1996 / 10月
Chang Chiung-fang /photos courtesy of Hsueh Chi-kuang /tr. by Jonathan Barnard
Civilization has brought humanity many conveniences, but it has its ill effects too. People who live in "civilized" environments for too long become afflicted with the "diseases of civilization": high blood pressure, asthma, panic disorders. . . it's a long and growing list.
While solving some problems, science and technology have caused others. Humanity has created antibiotics to kill bacteria, but bacteria have mutated to resist antibiotics. In December of last year, Taiwan, on the heels of many other developed nations, discovered an intestinal bacteria in patients that was resistant to all drugs.
Can it be that civilization is creating a legacy of misfortune, and that children, who have weaker immune systems and are less able to fight disease, have started to display the ill effects of civilization?
From seeing children standing next to their parents, many people have discerned a trend: Because of ample nutrition and advanced medicine, today's children are as big and sturdy as horses (and free from cow pox scars to boot).
According a study carried out by the physical education department of the Ministry of Education, children in Taiwan aged 12 have an average height of more than 152 centimeters and an average weight of more than 44 kilos, which means that they are more than 10 centimeters taller and more than 10 kilos heavier than children of the same age two decades ago. But this trend doesn't mean that they are in any better shape than their parents were.
Comparing the differences between earlier generations and Taiwan's youth of today, one writer has made this observation: "The children of 40 years ago were like free-range chickens, running around barefoot and eating yam porridge. When they were caught in a tree picking fruit, they'd just jump off and run. The children of today, on the other hand, eat lots of meat, sea food, and vitamin pills, but they aren't fit enough to climb a tree, would break a leg if they fell down three steps, and might well faint after 10 minutes out in the sun. . . ."
Science and technology pushes civilization forward a step at a time, but the effects of civilization on the next generation are not all positive.
The end of natural selection
First of all, science and technology have changed nature's system of weeding out the weak. In treating infertility, designing procedures to ensure safe births, and caring for premature babies, great strides have been made. As a result, babies survive today that never would have in years past. It was widely hailed as a miracle when "Cucumber," a baby delivered at 650 grams after only 24 weeks in the womb, survived to attend his first birthday party on October 1.
The infant mortality rate in Taiwan fell from 16.7 percent in 1954 to 2.1 percent in 1994. Its drop is the clearest demonstration of the advance in medical science and technology. But science and technology can only solve some problems, and babies that didn't used to survive may now end up with previously unencountered problems.
Generally speaking, because their development hasn't been complete, premature babies often have undeveloped lungs and gasp for air, which may lead to chronic respiratory problems. What's more, they are more likely to be blind, their intestines are weaker and prone to tear, and they tend to suffer from hematosepsis.
According to Japanese research, out of three extremely underweight premature babies, one won't survive, one will suffer deleterious after-effects, and one will live in good health. A healthy child will live an estimated 70 years, and his future contribution to society will be three times what it cost to save three premature babies.
Hence, Japanese law states that babies born after the 22nd week of pregnancy must be saved, which is much stricter than the 24- week standard used in most countries.
Apart from ethical concerns and considerations based on scientific progress, another factor is the declining birth rate. The more "civilized" a nation, the lower its birth rate. With future generations growing smaller, "premature babies" are naturally getting more attention.
According to the estimates of the ROC Premature Infant Association, the rate of premature births in Taiwan stands at about 8-10%, within the 5-10% range seen in the advanced industrial nations. What are the causes of premature births? Most researchers believe they aren't clear, though a few see links to the mother's age, the amount of stress she bears, and if she smokes or drinks.
With economic development and affluence, the diseases suffered by children are changing as well.
The four big pediatric problems used to be vomiting, diarrhea, chicken pox and measles. According to the Health Department's "ROC Health Statistics," in the 1950s the biggest killers of people in Taiwan were gastritis, duodenitis and enteritis. Pneumonia and other various infectious diseases were also in the top ten. Chen Chien-jen, the director of the Institute of Epidemiology at National Taiwan University, points out that most of those who got infected and died were the very young and very old, who had low resistance to disease.
Vaccinations have brought down the rate of children infected with such diseases, and the use of antibiotics has also somewhat lowered the risks to those who do get infected. Huang Fu-yuan, the vice superintendent of Mackay Memorial Hospital, who has been working in medicine for 30 years, notes that the encephalitis, pneumonia and meningitis which pediatricians had to deal with 30 years ago have largely been replaced with illnesses caused by viruses: trachitis, enteritis, fevers caused by viral throat inflammations, etc. "For the illnesses caused by these viruses, one will get better without treatment, which makes it harder for us doctors," Huang says laughing. Besides trying to prevent complications, the main job of a pediatrician is to console mothers.
And a number of serious children's illnesses rarely seen before have now been rearing their heads one after another. According to Health Bureau statistics, since the 1980s the second and third biggest killers of children have been congenital conditions and cancer (accidents are first).
According to the statistics of the ROC Children's Cancer Foundation, since the 1980s, about 530 children in Taiwan have been diagnosed with cancer every year. To put it another way, one out of every 10,000 children now suffers from cancer.
