This post has been one I’ve been excited to write for quite a while, and now that the festive season is behind us and my brain has had a little bit of post-exams chill time, I was finally able to sit down and write it. The end of the year always makes me quite reflective, as you’ll have seen from my 2018 post recently, and I’ve also been asked A LOT about my Masters over the past few months. So here’s a little introduction before we get into what I’ve learnt a bit more.

Most of you will know that I’m a qualified (Irish-trained) medical doctor, and after graduating in 2015 and working for 3 years in hospital medicine (completing my intern year, my 2 Senior House Officer years in medicine, and my Royal College of Physician exams to allow me to specialise), I decided that my passion was in the arena of preventive medicine and health promotion, all under the umbrella of ‘public health.’ My favourite definition of public health is this ‘the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society.‘ (Acheson, WHO, 1988). To pursue this in Ireland, in a nutshell you have to apply for a four year scheme that will train you to ultimately become a public health consultant (the same way you would do for cardiology, respiratory, gastroenterology – you get the picture). And to have a strong application for this scheme, really a Masters in Public Health is the currency needed (in Ireland anyway). So I made the decision to leave hospital medicine, take a leap of faith and apply for a Masters in Public Health and Nutrition. I’m studying this at University College Dublin (UCD) – my undergraduate degree in medicine was at Trinity College Dublin (both are major Irish universities).

Thankfully, my leap of faith paid off. I started the programme in September, and have loved every second – every lecture (yep, even Biostatistics, because now I (sort of) UNDERSTAND the basics of interpreting research), every assignment, every day on campus. UCD is a beautiful university – big, open, sprawling, requires lots of walking to get from A to B (you know me, all about the movement snacks!), and has set up a brilliant initiative called Healthy UCD, the committee of which directs the movement towards a healthy and health promoting campus. I’ve become a guest writer for the website on topics including nutrition (with recipes!) and stress management, and will be writing more articles in 2019! You can have a read of those on the website here.

Let’s get to the good stuff. What do we LEARN?! So, I can only speak for Semester 1, but I’ll break it down into 3 key things I’ve taken from the past 4 months. In total, this semester we’ve covered modules on areas including health psychology (chiefly risk perception, communication and behaviour change theory, including looking at social media and health), non-communicable diseases (i.e. diseases that aren’t infectious, such as coronary heart disease, type 2 diabetes and cancers), communicable diseases (i.e. infectious, such as influenza, or measles), public health policy, biostatistics and the basics of epidemiology. Epidemiology, if you haven’t heard of it, is a core aspect of public health, and can be described as the study of occurrence, distribution and determinants of disease and the use of this knowledge for health protection and promotion of populations. It involves looking at what diseases occur, where they occur, who to, WHY the occur, and using this information to design prevention and intervention strategies addressing these aspects of the diseases in question. I also got to study a cool area called ‘One Health‘, which is defined by the U.S.A. Centers for Disease Control (CDC) as a ‘collaborative, multi-sectoral, and trans-disciplinary approach — working at the local, regional, national, and global levels — with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment.’

Now, I’m going to share 3 big things I have learnt over the past semester. Of course, I have learnt a LOT more than 3 things, but I want to give you guys a broad idea of the knowledge I have gained, while illustrating to you what public health is, what it involves and why it’s so important. I also want this post to provide you with, as always, some actionable healthy living tips you can bring to your own lifestyle. And if you do want to know more, just pop a comment/DM on Instagram/email, and I’ll write a part 2! Let’s get into it.

One: Health is not a one-size fits all, and more than the absence of illness.

