JOURNAL OF RESEARCH IN HEALTH AND SPORT SCIENCE (JORHASS)
Department of Physical & Health Education
Bayero University, Kano
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1
STRESS AS A GLOBAL HEALTH PROBLEM
BY
Dr. Shehu Raheem Adaramaja & Dr. (Mrs.) Ursula, C. Nnabueze
Abstract
The paper examined the meanings of stress and those factors that can
predispose an individual to a stressful life situation. Stress is seen as a body of
mental tensions caused by some physical, chemical or emotional factors. The
paper also discussed the interrelationship between stress and human health. This
is in addition to the various behavioural tendencies like smoking, alcohol
consumption and accident resting from stress as sources of human health
problems. The paper also examined implications of stress to men like incidence
of obesity, hypertension, stroke, sudden death, heart diseases, accident,
chemical and physiological disturbances. The paper also reviewed some health
education programmes and strategies for coping with stress. Finally, the authors
recommended, among others, that the three (3) tiers of government should
provide recreational facilities and create enabling conditions for citizens so as to
remove stressful situations from the people for healthful living.
Introduction
Stress is considered a global health problem because of its implication on
the health of the people. Stress here applies to the normal difficulties of life
whether they are large or small. Only an infant (0-2 years) leads a virtually stress
– free life, since when he is uncomfortable or in pain, he cries and usually his
discomfort it removed. By the time he is three (3) or four (4) years old, he is
given tasks which require some initiative, responsibility and even judgment. He is
expected to be somewhat more independent. Stress then is part of life from
childhood. Stress varies in nature, amount and duration.
2
Any difficulty can be considered a stress, including even genetic factors
which predispose an individual to illness and also certain congenital handicaps
physical and mental. Stresses are products of external and internal environment.
Example of external stress could be physical factors such as illness, malnutrition
or a difficult work assignment (academic pressures and social pressures). Other
examples of psychosocial stresses coming from outside include excessive family
responsibilities, unfriendly neighbours or boss, frightening situations of any kind,
a new experience or parental neglect. Example of internal stress includes various
illnesses, hormonal changes that occur during adolescence or menopause, and
even certain normal physical reactions such as palpitations occurring when
frightened.
The Definition of Stress
A leading researcher in the field of stress, and of course someone who
could be referred to as the “father of stress”, Dr. Hans Selye, defined stress as
nonspecific response of the body to any demand (Selye, 1983). In other word,
stress, can be simply defined as a body of mental tensions caused by some
physical, chemical or emotional factors.
*
Dr. Shehu Raheem Adaramaja is a lecturer in the Department of
Physical and Health Education, University of Ilorin, Ilorin, Nigeria.
*
Dr. (Mrs.) Ursula, C. Nnabueze is a lecturer in the Department of
Health and Physical Education, Enugu State. University of Science and
Technology, Enugu State. Nigeria.
3
JORHASS Jan – June 2007
The Encyclopedia and Dictionary of Medicine, Nursing and Allied Health
(Miller & Swain 1987) suggests that stress is the sum of all the non-specific
biological phenomena elicited by adverse external influences, including damage
and defence, stress may be either physical or psychological or both.
Steadman’s Medical Dictionary (1982) defines stress as:
1.
The reactions of the animal or human body to forces of deleterious nature
infectious and various abnormal states that tend to disturb its normal
physiological equilibrium.
2.
The resisting force set up in a body as a result of an externally applied
force.
3.
In psychology, a physical or psychological stimulus, when impinging upon
an individual produces train or disequilibrium (Steadman’s Med Dic.,
1982).
In the eighteenth and nineteenth centuries, the use of the word stress
changed to indicate
“strain, pressure, tension, force or poor-fit”, which are
perceived and recognized by man and are caused by stressors (Cohen, 1998).
Stressors are factors that cause stress. This include loss of loved ones, the fear
of examinations, expectations, competitions, hunger, work-load uncondusive
environmental conditions, fear of punishment, noise, vibration inadequate
ventilation, fatigue, travel on a long journey, traffic jams, leadership style, group
4
pressure,
role
conflict,
job
insecurity,
social
density,
unemployment,
relationships between work and family, divorce and single parenthood, etc.
It is important to point out that stressors excite or agitate. But no one can
determine before hand whether, in any given situation, the same stressor will
produce enstress or distress.
Selye (1983) distinguished between the two
varieties of stress: Distress is the harmful stress of unpleasant events, while
enstress refers to response to positive stimuli.
