Heavy metals are dense metals that are found naturally in the earth. The major heavy metals of public health concern are lead, mercury, cadmium and arsenic which are all included in World Health Organization’s list of 10 chemicals of public health concern. These metals are quite toxic to the human body as there are no known safe levels in humans or other species. This propensity to harm not just humans, but to accumulate in plants, fishes and soil poses great risks to potentially compromise the ecosystem. Despite being harmful, these chemicals have been found to be useful in several ways which include:

• Lead-As an additive in petrol which has been phased out by most countries, use in certain folk medicines, lead based paints and lead solder for canning
• Mercury-use in electrical equipment, thermometers, pharmaceuticals, thimerosal which has been removed from most vaccines, dental amalgam and use in artisan gold mining which has drawn recent attention of the UN
• Arsenic-widespread use as components of pharmaceuticals and semiconductors
• Cadmium-used in batteries and fertilizers

Cigarette smoking is an important source of exposure to some chemicals thus leading to ease of exposure. In addition, poor disposal of these substances either by dumping on land or rivers- especially ones used by communities can result in devastating effects to a population. Take the Minamata disease catastrophe that happened in japan in the 1950s as an example: more than 600 people died (not including the thousands with disabilities) from dumping of mercury wastes in Minamata bay by a chemical factory. It is sad that despite the disasters that have been caused by heavy metal exposures, it is still a largely neglected public health problem. It is worthy to mention that there are dangerous and life threatening levels of these metals in Tasmanian lakes of Australia, Kurang river in Pakistan, Shur river in Iran, Ganges delta in India and Bangladesh and many others.

Some of the oldest diseases of human can be traced to heavy metal poisoning associated with mining, refining and use. They cause disease primarily by inhibiting important enzymes in the body. It can either be acute due to eating or inhalation of high levels of these metals usually leading to death or a chronic accumulation from continuous exposure resulting in disabilities. This leads to neurological problems as in the Minamata disease discussed and other clinical manifestations. Importantly, they are associated with increased carcinogenic and teratogenic risk.

The clinical treatment of giving chelators is obviously not sufficient to address this problem (as clinical solutions are not public health solutions).Even though clinicians have an important role as part of the surveillance system, what is needed is remove the source of exposure just like the great Doctor, John snow. Many organisations like the EPA, WHO, UN and others have to work with governments and health agencies to ensure minimal exposure to these chemical by regulating their use and enforcing proper disposal. There should be continuous research in the use of associated products by the general public to monitor and report any adverse effects.

Whether conscious of it or not, everyone is faced with the important health choice of good or bad diet daily unless you decide not to eat for one reason or the other. Diet is a significant modifiable risk factor in the development of NCDs such as diabetes, cancer, heart disease and high blood pressure which are the leading causes of death in developed nations. According to a study published in the prestigious lancet journal in 2017,11 million deaths (95% uncertainty interval [UI] 10–12) and 255 million (234–274) DALYs were attributable to dietary risk factors:

• High intake of sodium (3 million [1–5] deaths and 70 million [34–118] DALYs)
• Low intake of whole grains (3 million [2–4] deaths and 82 million [59–109] DALYs)
• Low intake of fruits (2 million [1–4] deaths and 65 million [41–92] DALYs)

These figures represented the negative effects of the leading dietary risk factors for deaths and DALYs globally and in many countries. As scary and authoritative as this is, it doesn’t make much public influence due to the widespread use of media by the nutraceutical industry to throw out health claims here and there. This along with constant churning out of facts by pseudoscientists and others with personal interests have somewhat made the public numb to health facts. It is difficult to make a positive health choice when one is overloaded with false information.

In addition to the prevention of NCDs, a healthy diet also protects against protein energy malnutrition. Generally, a healthy diet involves the intake of fruits, vegetables, legumes, whole grains, less salt, sugar, and unsaturated fat (found in fish, olive oils). The healthy diet is exemplified in the Mediterranean diet, indigenous to the people of the Mediterranean region (modern day France and Italy) which attracted worldwide attention in the 1960s when high adult life expectancy and low rates of chronic diseases (coronary heart disease, certain cancers and diabetes) were reported across the region. It is the most studied of all diets and have been clearly shown to control diabetes and hypertension. It is not a ‘diet’ in the strict sense as the Mediterranean countries eat very differently but an eating pattern which involves high fruits, vegetables, legumes, monounsaturated rather than saturated fat or trans-fat, moderate ethanol, milk, dairy products and low meat and meat products.

The case with an unhealthy, poor or bad diet is the complete opposite of a healthy diet with increased risk of nutritional deficiencies, NCDs, obesity and cardiac arrest. The prototype bad diet is the western diet which is high in total energy, saturated fats, salt, sugar and low fibre. The most convincing evidence of the association of western diet to NCDs comes from the observation of higher incidence of colorectal cancer in Asian immigrants in the US who adopt western diets. Also, there is increasing frequency of this cancer in Africans- who are also adopting the western style of diet. Worse still, the Africans who less able to handle salt are more predisposed to hypertension and it’s complications.

The list of other types of diet is endless; popular ones include the DASH diet, MIND diet, Nordic diet, Atkins diet, Asian diet, Weight watchers diet, Vegetarian or Vegan diet etc. The diet you adopt must be supplemented where applicable if it is deficient in an important nutrient for example if you adopt the vegan diet, you should receive iron and vitamin B12 supplements as they are lacking in these diet. The point is, irrespective of the diet choice, a good, healthy balanced diet should be the goal.

