According to the CIA, Monaco has the highest life expectancy at almost 90 years old. Countries with a good healthcare system, low rates of violence, and democracy, among other factors, are more likely to have a higher life expectancy. Certain places in Asia, such as Macau, Japan, and Singapore, range between 84 and 83 years.

Asia’s relative advantage is related not only to genetics, but also its universal healthcare system and better diet. The United States, with an average life expectancy of 77.49, ranks fiftieth, which is below middle income countries such as Gibraltar, Denmark, and Portugal. At the bottom of the list is the African country, Chad, with an average life expectancy of 49 years.

Why are Monacans expected to live so much longer than anyone else? Monaco borders the Mediterranean Sea on the southern coast of France, near the border with Italy, and is the second-smallest independent state in the world (after Vatican City). Monaco is home to 30,510 people and became independent in 1419 by the House of Grimaldi. Monaco is a popular resort, attracting tourists to its casinos and pleasant climate.

The state has no income tax and low business taxes and thrives as a tax haven both for individuals who have established residence and for foreign companies that have set up businesses and offices. Living standards are high, roughly comparable to those in prosperous French metropolitan areas. Monacans have access to good water, sanitation, and healthcare, and zero percent of the population has AIDS or HIV.

In contrast, Chad faces many health problems, such as malaria, Hepatitis A, and meningitis. The Chad government estimates that 11,000 people died due to AIDS or HIV in 2009. Currently, 210,000 Chadians are living in the country with AIDS or HIV. Residents of Chad have less access to healthcare than Monacans, mostly because of poverty.

Animals with diseases are another factor of risk for Chadians that sometimes consume poisonous foods due to the lack of regulations. Chad relies on foreign assistance and foreign capital for most public and private sector investment projects. At least 80 percent of Chad’s population relies on subsistence farming and raising livestock for its livelihood.

Transnational issues do not help the life expectancy of Chadians. There is a lot of crime and violence on the cross-border with Cameroon, Sudan, and Nigeria. Moreover, Chadian children are trafficked to Cameroon, the Central African Republic, and Nigeria for forced labor and forced prostitution.

Image Courtesy of   jbor / Shutterstock.com

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Experts at Montefiore Medical Center urge the general public to be tested for the Hepatitis C virus, especially baby boomers, adults born between 1946-1964, who could be most at risk for this disease. Baby boomers are more likely to have been exposed to dangerous risk factors decades ago, such as sharing a drug needle, being tattooed or pierced with unsterilized tools or receiving a tainted blood transfusion.

The disease often has no symptoms, and if untreated, can lead to chronic infection that can scar the liver, cause liver failure or cancer and potentially lead to liver transplantation.

Hepatitis C virus (HCV) is the most common chronic blood borne infection in the United States, with 35,000 to 185,000 new cases diagnosed per year. Worldwide, 180 million people are chronically infected with Hepatitis C, with an estimated 3-4 million new cases reported each year. The disease particularly affects minorities, Hispanics, Asian-Americans and African-Americans.

“This disease has grown to epidemic proportions, with 350,000 people around the world dying from Hepatitis C-related liver disease,” said Milan Kinkhabwala, MD, Chief, Division of Transplantation at the Montefiore Einstein Center for Transplantation. “But it is called the ‘silent killer’ because many people don’t even know they have it.

This condition can be asymptomatic for decades and then present itself when it has already severely damaged the liver.” Individuals at risk can get a simple blood test to detect the virus before chronic infection leads to permanent liver damage. The Montefiore Medical Center Comprehensive Liver Disease Program offers simple and effective screenings.

It is recommended that individuals talk to their primary care physician or contact 888-RX-LIVER (888-795-4837) for more information or to set up an appointment for a screening. ”This is a revolutionary time in the treatment of the disease and there is more hope than ever before,” said Dr. Kinkhabwala. “The blood test is essential to detecting Hepatitis C, because now there are ways to treat the condition, and even reverse damage to the liver.”

Two new anti-viral oral medications, boceprevir and teleprevir, received FDA approval in May 2011. Both drugs work by blocking an enzyme that helps the virus reproduce. The drugs are intended to improve on standard treatments using the injected drug pegylated interferon alpha and the pill rivavrin.

“So far, the new drugs have shown promise in clearing the virus from the body and almost doubling the cure rate of the disease,” said Allan Wolkoff, MD, Professor of Medicine and of Anatomy and Structural Biology at Albert Einstein College of Medicine of Yeshiva University and Chief of the Division of Gastroenterology and Liver Diseases at Montefiore and Einstein.

“Another key benefit is that they cut treatment time in half, thus reducing the time the patient has to endure the severe side effects, which include anemia, depression and flu-like symptoms like fatigue, fever and headache.”

When symptoms do occur after the disease has progressed, they’re generally mild and flu-like and may include fatigue, fever, nausea or poor appetite, muscle and joint pain, bruising, abdominal pain, jaundice and itching. At that point, chronic infection can lead to scarring of the liver (fibrosis) and then advanced scarring (cirrhosis).

Scarring of the liver makes it difficult for the liver to function properly and can be devastating to the rest of the body, often causing liver failure or liver cancer. If the liver disease progresses too far and the medications are not effective, then transplantation is the last resort. However, more than 16,000 people in the United States are currently waiting for a liver donor, and in New York State, there are 1,700 patients on the waiting list.

Factors that have been reported to accelerate the rate of HCV disease progression include age, gender (males have more rapid disease progression than females), alcohol consumption, HIV coinfection (approximately 35% of patients) and fatty liver (the presence of fat in liver cells caused by obesity).

Unlike Hepatitis B, there is no vaccine to prevent this disease. While the symptoms are similar, distinct differences exist between the two viruses. Hepatitis B is primarily transmitted through sexual intercourse and is less severe. Dr. Kinkhabwala will be available for a live twitter chat to answer questions about Hepatitis C and liver disease on December 8, 2011 at noon. Follow @MontefioreNews to discuss #MonteHepC.

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