How Can We Put Prevention Into Practice?

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Last week, I was delighted to attend the 2019 Summer Public Health Conference in Ireland. It was a particularly special one for me as previously, I’ve attended as a doctor yes, but not as a public health doctor. I presented research I had done through oral and poster presentations at the last two conferences, but this time around since I’m working on my thesis at present, I wasn’t presenting anything. BUT – I was attending as a future public health medicine trainee, as I start my 4 year training programme in July, so THAT was very exciting and made me feel pretty proud of myself. I don’t make a big deal out of achievements, but it was really, really nice to enjoy the 2-day conference and feel that the work I have put into this Masters and my application to get on the programme has come to fruition.

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As you can imagine, the work presented at the public health conference always fascinates me, and there was a lot of interest expressed when I shared the fact that I was attending on my Instagram. Given that, and because I like to share what I learn on this platform to help you guys learn more about the importance of a healthy lifestyle, I decided to put this post together. What also made me want to do so was one talk in particular – a woman called Professor Annie Anderson, who is a Professor of Public Health Nutrition, a dietitian by background, and the Co-Director of the Scottish Cancer Prevention Network. She gave an incredible talk on Cancer Prevention, titled ‘Celebrated in Principle, Resisted in Practice.’ It stuck with me and not just because I found it fascinating – I was jotting down notes throughout her presentation!. But also because I’ve been thinking a lot why the basics of a healthy lifestyle, particularly on social media, often fade in comparison to whatever the latest diet or fitness fad/trend is, and why important lifestyle behaviours outside of food and exercise such as alcohol moderation, smoking cessation, and to a less extent stress management, social interaction and sleep, get a LOT less airtime. We know, for example, based on data from the Irish population, that:

  • Only 37% of Irish adults consume five or more portions of fruits and vegetables per day
  • Only 32% of Irish adults are exercising enough when their activity levels are compared to our national exercise guidelines
  • 19% of primary school children and 12% of post-primary school children are active enough to reap the health benefits
  • 20% of the population smoke regularly
  • 37% of Irish people who drink alcohol do so in a binge-style of intake on a typical drinking occasion, while 22% do this at least once per week

In the references at the bottom you’ll find the publications where I’ve sourced those figures, which are all based on nationally representative data. In addition to these unfavourable figures, we also know that 60% of Irish adults are overweight or obese – that figure is accompanied by a high prevalence of chronic disease that accumulates with age – for example, 40% of those over 50 years of age have at least one chronic illness (diseases such as heart disease, type 2 diabetes, some cancers and dementia), illnesses which causes 7 in 10 premature deaths. Not great, is it? Coupled with the fact that we have an ageing population both here and in many other Western countries. We are living longer, but not better. We’re adding years to our lives, but not life to our years, at a population level. 

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So if we know, for example, that just doing four things as part of a healthy lifestyle – eating a healthier diet (in line with current Irish dietary guidelines), being regularly physically active, not smoking, and keeping alcohol intake to within our low-risk consumption guidelines (these are given in a previous blog post I’ve written on the blog) – can prevent 30% of cancers, and 80% of heart disease and type 2 diabetes, why aren’t we doing them? 

There are a lot of answers to that question, and the relevance of each will vary depending on what level of society you reside in. For example, in the case of diet, reasons include food affordability, food accessibility, health education and literacy, nutritional knowledge, food preparation skills, awareness of dietary guidelines – and that’s all before you add the confusion from ‘social media myths, fads and fiction’ to the mix. The purpose of this article is not to go through every single reason for why as a nation we aren’t nailing the basics (though I do plan to spend a decent portion of my public health career focusing on just that). However, I do want to communicate a couple of things, which I’ll keep short and sweet to hold your attention, but hopefully will make you a little bit more aware of what needs to happen for us to see widespread adoption of healthy lifestyle behaviours that, if people focused on nailing consistently, could us big improvements in population level health from small changes adopted by a large number.

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We know that knowledge, awareness, skills and support are essential as the foundation upon which to try to make sustainable healthy lifestyle habits persist for life. That’s a big motivating factor for why I share the content I do on this platform, because I do firmly believe that education and awareness inspires change – if you don’t know, you can’t act. But that’s the starting point. I’ll be expanding on this in an upcoming article on how our modern environment affects our health, but once we have awareness, we have to have changing norms for the majority to make changes. For example – when you walk into a shop, at the front of the store for the most part you are faced with a range of snack options, all of which are typically chocolate, sweets, crisps or some other form of highly processed, nutrient sparse food product. All at eye level of course, and none of which are ideal snack options nutritionally. I’m not bashing having these foods occasionally – but, as stated by our national dietary guidelines, NOT as a regular go-to snack, and NOT as the food choice ‘norm‘. Similarly with physical activity – it has never been easier NOT to have to physically be active to get from A to B. Public transport, cars everywhere, home and work environments designed for sedentary behaviour – we have to work quite hard to get moving. A third example is alcohol, particularly in Ireland – only 20% of the population abstain, and if you’re either not a drinker at all or choose to do so infrequently, you’re more often than not asked for your reasons why. Because the norm in Irish society is for many ‘to have a few drinks’ to ‘unwind’ or ‘blow off steam’. The only behaviour that doesn’t apply here is cigarette smoking – thankfully, a lot of hard work from a public health perspective has changed that norm given the extensive risks to our health as a result of inhaled tobacco smoke both directly and indirectly – but it took a long time for us to get there.

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Which brings me to my second point that I’ll leave you with. The use of legislation to help change norms of lifestyle behaviours. You may have heard of the phrase ‘nanny state‘ before, with reference to measures usually taken at a government level – for example, banning smoking in all workplaces, or placing a taxation on sugar-sweetened beverages. Some criticise these measures, and this post is not to do a ‘pros and cons’ lists of each – I simply want to highlight that sometimes, certain measures such as these are needed to maximise the health of the maximum number. Such measures usually involve addressing the marketing, price and/or availability of food, beverage or other products, and in Ireland there’s been a lot of discussion on this topic as regards alcohol especially, after our Public Health Alcohol Bill was (finally) passed last year. All three of marketing, price and availability drive consumption and associated harms, and I think they are important so that we can, as Professor Drummond said, ‘Shame the product, not the person.‘ We are likely to see more and more discussion on this topic in future, particularly around the food industry, as it’s been probably the least addressed area in an Irish context (I’m aware the U.K. have been more active on this – we did a project on it for my Masters).

And with that, I’ll share my third and last brief point – the need for us, public health and other healthcare professionals, to make sure we communicate the evidence for and importance of these healthy lifestyle basics with you, the public, so that as hopefully, over time we change current norms through raising awareness and legislative measures, we link this communication with environments that make the healthy choice the easier choice. I’m writing an article on the topic of how our environment affects our health (and tips to circumvent those effects) soon – but for now, that’s the thought I’ll leave you with.

References

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