Founded as recently as 1902 and incorporated as a city just a few year later, the history of Las Vegas (The meadows) is a great example of the challenges facing healthcare.
In a recent training session on life support, the instructors asked us where we thought the best place would be to have a heart attack in terms of a favourable clinical outcome. Putting aside the obvious answers (a hospital or on a football pitch within spitting distance of a cardiologist in the crowd with the nearest specialist cardiac centre being just minutes away), we were rather surprised to learn the answer.
You will have guessed by the title of this piece that Las Vegas is indeed one of the safest places to be when having a heart attack. To be specific though, you would ideally want to be sat in front of a slot machine monotonously feeding it with silver dollars. That is because, each machine is reportedly accompanied by a defibrillator. Assuming this is due to good planning rather than luck, it begs the question, why?
Because the casino owners know that the chances of a heart attack are significantly increased when somebody is going through the stress of gambling, they have provided the very best medical response. Well, nearly. For fear of a sudden outbreak of altruism among the casino owners, their stance is simply to treat the heart attack rather than deter the person from gambling. As vested interests go, this takes some beating. Ergo, if the addiction is making you money, feed the addiction.
Not far from Las Vegas is the town of Shivwits. This is the ancestral home of the Paiute Indians. They, of course, pre-date the gambling havens of Vegas and Reno by centuries. The arrival of the casinos brought prosperity to the Mormons who opened them but health misery to indigenous tribes such as the Pauites. The main concern of the Pauite tribe leader is not alcoholism although that has been an historical problem. No, the one thing which threatens them as a race is type 2 diabetes. They have one of the highest rates in the USA - and that is saying something! The rate of diabetes in under-19s in the USA is three times higher among the indigenous Indian tribes. But why is that?
There are both genetic and lifestyle factors which have contibuted to this anomaly. For the last two centuries, addiction among the North American Indians has been well documented. In the early days, alcohol was the substance of choice but then habits started to mirror those of the wider society springing up around them. Abuse of marijuana, amphetamines, hairspray and crystal met have all been documented. So are these Indian tribes inherently predisposed to substance abuse? Well, maybe they are.
Before Westernisation took hold in the form of Vegas, these tribes were hunter gatherers. The content of carbohydrates in their diet was tiny and thus they evolved as an incredibly efficient race able to cope in the harsh temperatures of the dessert with limited nutrition and water. They ate what they could kill or find and that didn't amount to much. Post Vegas, their lives have been transformed for the worse from a health perspective as they no longer have to hunt or find. Added to this is the fact that their diets have now become awash with carbohydrates as Westernisation has exerted a vice like grip on them.
But just as the Mormons used their religion to build Vegas and therefore become richer, a similar picture has been going on back in the UK for years. Go in to your local supermarket anywhere in the UK for the last couple of months and you will be bombarded with images of a festival to which few people have any allegiance. I speak of course of Christmas. As with Vegas, religion has little to do with profits and the profits made out of Christmas are enormous. The mountains of carbohydrates which now confront us in the name of a festival whose meaning has long since been hijacked by the all conquering retailers are contributing to our own diabetes time bomb. Worst of all, it is completely unregulated and makes no attempt to hide its cynical intentions.
Meanwhile, we are being told daily about what a mess our NHS is in. Standards of care are being questioned. Medical competencies are being questioned. The numbers of nurses are being debated. Community hospitals are being closed down. GPs are being asked to work longer hours to try and relive the strain on the hospitals. All the while though, little if anything is being said about the causes of these problems. I can stuff myself stupid with a diet rich in carbohydrates and fat and do little or no exercise. I can pour alcohol down my throat for fum because it is so ridiculously cheap and I can then smoke myself like a kipper. But after all that I can turn up at my GP surgery or local A and E department safe in the knowledge that someone will give me a pill to make it better. Nobody will judge me because they are not allowed to do that. They will even refrain from referring to my weight for fear of the distress this may cause me. Given all of the above, is it any wonder the NHS is struggling? Also, is it any wonder the supermarkets so utterly dominate our society? Illnesses such as heart disease, diabetes and strokes are the legacy of their strategies. But they don't have to worry about the cost of putting us right because the NHS does that. They are therefore to do as they please and make profit for fun with no recourse to anyone.
On balance then, I question which is worse. Vegas with its defibrillators behind every slot machine or the UK with its unregulated supermarkets? Both induce ill health but I would argue that Vegas does so with a touch more honesty. I don't agree with them fuelling an addiction but at least they make no bones about it however unpalatable that is. The supermarkets though are a different kettle of fish. They vie with each nother to show who is the cheapest and offer us reward points for coming back. They are therefore charging us more in the first place and rewarding us by selling cheap carbohydrates and alcohol to fuel our addiction. Thus they ensure our custom and make their profits. In any assessment, that is a pretty rotten business plan and yet millions of us are drawn to it daily. They even sell us our petrol now just in case there is an aspect of our spending which they haven't yet sufficiently exploited.
It is not the casino which has made the native Indians obese in Nevada. It is the Western diet which has done that. We in the UK are merely mirroring what has been going on the US and reaping similar rewards. Just this week I saw another proposed supermarket development in the market town of Mold in North Wales. As usual, the justification for such a decision revolves around jobs because apparently this is the best we can do in this country. This is lame excuse to finish off another high street as it surely will. An elderly lady in Aberystwyth faces being evicted for another supermarket to be built. Once agin the local councillors cite jobs as their rationale. If this constitutes the extent of the vision held by those charged with making the big decisions in our locality, Heaven help us all. By comparison to the myopic vision of North Wales councillors, Viva Las Vegas!
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