Cultural Issues

Diverticular disease of the large bowel in western societies is common and it appears that the prevalence of this disease increases with age (Horner, 1958; Hughes, 1969; Parks, 1968; Sim and Scobie, 1982; Thompson et al., 1982). Much of the population in Europe, North America and Australia may develop the disease and it is often quoted by healthcare professionals that diverticular disease is rare among African peoples; yet Africans adopting a western lifestyle become susceptible to the disease (Keeley, 1958; Burkitt et al., 1985). It was noticeable that war-time Britons and vegetarians whose diet is high in fibre appear to be less susceptible to the disease, therefore reinforcing the view that the disease is one of western civilization resulting from a fibre-deficient diet (Almy and Howell, 1980). In the USA, the minority with complications of the disease (200 000 hospitalizations per annum) cost three quarters of a billion US dollars annually in healthcare bills (US Department of Health, Education and Welfare, 1979).

In a comparison of European and non-European communities, Kyle et al. (1967), researched populations served by main teaching hospitals in Fiji, Singapore, Nigeria and northern Scotland by four surgeons, all of whom were known to each other. In looking at the results of this trial, using admission to hospital as a reflection of the incidence of the disease, it appears that there is very little diverticulitis among Africans, Chinese, Malay and Indians in Singapore. Yet the incidence among Europeans in Fiji and Singapore indicates that they have admission rates for diverticulitis 40 times higher than those of other inhabitants on these islands (Kyle et al., 1967).

There are possible explanations for the difference in admission rates for the Europeans, or those of European derivation, as against the population of Africans, Asians and Melanesians. Racial differences in epidemiological studies are often difficult to separate from cultural, dietary and other extrinsic factors. One factor in the study may be the way the population seek healthcare advice.

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