Semester 2 Reflections – My Masters in Public Health and Nutrition

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This week, I finished my final exam of my Masters. Over the past academic year, I’ve been a full-time student at University College Dublin, studying a Masters in Public Health and Nutrition, which has helped me to secure a position on the Public Health training scheme for doctors in Ireland. I’m moving to Galway to start in July for the first of a 4 year programme, and I cannot wait.

I still have my thesis to write, and of course, a home out West to find. But finishing my last exam was a big hurdle, and of course, it made me more than a little reflective on what an amazing year it has been going back to school. I absolutely LOVE learning (I’m proudly a nerd, especially when it comes to health-related topics, and always will be), and to spent a year immersed in an area of medicine that I know I want to pursue full-time, and now have the opportunity to as a result…well, that’s something I’ve been very, very grateful for.

Many of you following the blog and my social media have asked about my Masters over the last few months, and so at Christmas, after my Semester 1 exams I decided to write about what I had taken from the programme at the time – you can have a read of that here. Since that article proved pretty popular, and semester 2 has now ended with my last exam, I decided to write a similar piece for this week’s Friday Focus. I’ve summarised 3 big take-home lessons from the past 4 months to share with you, and I’m excited to hear what you all think.

Our Environment Does Not Always Nudge Us To Healthy Habits –

But We Can Fix That.

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I gave my first talk at Wellfest last weekend, and I spoke all about the Blue Zones, regions of the world with the highest proportion of people living the longest and healthiest lives (have a read of my previous articles on them here), a topic I’ll be bringing to the Podcast soon too. A major point I emphasised was the role the social and cultural environment we live in plays in shaping our lifestyle behaviours. I think it’s really, really important that people are aware of this, because our environment is, in my opinion, something about our day to day lives that has changed the most dramatically over the last 50 years in particular. Let me ask you this – do you think our environment nudges us towards healthier habits?

If you’re struggling to answer, or are unsure, I’ll give some examples that show you how our environment does nudge us towards health, and how it doesn’t:

  • In Ireland we have a ban on smoking in the workplace, and our government increases the prices of a pack of cigarettes every year, which is an example of how our environment nudges us towards health, by discouraging smoking through making it difficult and more expensive to do so.
  • We live in a world where we can get public or personal transport more or less everywhere, especially in cities, and the majority of these modes of transport allow us to be sedentary (i.e. sitting) while we travel. Meaning it’s easier to be less active as we go through our day as the world becomes more and more technologically advanced.
  • Next time you pop into your local shop, have a look at what it eye-level, at the front of the store. More than likely, it’s food products like chocolate, sweets, crisps, cakes, etc – all located exactly where they are as part of clever marketing strategies to boost the most sales. The same goes for price promotions on these products, which are also often placed at eye level for children too, which can lead to what’s called ‘pester power’ – I probably don’t need to explain what that means, especially to any parents reading! So this is an example of how our food environment can nudge us towards less healthy dietary choices.

If we know these things about our environment, that’s the first step towards engineering our lives to circumvent them if they have the potential to negatively affect our health behaviours. Let’s take movement as an example. If we want to build more movement into our day, we need to build little strategies to do so that work in the environment of our daily lives – taking the stairs, grabbing a walk at lunchtime, hopping off the bus a stop early – all little ways to snack on movement throughout our day! The reason I’ve included this as my first big take-home from Semester 2 is to make you guys aware of it, but also because it’s a big focus of public health medicine – how to make the healthier choice the easier choice for everyone in society. Sometimes these measures can come across as being very regulatory and controlling (e.g placing a levy on sugar-sweetened beverages), but are often justified at the population to maximise the benefit to health for the majority of people.

Health Inequalities Are Everywhere – But We Don’t Talk About Them Enough. 

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To me, it seems there is an elephant in the social media room about health. Inequalities. As part of Semester 2 on my Masters, I studied both sociology and social epidemiology. Social epidemiology opened my eyes to the past and present research on the unequal distribution of health in developed countries. I wasn’t naive to them of course – I worked in a busy Dublin hospital for 3 years, and saw patients of all backgrounds, ethnicity, etc – but the degree to which there is an unequal distribution of health and health resources in society was hammered home during our module. It’s fresh in my mind as it’s the last exam I had (yesterday, as I write this).