The World Health Organisation (WHO) defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.‘ I’ve mentioned this definition a few times, and I was so happy to see it on a slide in one of my first lectures. Being ‘healthy’ has a unique meaning for everyone, and we are not automatically ‘healthy’ if we aren’t suffering from a medical condition. Read the WHO definition again – physical, mental and social well-being. Think of your own life. Can you currently say that you feel 100% for all 3 of those aspects of well-being? For example, this year my physical health, bar a nasty bout of food poisoning recently, has been pretty overall pretty decent (*touches wood*) but I picked up two training injuries (self-inflicted) which I had to take time to rehab (side note: do what your physio tells you, it pays off!). When I recently had Christmas exams, I definitely didn’t have the best social health – studying at home for a full week, seeing only my family really, saving catch-ups with friends for post-exams. During that stressful time, I tried to safe-guard my mental health by keeping up daily exercise and meditating for 10 minutes a day, but all the same, exams are exams, and I’ve definitely had a happier head since finishing! My point is this – health and illness exist on a spectrum, not in isolation.

If your health is affected by a medical condition, then that illness needs to be either cured, or (if not curable) management optimised with appropriate medical care. But even if you don’t have such a condition currently, that doesn’t make us automatically healthy. And this is where lifestyle factors play a role. For example, smoking, consuming alcohol to excess (either in volume or frequency), eating an unhealthy diet, living an inactive lifestyle – all of these things can damage our health in the short and long-term. Therefore, addressing these factors, and making changes, moves us further along the spectrum in the direction of health. Quitting smoking. Cutting down on alcohol intake to under the maximum weekly and daily limits. Making small dietary changes such as consuming more fruits, vegetables and whole-grains, drinking 2 litres of water a day, cooking more meals from scratch. Building exercise into your day – getting off the bus a stop early, going for a short walk on your lunch break, finding activities you enjoy. Ensuring you get a minimum of 7 hours sleep per night. These aren’t radical changes to make to your life, but they can have a radical impact over time. A big BIG realm of public health is the research into and promotion of these lifestyle factors, to encourage the members of the population to be the healthiest versions of themselves possible, without breaking the bank or advising unrealistic changes.

Two: Sustained behaviour change is complicated, and takes time, commitment, and regular celebration of small wins. 

How often have you said to yourself ‘I’ll start tomorrow’, or ‘I’ll start on Monday’, when attempting to make a change to your lifestyle? It might have been to hit the gym, or eat a little bit better, or cook more, or get more sleep. It might have been to start a college assignment, or a work project, or maybe just get a better night’s sleep. Regardless, it was a change that in that moment, you put off trying to make a habit. And trust me, you are NOT alone there.

They say it takes 66 days for a habit to really become a normal part of your life, and while that sounds like a long time, I fully agree with it. We can’t expect overnight success, and to do so is to set yourself up for failure. I’m being frank, but for good reason. I started meditation and mindfulness this year with the Calm app, and only after sticking to doing it for just 10 minutes a day for over 2 weeks did it begin to feel like a habit. After a month, if I missed a day I still went back the next night, and after 2 months, I realised I missed hardly any days, and was noticing major differences to my stress management at work. It took time, commitment, and the celebration of small wins like getting a full week straight done, and it did pay off.

One of my favourite modules in college this past semester was our Health Psychology module, through which we learnt about behaviour change models, health promotion, health risk communication, and fascinatingly, how to use media for behaviour change in public health. I got to write my assignment essay on stress in modern society, which was awesome. What stood out to me most was the behaviour change process (the image above illustrates my favourite behaviour change model, called the ‘COM-B’ model – more on that another day!), the time it takes for success with it, and the multitude of factors that affect our day to day decisions about our health. These factors are psychological, physical, emotional, environmental, family-related, work-related, biological and more. For example, let’s say one of your 2019 goals is to use your gym membership more. You want to start tomorrow (Monday). Great! So, it’s Monday, and you plan to go after work, 6pm. But then, BOOM – work is crazy busy, and you finish at 6 instead of 5. You’ve got a headache after the mental day. You know you need time to cook after the gym too…but still, you’re gonna go. You hop on the train, aiming to get to the gym for a quick 30 minutes, but then the train is delayed. With each little change to your day, your best intentions and plans seem to move just beyond your reach of control. By the time you get home, it’s 8pm, and you’ve lost all motivation. Tomorrow I’ll go, you say.

