Imagine getting up early to visit the local market on a sunny, Saturday morning with the thought of buying fresh fruits and vegetables. Would it not be healthier to walk or perhaps ride a bike to the nearby marketplace instead of driving a car? After obtaining the daily groceries, what about considering getting a blood pressure check near the fruit and vegetable stands or the local pharmacy? On the way back home, why not drop by and support the local bakery, wherein the friendly owners know the customers personally? This is the typical life of an Italian. Italians live active lifestyles compared to the average American. If lifestyle changes are related to cardiovascular or heart health, then promoting an active lifestyle will result in improved heart health.
Heart disease and stroke combined are amongst the contributing, costly health factors in our nation today. In 2006, cardiovascular diseases are the main cause of mortality in most of the OECD countries with about 36% of all deaths recorded (OECD, 2009). United States was among the countries with the highest rates. In contrast, Italy ranked amongst four other southern European countries that have the lowest heart attack mortality rates (OECD, 2009). The hypothesis is that underlying risk factors, which include diet and physical activity, may have contributed to the differences in heart disease mortality rates across the countries. In the United States, heart disease is the leading cause of increasing mortality rates (U.S. Department of Health and Human Services [HHS], 2011). Presently, greater than 1 in 3 adults, about 81.1 million have cardiovascular disease (HHS, 2011). In 2010, the U.S. spent greater than $500 billion in health care expenses alone (HHS, 2011). Like heart attacks, reduction in stroke mortality may have attributed partly to a reduction in risk factors. Medical treatments for cardiovascular diseases, such as stroke, may have increased survival rates.
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| [Bikes near "The Wall" in Lucca, Italy] |
The American definition of “physical activity” is not quite the same as that in Italy. Some Americans think of physical activity as going to the gym. However, our native-born Italian professor, Angela Migliorati, mentioned that Italians love to stay active, and they stay healthy in various ways (personal communication, 2011). In fact, during our brief two-week stay in Lucca, it was prevalent that instead of driving, older adults enjoyed riding their bicycles. At any time of the day, the so-called “The Wall” that surrounded the area where we lived always had people walking with their dogs, children in their strollers, or even biking by themselves, doubles, and even in quads. During one morning, as a friend and I strolled down “The Wall,” we saw a group of five adult males in their 60’s jogging and motivating each other. In Vicenza, asides from riding their bicycles, elderly adults enjoyed walking around their neighborhood and visiting the local markets. In addition, community parks surrounded by a lake, fountain, tall, green trees, and beautiful Renaissance figures are within walking distance of the Italian homes and other shopping areas. Just the other day, we also saw a group of students jogging together for what it seems like their physical education class. Italians know how to use their local resources in order to live active lives.
During our last night in Lucca, we ran across our professor’s Italian friend named Fabio, who was an emergency (hotline) nurse. In our brief talk, he mentioned that in Lucca, about two Italians per day call their local department to seek help regarding their heart conditions (personal communication, 2011). This, he thought, was a big deal. However, as Americans, we think of this as a small percentage, since in the emergency room, elderly patients frequently come in with symptoms regarding their heart health. We also pondered if Italians are aware of cardiovascular disease symptoms and the treatments available, and Fabio agreed. He added that Italians are quick to respond if such cases occur. This supports the fact that early treatment is crucial for the successful intervention in any cardiovascular accident.
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| [Blood pressure stand at a local pharmacy in Lucca, Italy] |
In the United States, places such as the local pharmacies provide Americans with electronic blood pressure screenings. Other organizations give citizens free blood glucose and cholesterol readings as well. Are there readily available places like those seen in America where Italians can regularly check their blood pressures, blood glucose levels, and cholesterol? In Lucca and Vicenza, most pharmacies have blood pressure stands, wherein local Italians interact with the pharmacist and have their blood pressures checked. In Vicenza, free blood pressure, cholesterol, and glucose checks are provided to the locals about two times per week near the local marketplace. The bi-weekly market enables the elderly not only to walk around and get their daily dose of exercise but also to keep their health status in check.
Engaging in physical activity is not the only factor in order to have a healthy heart. Dr. Massimo Ranconi, an Italian physician, and Dr. Francesca Baggio, an Italian psychologist, stated that participating in the intake of a Mediterranean diet at a young age would help decrease the risk of cardiovascular diseases in the long run (personal communication, 2011). A healthy, Italian diet consists of eating fruits, vegetables, olive oil, cereals, grains, fish, and minimal intake of dairy as well as meat. Moreover, it is common to have cereal, home-baked cookies and milk for breakfast. For lunch, many Italians come home and eat their meals, such as pasta with fresh tomatoes, bread, fruit, and water. Also, Italians enjoy their breaks, which include eating cookies, fruits, and drinking tea. Lastly, for dinner, soup with protein, such as fish is served along with fruit, water, and a glass of wine.
