Of sound heart

It's a land we associate with sun, surf and freshly caught prawns flung onto the beachside barbie. Australia screams with good health and vitality; even the old fat guys have outdoorsy complexions and the stamina to polish off two slabs of Foster's lager before sundown. Or so it goes.

In fact, in common with all wealthy Western nations, Australia has an obesity epidemic on its hands and, despite the fact its athletes scooped armloads of gold at last year's Olympics, half its population takes no aerobic exercise at all. Despite this uncanny resemblance to our own health problems (right down to deep-fried Mars Bars, now sold on Bondi Beach), Australians do not face the same mortality rate as us.

Cardiovascular disease (CVD) remains the western world's biggest killer, responsible for twice as many deaths as cancer and ten times as many as Aids. This despite plummeting death raters from CVD over the past 15 years. In Australia, they have dropped by 44 per cent, and continue to fall; while in the UK, they have fallen by only a third, leaving us top of the fatality league - and Australia at the bottom.

The reason for this striking difference? Cholesterol. It's not that we are more prone to accumulating it than our Antipodean cousins. But until the Eighties, we failed to pay it very much heed. Even now, we're still new to the game while Australians are obsessed. They measure blood cholesterol levels in machines at the mall, or get it done at the doctor's, along with the blood pressure reading and the scales. Over 50 per cent of the population has taken cholesterol tests in the past four months, compared to between ten and 20 per cent over the past year in the UK.

But it wasn't always thus. Back in the Sixties, Australia's CVD rate was on level pegging with ours. Dr Bill Shrapnel, a consultant nutritionist who has worked with the Australia Heart Foundation (AHF), recalls that the organisation took a progressive view, believing that prevention was better than cure. By contrast, the British Heart Foundation (BHF) felt that studies into the role of blood cholesterol were too incomplete to act on and took a conservative route, concentrating on research and medical treatment.

The AHF devotes a third of its funds to research and a quarter to education and health promotion; while the BHF devotes half its budget to research and cardiology, and a mere ten per cent to education. It also allocates 25 per cent to chairs of cardiology, which the AHF phased out ten years ago, deeming them a "waste of money". The UK attitude, summed up by British heart specialist Dr Godfrey Fowler, has been to "wait until people are ill and then throw money at it. The UK was very backward with regards to cholesterol levels."

Here, it was not until the Eighties that the cholesterol argument - that high levels in the blood could contribute to heart disease - was endorsed by the British medical establishment. And it only became official in 1994, with the publication of a report. It was, as the British Medical Journal described it, "the end of a static decade for CHD".

Australia, however, has been tackling the cholesterol issue since the Sixties. Back then, butter accounted for three-quarters of "yellow fats" consumed; and margarine only a quarter. In the wake of recommendations from public health bodies, Australians rapidly adopted margarine, reversing the trend within a decade. One factor in this remarkable switch was the widescale introduction of domestic fridges (which occurred in Australia years earlier than in Britain) which left butter harder to spread than margarine.

The health revolution continued: full-cream milk gave way to semi- skimmed, to the extent that in Adelaide you'd be hard-pressed to find anything else. Red meat gave way to chicken and fish in the national diet. Fruit and vegetable consumption rose so satisfactorily that the AHF now believes it can achieve the World Health Organisation's recommendation of seven-a-day (five portions of vegetables; two of fruit). In the UK we are still struggling to achieve five-a-day.

Another factor in Australia's rude good health, according to Professor Stuart Trusswell, Emeritus Professor of Nutrition at University of Sydney, is citizens of a "new" nation are not hidebound by tradition. "Food habits are less ingrained," he says. "Aussies are always on the look-out for the latest thing, which means that dietary changes are easy to implement." Which is why the manufacturers of innovative foods, such as Flora Pro-Active - Unilever's cholesterol- reducing margarine - often launch in Australia, where the public is receptive.

The move towards low-fat options took place in the UK too, but only ten to 15 years later. That may be why our cholesterol average stood at 6.2 for men and 6.1 for women in 1996; while as early as 1989 both sexes in Australia had achieved a level of 5.5. Each percentage point translates as a three per cent reduction in heart disease, according to a report in the British Medical Journal. Despite this, there are no national targets in the UK for blood cholesterol levels Australians have as many weight problems as us, but are far less likely to suffer from cardiovascular disease. Reducing cholesterol worked for them - so why not us?

Copyright 2001
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