The choice of diet is not necessarily based on health benefits, other factors like cost, availability, culture, beliefs, geographical and environmental factors affect what individuals choose and eat. The government can promote healthy diet by increasing incentives for healthy products and taxation of unhealthy food products.

Most people have heard about Chantal petitclerc- the exceptional Canadian wheelchair athlete with 21 Olympic medals who went on to become a senator despite her condition. The society does not hesitate to celebrate outstanding and inspiring figures like her, however, there are many more physically challenged individuals without much success stories that are ostracized, abused, infantilized, ridiculed, ignored; name it! The ‘disabled’- a word that in fact should be substituted with a more societally neutral term due to the stigma attached to it, constitute the largest marginalised group of individuals with over 1 billion individuals affected worldwide. Disability is either congenital (born with) or acquired through aging, disease conditions, traumatic injury from wars, natural disasters etc. The fact that 15 out of every 100 individuals are affected should stress the commonality and accommodation of their rights as full-fledged individuals. Unfortunately, the reality is quite different; they are confronted with problems in various social areas ranging from healthcare to education.

Across the globe, it is glaring how the healthcare sector has failed disabled individuals as they are 3 times more likely to be denied healthcare and 4 times more likely to be treated badly in health systems; the situation is even worse in developing countries with out of the pocket system and the US where they often lose their insurance. The perplexing fact is that some of these things are caused by governmental conflict or failure of a system in the society. Consider the thalidomide disaster (a typical example of failure in the drug surveillance system) where many mothers bore babies with limb abnormalities due to the effects of the thalidomide drug taken by these mothers while they were pregnant. Now, shouldn’t the government take a moral stand to take responsibility for its inaction? Another area of health that is often ignored is the sexual health of these physically challenged individuals. With little or no sex education, they are seen as lacking or having less sexual needs which is completely false and wrong. The ‘ideal’ and accepted culture of how people engaging in intercourse should look and how sex should be done has left no room for them.

Consider the situation of a thalidomide baby who due to the failure of the society is born without limbs and has problems with schooling, and consequently becomes poor due to the inability to get a job. Such is the vicious cycle that can arise from not allowing and supporting people with disabilities reach their full potential. Children are faced with psychosocial problems of isolation and exclusion which injures their self-esteem. Also, problem with transportation and communication can make everyday living difficult. The discrimination continues to employment and pay. The most important thing is inclusion in every aspect for everyone including the elderly, women (who suffer double blow gender discrimination and this) and children who are often abused and neglected. Proper integration of these children into the educational system is of prime importance if the SDGs are to be realised. Inclusive legislation like Americans with disabilities act and Canadians with disabilities act which prohibit discrimination based on disability are to be encouraged. The right to receive healthcare and other necessary services just like every other member of the society must be protected. Beyond these legal amendments, there should also be support and enlightenment of the public to correct unfounded beliefs about ‘disability’

It is quite difficult to imagine those times where people had to travel many kilometres in search of scrolls in a public library to access information; something that can now be done from the comfort of one’s bedroom using mobile phones and other electronic devices. The internet and social media have made a revolutionary impact on all aspects of human life particularly information distribution. As such, our lives have become interwoven with the internet; it is impossible to resist the urge of checking for screen popups on mobile devices. Despite immense benefits, the internet brings its own set of problems. Due to the anonymity and freedom of using the internet, anybody and incredible sources can share health information which can be false and disastrous to the society. Such false health news can come inform of an outright lie as exemplified in the Ebola crisis of 2014 in Nigeria where the use salt water bath against the virus was widely disseminated via social media platforms. Of course, this led to a catastrophe with several recorded morbidities and mortalities. Other ones can come inform of a health advice- for example “a combination of banana and coke is suicidal”. In fact, there are so many variations, but they all have one thing in common- they play on the irrational ignorance and fear of the public on health matters.

Not all misinformation regarding health matters are false or fake news, some are actually caused by the way health facts are presented which leads to over- magnification of risks. If you goggle about the statins- a group of drugs mostly used to lower blood LDL cholesterol levels, most websites focus more on the side effects like muscle pain but comment little on their benefits. Consequently, patients may be more likely refuse the medication due to a biased risk benefit assessment from the exaggeration of side effects. Another example of this irrational risk presentation is seen in the issue of vaccine use. With drastic reduction in the prevalence of many of the dreaded diseases like small pox, polio and others, the efficacy of vaccines are an established fact because it is clear that their benefits outweigh any risks. However, the overemphasis on the adverse effects of vaccines continues to increase the fears and doubts of potential patients. Additionally, the benefits of some health products can also be overemphasized as a form of advertisement strategy for the pharmaceuticals. It is not uncommon to find different brands of the same drug in stores- each claiming to have superior effect over the other and people could intoxicate themselves in a bid to combine these drugs for superior effect. Further, herbs are advertised to have magical healing effects for many conditions especially in developing nations. The public tends to agree with these claims mostly because of faith in traditional medicine and that these products are ‘natural’ but then natural doesn’t mean that something cannot cause harm. The public must know that anything can cause harm no matter how natural it is because these products don’t come with doses so there is great risk of intoxication.

Media misinformation can be reduced by proper education of the public through enlightenment and awareness programmes by health organizations or affiliates. People should be encouraged to seek health information from reliable and proper sources. However, it is bound to happen especially in less known diseases and outbreaks. Regular distribution of information-no matter how little, from registered health organizations is a line towards the right direction.