Sound familiar? I hear ya. That’s why behaviour change isn’t easy – it’s hard. It takes commitment, planning and time – everyday. It takes encouragement – from within yourself, and from those in your social network to support you. It takes celebration of every win along your journey. It is worth it. But we need to remember, for ourselves and for those around us, that many factors affect our very best intentions, and progress, not perfection, is what is most important.

Three: Prevention is better than cure. 

One of my favourite sayings. In public health, there are 3 levels of prevention described. Primary prevention is the proactive approach, before disease is present, and includes things like vaccination (e.g. against measles, influenza, etc) and education on aspects of health (e.g. advising people to not smoke due to the major health harms that it causes). Primary prevention is something I’m particularly interested in and passionate about. Secondary prevention involves early recognition of disease and when present, treating disease early to minimise any damage from it. An example would be breast cancer screening programmes, and if cancer is detected, ensuring early management of the patient to ideally treat disease and minimise any long-term impacts. Tertiary prevention involves improving the quality of life for those who have established disease – for example, through rehabilitation, and minimising the effect of any symptoms present (e.g. for a patient with type 2 diabetes, making sure they get regular feet and eye checks, with optimising blood sugar control, to detect early damage to the blood vessels supplying the nerves and eyes, and prevent the nerve damage and blindness that can result without this).

I want to emphasise this – modern medicine is amazing. If you come to your doctor or hospital with an acute, potentially life-threatening condition, such as pneumonia, or a stroke, or heart attack, modern medicine will endeavour to save your life, and more often than not, succeed. That model of care is not broken, however much you might see your own healthcare system criticised, the majority of doctors and staff in hospitals just want to help those in need to survive and thrive, and get back to their ‘well’ self. These interventions are what has led to the major increases in life expectancy over the past century – stenting of coronary arteries, removal of clots in the brain causing strokes, intravenous antibiotics for many infections, even the simplicity of clean, safe water  – these things are based on sound science and research, and save lives every single day, allowing us to hopefully live into our seventies, eighties and beyond in most developed countries.

But. Much of the disease burden we see in primary and hospital care can be prevented. That’s a well-known fact. Non-communicable diseases (NCDs) such as coronary heart disease, cancers, dementia, type 2 diabetes mellitus, and yes, obesity, among others, cause 71% (yep, SEVENTY-ONE PER CENT) of deaths globally per year, according to the WHO. Cardiovascular diseases account for most of these, followed by cancers, respiratory diseases (e.g. chronic obstructive lung disease, largely due to smoking), and diabetes. What are the major drivers of these conditions? Lifestyle factors. Smoking. Physical inactivity. Alcohol misuse. Consuming an unhealthy diet. All modifiable. Preventable. Not through insanely expensive, radical or inaccessible interventions, but through simple, sustainable behaviour changes that admittedly requires commitment from us all to see large scale change. But the majority of us do have the power (and being honest, the personal responsibility) to make these changes, and prevent (or at least reduce) further increases in this disease burden.

Powerful, right? This is why I love public health and prevention. And why I’m so passionate about spreading these messages – because they are relevant to us all, and need to reach as many as possible. 

Trust me, I could go on. But instead, I will leave you with those 3 key things I’ve learnt during my first semester of my Masters, and I hope that this article has helped you to understand what public health, the major role it can and does play in shaping the health of nations, and how it’s relevant to your life. If you would like to see a Part 2, let me know! I would love to hear your thoughts – leave a comment here, drop me an email, or find me on Instagram/Twitter/Facebook – @theirishbalance!

Finally, in Semester 2, I will be starting a whole new host of modules, and diving headfirst into my literature review for my thesis. It’s going to be on shift work and lifestyle/health, so I can’t wait to share some learning on that area, it fascinates me!

Ciara 🙂 x