Stress and Health
When we are faced with a threat whether real or imagined – the body
responds in what is called the “Fights or Flights Reaction” (Peeke, 2000, &
Saladin, 2001). Virtually every organs and chemical constituents of the human
body is involved in this reaction. According to them, the thyroid gland releases
hormones, which stimulate metabolism. The liver provides energy-yielding
material to satisfy the body’s increased demand and regulate the concentration
of sugar, protein and other elements in blood. The white blood cells regulate the
immune reaction to various foreign substances. The hypothalamus stimulates the
pituitary gland, which secrets hormones into the blood. Blood flows away from
the skin, the digestive organs and brain and muscles.
All the above-mentioned physiological changes as a result of stressor(s)
lead to those manifestation of stress that we can readily observe: agitation, loss
of appetite, impulsive behaviour or emotional instability, increased blood
pressure, dilated pupils, dry mouth, accelerated pulse, anxiety and excitement,
5
insomnia, grinding of teeth, sweating, fatigue, inability to concentrate, increased
smoking, pain in the neck or lower back, pre-menstrual tension or missed
menstrual
cycles,
migraine
headaches,
accident
proneness,
nightmares,
increased use of legally and illegally prescribed drugs, violence and destructive
tendency, diarrhoea, indigestion, uneasiness in the stomach and sometimes
vomiting (signs of disturbed gastrointestinal function that can lead to peptic
ulcers and ulcerative colitis).
Behavioural Responses to Stress as Sources of Human Health
Problem(s)
People engage in a number of unhealthy behaviour in an attempt to deal
with stressful life situations. Most often, these behavioural responses resulted
into serious health related problems for the individuals. The following are some
of the unhealthy behavioural responses to stress.
 Smoking
People commonly turn to tobacco as a means of dealing with stressful
situations. Hawkins, White and Morris (1983), reported that 35,000 nurses in the
United Kingdom (UK) found that smoking was one of the most commonly
reported ways of coping with stress. Smoking as a coping strategy contributes to
an estimated 350,000 premature deaths each year (National Cancer Institute,
1985). The American Health Association (1986) and Shehu (2005) also noted
that cigarette smoking is the biggest factors for sudden death in American and
Southern part of Kaduna State, Nigeria; smokers have between two to four times
6
the risk of non-smokers. Shehu (2005) reported that at least 25 per cent of all
deaths from heart diseases in Southern part of Kaduna State are caused by
smoking and excessive alcohol consumption. In Great Britain, AHA (1986)
reported that cancer of the trachea, bronchus and lung rate third as killer disease
among males in the 16 – 64 years age group in the 1980s.
 Alcohol
Alcohol is used to relieve stress and help the individual to manage a crisis,
but in reality, alcohol renders the distressed person less able to cope and prone
to accident conditions. Fleming (1986) and Westrin (2000) suggest that there
seems to be a strong link between stress, alcohol consumption and accidents.
Alcohol consumptions have been associated with hypertension and obesity in
number of epidemiological studies (Larbi, Cooper and Stanler, 1983). Both high
blood pressure and obesity increase the risk of heart diseases. Therefore, the
effect of alcohol has immediate consequences in terms of behavioural change for
the individual and those around him or her. Judgement and co-ordination are
likely to be impaired and reactions are slowed, rendering the person more
vulnerable to accidents (Shehu, 2005). Alcohol consumption may lead to loss of
jobs, cirrhosis of the liver (liver damage) and hypertension. A combination of all
these and many more may lead to premature death.
 Accidents
Accidents may be defined as an unplanned event, which could result in
injury to person, damage to properties or death, all these are the consequences
7
of unplanned (unsafe) acts or unplanned (unsafe) physical conditions created by
people (Jones, 1982 and Adesoye, 2001), stress has been implicated as a causal
factor in all types of accident(s). The physiological effects of stress include
slowed reaction time fatigue, impaired concentration, and poor physical coordination. From a psychological perspective, insecurity, worry and anxiety may
impair one’s ability to concentrate, mental turmoil and distraction reduces
efficiency and increases potential accident vulnerability. What is often described
as carelessness is more likely to be thoughtlessness because judgment of a
situation is restricted or blocked. The above examination of physiological and
psychological stressors, has shown that or shows that stress is a prime
contributor to the occurrence of accidents(s).