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| [Italian owner of a palazzo in Lucca shares his grandmother's cookbook.] |
Food not only brings Italians together, but it is also an extension of their culture. It is common for the elderly to teach the younger generation about the texture and taste of various Italian dishes. This, in a sense, drives the young ones to appreciate local ingredients as well as the traditional way of making Italian cuisine. In addition, Italians tend to eat their meals in a slow-paced manner, while socializing with others. Portions are also a lot smaller than those given in the United States. Therefore, not only do Italians eat healthy, but they also enjoy the company of their family members and close friends.
Asides from eating a healthy diet and engaging in physical activities, educating patients early at home and through interactions with their healthcare provider are keys in preventing chronic heart problems in the future. According to Dr. Ranconi, it is essential for healthcare professionals to form a good rapport with their patients, including their families (personal communication, 2011). He stressed the importance of personalizing his patient’s health regimen. Dr. Ranconi added that Italians bring their family members during their visits, thus they actively participate in the care of their loved ones, especially the elderly. Families and even some close friends help ensure that the elderly would comply with their hypertension medications and other non-pharmacological ways of staying healthy.
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| [Italian woman with her badante in Lucca, Italy] |
Italians also have badantes, who come from neighboring countries and help the elderly with their activities of daily living. In Lucca, an elderly woman in her 80’s held on to her African, female badante’s hand as they walked one afternoon. This elderly woman had a somewhat unstable gate and looked like she needed a cane and even a wheelchair, but her motivation and trust in her badante enabled her to engage in her preferred physical activity for nearly an hour. In Vicenza, another elderly woman in her 70’s walked with her female badante, as they strolled through the local marketplace. These are hardly ever seen in the United States, as the elderly are often placed in nursing homes. Some even struggle with attaining their much-deserved independence, as many elderly men and women are placed in wheelchairs. Indeed, Italians expressed the importance of having a strong support circle, which enables elderly Italians to live active, strong lives.
Cardiovascular disease is one of the leading causes of mortality rates in the United States. In order to help prevent this, Americans should embrace a healthier lifestyle, such as those practiced by the Italians. However, this is not a simple task. Due to economic hardships, it is common and most often affordable for families to eat at fast-food places. Many are also single parents who try to make ends meet, thus those with chronic illnesses often times do not attain the necessary healthcare that they deserve.
In 2007, OECD countries dedicated 8.9% of their GDP to health spending. Moreover, public and private expenditure on health as a percentage of GDP in the United States was approximately 16% compared to that of Italy’s, which was 8.7% (OECD, 2009). Equitable access to health care is a fundamental objective of the Italian health care system, which should be introduced to the United States. In Italy, the Local Health Unit (LHU) is an organization that promotes health education, especially for those with hypertension. Asides from local organizations, Italians are given free check-ups and additional health information by their general practitioner. If extra exams are needed such as an X-ray, Italians only provide a minute co-payment amount. Moreover, prescription medications are very affordable. Italians therefore do not worry much about the costs of healthcare. Rather, they focus more on the education and prevention of chronic illnesses. The down side of this is that general practitioners have a limited number of patients, and healthcare providers get paid depending on the number of patients they have, rather than the number of patient visits. Nevertheless, Italian physicians such as Dr. Ranconi expressed that the main role of Italian healthcare providers is to form solid rapports with their patients, so that they too can become active participants in their health.
Asides from medical interventions, Italians expressed various ways of preventing heart disease. According to the CDC (2009), eating a healthy diet, maintaining a healthy weight, and exercising regularly are non-pharmaceutical ways to prevent chronic diseases. True enough, promoting an active lifestyle starts at home through the local foods grown and cooked. Moreover, the sense of family and the community play a vital role in preventing chronic illnesses.
Though some health education and prevention is given to those with chronic conditions
such as hypertension in the United States, Americans still lack the support of their family, their local community, and the government. In addition, since many Americans have hectic schedules, they often times eat unhealthy foods, live inactive lifestyles, and depend on medications alone. The government should take part in providing more education and prevention of cardiovascular diseases, especially in the elderly population by encouraging policies which limit the intake of unhealthy foods, having more frequent and affordable check-ups, as well as encouraging healthcare professionals to integrate the patients and their families in their care. If these recommendations are done with the active cooperation of the individual concerned and the community, only then will Americans be able to appreciate the beauty of living active lives with healthy hearts, just like the Italians do.
References
A. Migliorati, personal communication, August- September 2011.
Centers for Disease Control and Prevention. (2010). Division for Heart Disease and Stroke
Prevention. Retrieved from http://www.cdc.gov/dhdsp/maps/social_determinants_maps.htm
Fabio, personal communication, September 2011.
F. Baggio, personal communication, September 2011.
M. Ranconi, personal communication, September 2011.
OECD. (2009). Health at a Glance 2009: OECD Indicators, OECD Publishing.
doi: 10.1787/health_glance-2009-en
U.S. Department of Health and Human Services. (2011). Healthy People 2020: Heart
Disease and Stroke. Retrieved from
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