The most common cancers suffered by children are leukemia, brain cancer and lymphosarcoma. Yet because the causes for these cancers are not yet clear and there is so far no evidence to support an environmental connection, the rise of cancer rates among children might simply be a result of advances in diagnosis. Chen Chien-jen points out that since improved diagnostic techniques were widely adopted, there has been no marked rise in cancer rates among children.
Marks of civilization
Other illnesses-such as allergies, obesity, and mental illness-may not be fatal but can still cause parents big headaches.
Someone once said, "Civilization's diseases are the marks of modernization." The rate of allergies in developed nations, for instance, is far above the rate in undeveloped nations.
Chou Cheng-cheng, a pediatrician specializing in rheumatism at NTU Hospital points out that the rate of asthma in New Zealand and Australia is close to 20 percent and is in the teens in America and Europe. While Taiwan may be seven to ten years "behind" those advanced industrial nations, he points out that "we are quickly catching up."
Allergies, especially asthma, as well as various other respiratory allergies, such as those affecting the nose and throat, are the most common of child illnesses. The rise in the rate of these "little" illnesses is closely linked to air pollution.
Most people believe that only factories belching smoke count as sources of air pollution, but this a misconception. Li Chih-shan, a professor at the Graduate Institute of Environmental Health at NTU, points out that the greatest sources of pollution in Taiwan are mobile. Cars and motorcycles spew forth sulfur dioxide, nitrogen oxides, etc., which can irritate the breathing passages and cause allergies.
Apart from mobile sources of pollution, there are fixed sources of pollution other than factories which are often overlooked, including dry cleaners, restaurants and hotels. They may not belch black smoke, but the organic solvents and oily smoke that they do release are a form of pollution, and perhaps even carcinogenic.
According to long-term research carried out by several medical schools, children who are exposed to relatively large amounts of sulfur dioxide, nitrogen oxides and ozone are more likely to suffer from asthma by the age of three.
The pediatrics department of traditional Chinese medicine at China Medical College Hospital has recently released a study which claims that children who suffer from respiratory tract allergies have three times the amount of lead in their hair as normal children. This is further evidence that environmental pollution is a major cause of respiratory allergies.
Li Chih-shan points out that in the past, when the air quality was good, perhaps as many as 100 allergen particles would be needed to induce an allergic reaction. Now, with so many pollutants suspended in the air and with the irritation caused by sulfur oxides and nitrogen oxides, people have much lower resistance, and only 50 such particles may now do the trick.
Mighty dust mites
But then, air pollution is not the only factor contributing to children's allergies. Taipei's air quality is not the worst in the province, yet Taipei does have the highest rate of respiratory tract allergies and asthma. The reason is that apart from the air pollution incurred by industrialization, Taipei also has a lot of "civilization pollution." Chou Cheng-cheng points to the intense competition and pressures in modern society and changes in diet. High-calorie, high-protein and high-fat foods can cause asthma and skin allergies, and with cow's milk replacing mother's milk, newborns are more quickly being irritated by sources of asthma. Then there are changes to the home environment. Sealed-off and air-con-ditioned, with thick sofas and rugs and curtains that are hard to clean, homes are now excellent places for allergens to fester and reproduce, which has led to a rise in the rate of allergies.
The sources of allergies vary according to differences in climate and environment. In America and Europe, where there is a clear distinction between seasons, the principal source of allergies is pollen found outside, followed by pets like dogs and cats. In New Zealand, Australia and Taiwan, on the other hand, the main culprits are dust, mold, cockroaches and cotton fibers. According to a survey, 95 percent of the school-age children with allergies in Taiwan are allergic to dust mite eggs.
The dust mite is an eight-legged arachnid, which is only about 0.1-0.3 mm long, too small for the human eye to see. It lives on dander (shed human skin), and thrives in humid climates where it never gets too cold, such as those of Taiwan, New Zealand and Australia.
No place to hide
And dust mites aren't the only invisible threats.
Many people worry about the pollution outside, but can children hidden at home escape from danger? The fact is that pitiable modern children will find it hard to escape danger even at home.
Most children are at home more than they are outside, and the truth is that the indoor environment is full of dangerous pollutants. As a result of technological and scientific advance, every household has various kinds of new furniture, "high-efficiency" appliances and daily-use items-all of which are potential sources of pollution.
Plywood furniture emits formaldehyde. Rugs fester with mold, germs and dust mites. Wireless phones and televisions emit electromagnetic radiation. . . . It's not easy for a modern child to escape these environmental hazards.
To conserve energy, modern architecture makes it hard for air to circulate between the outside and the inside. In traditional buildings the air would be completely replaced within an hour, but in well-insulated modern buildings, the hourly rate of air replacement reaches only 50 percent. Where it is not easy for air to circulate, germs can more easily be transferred.