In Ireland, a recent report by TASC (the Think Tank for Action on Social Change) highlighted that we have a very good life expectancy – about 81.5 years on average (higher for women than men), and we have one of the highest rates of self-reported health in the European Union (1). But we are the only Western European country not to have universal health coverage of primary care (although this is going to be rolled out over the coming years through our Slaintecare strategy), and there is a 21.5% disparity in this high self-reported health between the highest and lowest income groups – i.e. those who earn the most enjoy the best health. While just 1.1% of people in the top income quintile (top 20%) have unmet medical care needs, 4.2% of people in the bottom quintile (bottom 20%) report unmet medical care needs. The latest ‘Healthy Ireland’ study from 2017 which researches many aspects of the health of the Irish population reported – ‘Self-reported good health is higher among those who are working than among those who are unemployed (93% and 78% respectively). It is also higher among those living in moreaffluent areas than those living in more deprived areas (90% and 79% respectively).’ (2).

This is not just the case in Ireland – to lesser or greater extents, these inequalities in health exist in many developed countries, and it’s beyond the scope of this article to detail this further – I’ve linked the TASC report below as it’s a really insightful read and well worth it. But suffice it to say that I am glad that I’m pursuing public health, a specialty which has a key role in assessing and figuring out how to reduce and ultimately eliminate these inequalities. I may sound idealistic, and maybe I am, but it’s a challenge I’m keen to be part of taking on in Ireland, and I wanted to make you all reading aware of this important, ongoing, and in some places, consistently worsening public health issue. Especially as it renders much of the media myths around diet in particular somewhat #firstworldproblems in my mind – the world does not need arguments over ‘low-carb’ versus ‘low-fat’ for example, a debate which is of no use to a person who struggles to afford to feed their family any food at all week to week.

The Healthy Lifestyle Basics Work – But We Aren’t Doing Them Right. 

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Okay. This one is a bug bearer, so I’ll try not to rant and keep it brief. Health has become over-complicated. This over-complication has created a ‘worried well’ group in society as well as confuse everyone. The numerous myths and mixed messages that have been spun out and spread through social media have led to such confusion among the general population, about many aspects of health – particularly food and nutrition, but also exercise, stress management and as I’ve written about, vaccination. So much so, that the basics, the foundations of a healthy lifestyle, have been forgotten. Why? There’s many reasons, but I think chiefly because they are not sexy to promote, but they WORK. For example, eating five to seven servings of fruits and vegetables per day! An additional serving consumed per day has been significantly associated with a 5% reduction in all cause mortality, and particularly cardiovascular mortality (3)! Another example is physical activity – just meeting our national exercise guidelines of 30 minutes of moderate intensity activity on 5 days per week has in research been shown to produce a 30% reduction in risk of all causes of death for those most active compared to the least (3). Other cornerstones of a healthy lifestyle include not smoking (period) and keeping your alcohol intake to below our low-risk consumption guidelines (full article on alcohol here). Yet although we know that doing these 4 things right (a healthy diet, regular physical activity, not smoking, low-risk alcohol consumption) as part of a healthy lifestyle can prevent 30% of cancers and 80% of heart disease and type 2 diabetes (3), just 32% of the Irish population get enough exercise, while just 37% eat five servings of fruits and vegetables per day.

Now, there are MANY factors that play into those figures, as you’ll appreciate from my second point above. But my point is this – instead of letting media myths run riot and confuse the nation, let’s bring it back to the basics and make sure we’re doing those right first. If we did, as a population we would be doing pretty frickin’ fantastic. This is a message I intend to hammer home for the rest of this year with my public health doctor hat firmly on my head.

And that folks, is a wrap. I do hope you enjoyed reading and would love to hear your feedback – hit me with a comment, a message on Instagram, an email, whatever way tickles your fancy – @theirishbalance on Instagram/Twitter/Facebook!

Ciara 🙂 x

References

  1. Forster, Kentikelenis and Bambra (2018) ‘Health Inequalities in Europe: Setting the Stage for Progressive Policy Action.’ Available at: https://www.feps-europe.eu/attachments/publications/1845-6%20health%20inequalities%20inner-hr.pdf [Accessed 14 May 2019]
  2. Department of Health (2018) ‘Healthy Ireland 2018: A summary of findings.’ Available at: https://health.gov.ie/wp-content/uploads/2018/10/Healthy-Ireland-Survey-2018.pdf [Accessed 14 May 2019]
  3. Department of health (2017) ‘Healthy Eating and Active Living Programme: National Implementation Plan 2017-2020.’ Available at: https://www.hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/heal/heal-docs/heal-programme-national-implementation-plan-2017-2020.pdf [Accessed 16 May 2019]

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