Asia's War With Heart Disease — page 4

Heartfile has already trained nearly 2,000 health workers and volunteers. It also feeds information on heart disease to the media, and it has worked with Pakistan's Ministry of Health and the who to form a national plan on disease prevention. The impact of these grassroots efforts can be dramatic. After a visit by Heartfile workers, farmer Salim Kahn of Basti Jhandhawala probably saved his 60-year-old father's life last year when the older man woke up with severe pain in his chest and left arm, and Kahn was able to recognize the symptoms as those of a heart attack. "I gave aspirin to my father to thin the blood and immediately rushed him to the hospital," says Kahn, who is now himself a Heartfile activist. His father survived the attack and is doing well.

Too often, however, brutal economics trump the best of intentions. In Basti Jhandhawala, Heartfile workers have urged villagers to abandon fattening vegetable ghee in favor of healthier cooking oil. But cooking oil costs 52¢ more per kilogram than ghee—a considerable difference in a village where the average income is about $600 a year. "When we ask families to change their diet and have their blood pressure regularly checked, they complain they don't have enough money," says Jamila Perween, a Heartfile-trained health worker. "They listen carefully, but then they say they can't afford it."

Fortunately, most people can at least afford to take a few heart-healthy steps: eat more fruits and vegetables and fewer processed foods and less saturated fat; cut out cigarettes; and exercise more (ideally, 30 minutes of moderate effort a day). Yusuf of McMaster University points to a study of the Amish in North America, who display very low CVD rates despite a diet that appears excessively rich in dairy fat. Research found that the average Amish man took some 18,000 steps a day, compared with 3,000 to 5,000 for the average American. "We have to make sure we find opportunities to expend energy, instead of opportunities not to expend energy," says Yusuf. "If this is done, we can dampen this potential epidemic by half."

They won't be churning butter anytime soon, but perhaps the Okinawans are turning a little bit Amish. Signs posted between every elevator at the Okinawa Prefectural Office read: "Use the stairs, too. Health. Save energy. 10,000 steps a day." Yoshifusa Miyagi doesn't quite make it to 10,000 steps every day, but since his heart attack, he has lost eight kilograms by cutting back on oily foods and fatty beef, reducing his intake of whiskey and Okinawan spirits by 80%, and walking whenever he can. "I tell my friends not to eat junk food or French fries or hamburgers," Miyagi says. "I don't want the same thing to happen to them." Across the region, a consensus is growing that Asia cannot afford to follow the West by allowing its own heart-disease epidemic to spiral out of control. The problem has to be fought here and now—one step at a time.

With reporting by Aravind Adiga and Sara Rajan/New Dehli, Ghulam Hasnain/Lodhran, Susan Jakes/Beijing and Hanna Kite/Tokyo

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