The Consequence of Stress
Krantz, Grunberg and Baum (1995), are of the opinion that stress have
direct psycho-physiological effects, including constriction of coetaneous blood
vessels, secretion of sweat, increased secretion of adrenalin from the adrenalin
medulla of the hypothalamus in the brain. Exposure to stress increases the
production of cortisol from the adrenal cortex. Cortisol, is a substance that
influences carbohydrate and protein metabolism. A deficiency in the production
of cortisol may result to the disorder of carbohydrate metabolism and ultimately
diabetes may result.
The psychological effect may predispose an individual to excessive eating
behaviour, a situation which, if persists, may result in obesity and overweight.
8
Cardiovascular disease due to stress is the most prominent killer among
industrialized nations. Masek (2000) reported that heart disease due to stress is
responsible for 38 per cent of male 17 per cent of female deaths among 35 – 64
years old in England and Wales.
Stress may lead to health impairing habits or behaviour. In an attempt to
escape stressful situation, individual may result to the use, misuse and abuse of
drugs such as tobacco, Indian hemp, tranquilizers, sleeping pills and alcohol
consumption.
Health Education Programmes in Coping with Stress
Coping is not only a reaction to stress, it may be viewed as a preventive
strategy, if a potential stressful situation is anticipated. Ways of coping are varied
and include, confronting strategies, distancing, seeking social support, escape –
avoidance, good physical health (good nutrition, exercise, rest and sleep);
diversion and being realistic about your goals.
A formidable Health Education programme in coping with stressful
situations and potential stress conditions as postulated by Payne and Hahn,
(2000) are as follows:
9
1.
Work off Stress: Get into a physically-demanding activity such as running,
washing the car, watching interesting films, listening to stories, etc.
2.
Talk out your worries: Share your concerns with a friend.
3.
Learn to accept what you can not change: Identify and appreciate your
physical ability.
4.
Don’t mask your problems with hard drugs or alcohol.
5.
Take care, of your health: Do not allow stress to interfere with your
sleeping and eating patterns.
6.
Enjoy yourself: Relax with some forms of recreation.
7.
Do something for others: Trying to help someone will distract you from
your own problem.
8.
Take one thing at a time.
9.
Make yourself available: Interact or associate with others and let others
understand your problems and difficulties for possible assistance.
10.
Select a quiet room and sit on a comfortable chair. Adjust yourself so that
you are as relaxed as possible.
Conclusion
Stress is unavoidable, but it is not harmful. Some forms of stress such as
exercise, are beneficial. These beneficial stresses have been termed “enstress”
while distress refers to negative tensions that have been aroused in our bodies
by some environmental, social or chemical factors. According to Selye (1983),
“stress in the non-specific response of the body to any demand”.
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When under stress our body undergoes a complex series of chemical
reactions that are handed over from a more primitive and physically-active time.
It is also concluded that, though the causal connection between stress and
disease has not been fully established, there is consensus that stress
undoubtedly aggravates a disease once it is present. Stress can create a
condition similar to intoxication in human mind and body, and this can make
people who are under stress more prone to violence than they would be
otherwise. It is particularly unwise to drive under the effects of stress.
The paper also examines some behavioural response like alcohol,
smoking, malnutrition (over-feeling and under-feeling) and accident as source of
human health problems.
Finally, the paper highlighted some coping strategies and Health
Education programmes for a stressful condition.
Recommendations
 Government at all levels (federal, state and local) should create enabling
environment for its citizens so as to remove stressful conditions from the
people, that is, they should provide both physiological and psychological
needs of the people, in addition to the provision of recreational facilities or
centres in the communities.
 Workshops, seminars and public lectures should be organized for the
people to enable them appreciate various coping strategies like good
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nutrition, exercise, rest and sleep, diversion, meditation and social support
against stressful situations.
 They should be made to identify and appreciate various effect of pressure
(stress) on bodily functions and how to avoid such conditions. Such
conditions
include
hypertension,
migraine
headaches,
chest
pain,
muscular tension and pain, heartburn and indigestion, menstrual
disorders, abdominal pain and diarrhea.
 Individual should appreciate their abilities and inabilities in an attempt to
prevent a stressful situation.
 Health counsellors, occupational therapists and other health professionals
with sound knowledge of stress should be employed or serve as
consultants to our schools, industries, government establishments and
private sectors in an attempt to prevent stress-related-accident situations.
 Adolescence should be educated on the effects of drug abuse, alcoholism,
smoking and other situations that are prone to accident.
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