Bursting at the seams
Apart from causing more children to suffer from respiratory illnesses, urbanization has also affected children's vision and weight. That a high rate of children in Taiwan are near-sighted is obvious to any observer. Lin Lung-guang, who is a doctor at NTU Hospital's Vision Protection Center, points out that more than 30 years ago about 20% of students graduating from elementary school in Taiwan suffered from near-sightedness. With civilization's advance, the rate of near-sightedness has grown by leaps and bounds, and Health Department statistics show that the ranks of the near-sighted now include more than half of sixth graders, 75% of ninth-graders and 85% of those in senior high school.
Apart from this tremendous rise, the children of Taiwan become near-sighted at a much earlier age than those of other countries. Abroad most children go near-sighted in high school, whereas here it happens in elementary school.
In years past the medical community thought near-sightedness and obesity were hereditary. Today they are believed to be connected to environmental factors.
Children raised in the concrete jungles of modern cities have less and less opportunity to come in contact with green hills and clean water. Day after day, if they're not reading, they're watching television, playing video games or using the computer. According to a report in The Economist, a first grader in an average week spends 1.8 hours doing homework in America, 3.7 in Japan, and 8 in Taiwan. The above figures point to another reason why more Taiwanese children go near-sighted, and to why they go near-sighted at an earlier age.
Apart from the problem of eyes not getting enough rest, there is also the problem of bodies getting too much. Home appliances all have remote controls now, and from the sofa one can change the television channel and turn on the air conditioning. One ascends and descends in elevators, and sits in cars instead of walking. With social progress and economic prosperity, not only does every meal have fish, meat and eggs, but out on the street there is one Western fast-food concession after another whose fares are based around deep frying, meats and sweets. "All you can eat" restaurants are appearing everywhere too. People are simply eating too much, and the problem is even more serious for children, who have no self-control and "pig out" if they like what they are eating. Quite naturally they just eat until they're sated, until they're stuffed, until they're fat.
Child, grow big and strong
And psychological problems are mounting as well as physical ones.
"Child, be stronger than other people!" "Don't let your child lose the race in the starting blocks!" While these may be clich廥, it doesn't stop modern-day parents from repeating them and making them their mottoes.
Competition in today's society is growing more and more intense. In the bookstores, you can find such "ambition- inciting" titles as The Secret to Success or How to Get Rich Before You're 30. They shed light on society's values. What parents wouldn't want their children to be "successful" or "stand out from the crowd"? And schools don't teach children to work together, but just emphasize competition. Students compete to get into the more advanced classes and to test into the best high schools, for only then will they have "futures."
Under greater and greater pressure, some children, who can't meet their parents' and society's expectations, use illness to "resist" pressure, leading to a growing number of psychosomatic disorders suffered by children. Huang Fu-yuan says that perhaps only 30% of children in pediatric clinics really need treatment. "Besides those that have common-cold type of viruses and don't need medical treatment, often the problem seems to be with the parents," says Huang, getting to the heart of the matter.
Dropping tolerance levels
What can't be denied is that the environment is closely related to whether or not an illness becomes a serious problem. Attention disorders and hyperactivity among children, which have come to everyone's attention in recent years, existed previously; modern environments just make them much more obvious. The environment used to be open and free and parents' expectations and standards were laxer too, and so when children were distracted or hyperactive, it wasn't a problem that would cause people great difficulties.
Wu Yu-yu of the children's psychiatry department at Chang Gung Memorial Children's Hospital, says that hyperactive children have problems adapting to modern life. Children who are hyperactive find restricted environments frustrating and find homework pressures hard to bear. Children with attention disorders also underachieve academically.
Currently the medical community holds that the root cause of "hyperactivity" is injury to the brain, so the number of hyperactive children shouldn't rise because of environmental factors. But the number of parents who believe that their children are hyperactive and seek treatment for them clearly has risen as a result of environmental change. To put it another way, with progress and greater knowledge there is less tolerance for aberrant behavior. According to the rough estimate of Chiou Chan-nan, more than half of the children whose parents suspect them to be hyperactive and take them in for treatment are not actually hyperactive.
Generally speaking, science and technology have brought progress, but they haven't brought the end to human illness, which has just changed its guise to cause even more trouble. Humanity's war with disease is endless, and children are its innocent victims. How can adults ensure that civilization causes children as little harm as possible? That is a question well worth our consideration.
(drawn by Lee Su-ling)
Children used to run through the fields; now they weave through the traffic. Civilization has brought conveniences but also a loss of freedom. (photo by Diago Chiu)
Children who have grown up in the concrete jungle of a modern city can't climb trees, so street lamps will have to do. (photo by Pu Hua-chih)
Music lessons are just one of the ways parents try to "cultivate" talents in their children. But for many children, they just become another source of pressure. (photo by Huang Lili)
As verdant hills and clear water grow removed from children's lives, and television, video games and computers become ubiquitous, modern children are confined to cramped spaces even when at play.
Habitually focusing their eyes at close objects for long periods, children are going near-sighted at growing rates.
Microscopic dust mites are our constant companions. (photo courtesy of Chou Cheng-cheng)
(right) Respiratory tract allergies are one of the major "diseases of civilization." The proportion of children with allergies and asthma has grown in step with "progress."
Are the "diseases of civilization" a necessary evil that comes with progress? How can innocent children escape from the danger?