Healthcare cannot exist in a vacuum – Anant Shah
By Anant Shah, junior doctor
15th Oct, 2020
Treatment of chronic disease accounts for the largest portion of the NHS budget. 15 million people in the UK currently have at least one long-term condition. Since the 20th century, the prevalence of chronic disease has significantly grown. As research has developed, we have gained a greater understanding of the impact of lifestyle on health. This has enabled us to become proactive as opposed to reactive, and to address patient’s lifestyle factors before the onset of chronic disease. The time is now right to take a further step back in the process, and address the underlying socio-economic determinants of lifestyle factors.
Nutrition has gained prominence as the first area of enquiry when addressing health. In the UK, average sugar consumption among adults is double the guideline intake. Intake is highest in the poorest socio-economic groups. Between 2010 and 2018 there has been a 34% increase in fast food outlets. This has occurred in predominantly deprived areas. The sugary drinks levy has been successful in reducing sugar content, but not overall sugar consumption. This levy should be expanded to all sugary food. The price of healthy food is considered by many to be a barrier to eating well. Subsidising healthy food and increasing levies on unhealthy food would lead to huge improvements in health and a reduction in subsequent healthcare costs.
Physical inactivity is one of the most important causes of ill health. It is responsible for as many deaths as smoking. In the UK, a large minority of adults and a majority of children do not meet physical activity guidelines. It increases the risk of almost all chronic diseases. People in the lowest socioeconomic groups are far more likely to be inactive than those in the highest.
Physical activity is no longer a necessity for survival. Human progress has always inevitably led to outsourcing work and reducing individual energy expenditure. It takes far more energy to hunt than to drive to KFC.
In schools, having children sit in one place for hours on end is not the optimal way to ensure their health and development. Indeed, interventions which have sought to increase activity levels at school have shown increases in academic attainment.
Physical activity needs to be promoted aggressively to induce culture change. The Dutch can be a source of inspiration for this; a quarter of all journeys in the Netherlands are by bicycle (compared to 2% in the UK).
Urban planning must make health an important factor in decision making. There is a strong relationship between health inequality and access to green space. Deprived inner city areas have higher levels of pollution and far less access to green space. Children growing up in these areas are far more likely to be obese. Importantly in greener areas, health inequality relative to income deprivation is a lot lower. By placing health and natural greenspace at the forefront of urban planning, we can reduce healthcare costs, improve health inequality and create a more beautiful country.
Loneliness is an under-appreciated health issue. Social connection is vital to human existence and progress, yet a startling number of adults in the UK report often feeling lonely. Social disconnection is extremely damaging to health, increasing the risk of many diseases and increasing the severity of many more. During the early stages of the lockdown, it was deeply heartwarming to see the true kindness of the human spirit. Local communities came together to support and look after each other, displaying resilience and kinship in the face of adversity. It is difficult to pinpoint specific interventions to address social disconnection; however it is my hope that the bonds forged during the pandemic will not easily wither.
Health extends far beyond the healthcare system or individual responsibility. It is inexorably linked with every facet of society and every governmental department. Just as we fought the tobacco companies in the sixties, we must boldly tackle the industries and groups today who are invested in our ill health. Deprived populations are suffering the most. The creation of the NHS was a significant improvement upon the Poor Laws and an ideological rejection of Malthusian principles. That vision can be built upon, to improve our collective health and wellbeing and enable us to enjoy life to the fullest.
Anant Shah is a junior doctor currently working in Kent. His main interests are sports medicine and lifestyle medicine. Anant is a BSLM member and aims to become a GP to improve health and wellbeing in his local community
This is an edited version of a longer article which you can find in our resources area – or click here read the full article.