that I think is really pivotal in maintaining good health.

CD: What role does the state government need to play? Should more money be spent on preventative health?

GE: Yes, we need to be spending more money on prevention, absolutely.

It’s difficult – we have a health budget that is already overstretched and pulling resources out of that for prevention for the future politically is a difficult decision for anyone to make. But I think there’s an increasing appetite for that in both sides of the political divide, because we can see it’s going in the wrong direction.

CD: What would your message be to people who don’t want to admit this is a problem or say people promoting preventative health are ‘fat shaming’?

GE: It’s not an issue at all of fat shaming, but there are some people that are dreadfully overweight and they have a real medical issue and it needs to be treated as such. Morbid obesity is a very real and nasty disease with a significant mortality rate.

It’s not something that you go, ‘well that’s just the way I am’. You actually need to address that and say, ‘this is not normal, it’s dangerous, and needs to be treated aggressively’.

The individual and the community will pay an enormous price for that if you don’t do something about it.​