Betel Nut Chewing in PNG - A Critical Public Health Issue
Patrick Nomos | 16/1/2019
Betel (Areca) nut is the seed of Areca catechu, a palm tree grown in much of the tropical Pacific, Asia and parts of East Africa. It is one of the most widely consumed addictive substances in the world after nicotine, ethanol and caffeine, being consumed by approximately 10 per cent of the world's population. In Papua New Guinea (PNG), betel nut ("buai" in Tok Pisin) was originally consumed by coastal people, but its use has now spread to the heavily-populated highlands region. In my grandfather's time, the chewing of betel nut was a practice followed mainly by the village chiefs as they sat in a meeting house to discuss the affairs of the village.
A branch full of betel nuts would be placed in the centre of the meeting house for the use of those chiefs wishing to chew during the course of the meeting. Young men and women didn't normally chew betel nuts until they became adults, but this practice has been gradually abandoned so that now almost everyone in my mother's village chews betel nuts, even children as young as two years.
Many regular chewers of betel nut, who combine it with the fruit or leaf of the betel pepper vine (Piper betel) and powdered burnt lime (calcium oxide), claim that it increases their alertness and ability to undertake hard manual labour, aids food digestion and gives a mild feeling of well-being. However, modern research shows that there are many health risks associated with this practice.
In fact, the World Health Organization (WHO) has classified betel nut as a cancer-causing agent (carcinogen) and has initiated an action plan to reduce its use. A 2014 review of the adverse effects of betel nut* notes that, in addition to directly contributing to poor dental health (badly stained and decayed teeth), there is substantial evidence for betel nut chewing to be associated with cancers of the mouth, throat and gullet.
The products of betel nut chewing affect almost all organs of the human body, including the brain, heart, lungs, gastro-intestinal tract and reproductive organs. It causes or aggravates pre-existing conditions such as nerve injury, heart attack, irregular heart-beat, liver toxicity, asthma, central obesity, type II diabetes, enlarged prostate gland and other serious conditions. Expectant mothers who regularly chew betel nut have higher incidences of low birth weight, low birth length and pre-term births.
These mothers have higher than normal blood concentrations of heavy metals like lead, arsenic and cadmium which are harmful to the fetus. Perinatal exposure to betel nut exposes the fetus to harmful carcinogens. In addition to the direct, harmful effects on human health of regular betel nut chewing, there is an associated public health issue related to the spitting of chewed betel nut and its role in spreading infectious diseases such as tuberculosis (TB). Although TB was thought to be nearly eradicated in PNG, there has been a recent resurgence of this serious disease, in a drug-resistant form.
Given the widespread use of betel nut in PNG across all age groups, there is clearly a need for the population to be accurately informed about its adverse effects on human health, particularly the health of young children and expectant mothers. With PNG's public health system in serious decline, it seems beyond the capacity of village health workers to effectively educate villagers about the risks they and their children face by the regular chewing of betel nut.
*A Review of the Systemic Adverse Effects of Areca Nut or Betel Nut, Indian Journal of Medical Paediatric Oncology. 2014 Jan-Mar; 35(1): 3-9.
Photo: Public toilet floor in PNG, stained red with betel nut spittle.