And why you should have a family doctor.
Dr. C. V. Alert, MB BS, DM. FCCFP.
Family Physician.
Founder and Director, the Wellness Clinic, Barbados.
The importance of a healthy lifestyle.
Maintaining a healthy lifestyle is a fundamental “long-term investment” that significantly enhances your quality of life. The World Health Organization (WHO) defines health not just as the absence of illness, but as a complete state of physical, mental, and social well-being. The best preparation for tomorrow is doing your best today.
Various stages in the life-cycle dictate the priorities if good health is to be maintained.
For babies and young children, the routine should include scheduled medical visits, which must include well-baby visits, routine vaccinations and a documentation of growth and development. Our data tell us that around 10 % of children at age 5 years are already on the road to NCDs; ideally they should be stopped in their tracks.
For the slightly older child, a focus on eating habits – no sweetened beverages, no fast foods – and exercise habits: go outside and play. Many fast foods and ultra-processed foods are addictive, and if our young children develop an appetite for these foods at a young age, it may be very hard to break the habit later. When they reach adolescence and are driven to exercise their independence, it becomes easier to continue inappropriate eating and exercise habits. The adolescent ‘knows it all’; they will do what they like because (they believe that) they are stronger and smarter than the generation that came before them. They are also tempted more than ever to experiment with cigarettes, alcohol and illegal drugs like marijuana and cocaine: emphasis must be placed on recognizing and stopping this behavior before it becomes established, and the individual becomes addicted. Sleeping habits are important: we are now realizing that poor sleep is a risk factor for the development of NCDs, although the medical research on this is in its infancy.
Young adults are probably the biggest problem area in our community, as far as health promotion and disease prevention is concerned. Starting new jobs and families tends to take away recreation time, and many find it hard to continue even the games they played in high school. Challenges on time and family building suddenly turn fast foods into a convenient option. This is the environment in which the NCDs incubate. But unless they are sick (or pregnant) our young people don’t seek preventive health care. Overcrowded clinics and long waiting times actually discourage people ‘who don’t feel sick’’ from seeking medical attention. In our young persons, the annual medical examination, in addition to screening for sexually transmitted infections (STIs), should include screening for NCD risk factors, as these are all ‘silent’ in the early stages, and generally only cause symptoms when the internal organs are damaged.
Young mothers should be informed, or at least reminded, that their eating, drinking and smoking habits can have a significant impact on the health of future generations, including NCDs and mental health, issues that currently overwhelm our health services.
Generally in adults immunizations are neglected, but as a population we are especially prone to a number of illnesses that can (and should be) prevented. In particular, the elderly population, especially those in institutions; and adults whose immunity is compromised by diseases like diabetes or chronic kidney disease, for example, can benefit from the protection offered by adult vaccines.
As we approach our 40’s, 50’s, 60’s and beyond, we see large numbers being diagnosed with the NCDs diabetes, hypertension, dyslipidemias (‘cholesterol issues’), nowadays lumped in a bigger category called Atherosclerotic Vascular Disease (ASCVD), or cancers. Unfortunately, far too many people show up with the complications of ASCVDs, like heart attacks, strokes, heart or kidney failure. Far too many show up with advanced prostate, colon, breast or colon cancers, without presenting themselves for any of the early screening tests, which can improve chances of survival.
Persons who present with advanced disease overwhelm out hospital services. Some of this causes the hospital to be unfairly blamed for poor health outcomes. In cricket terms, while it is technically correct to say that, if the no. 11 batsman had hit each ball of the last over for a six, the West Indies would have won the match by one run. Even ardent supporters of the West Indies cricket team would admit that, unless the early work is put in, then the team overall would fail. If someone rarely shows an active interest in their health throughout life, when disease(s) have become fully entrenched then the hospital services are unlikely to return that person to ‘perfect’ health. The hospital, as a place of last resort, is unlikely to hit six consecutive sixes.
The NCDs can’t be cured, but at best be controlled. When young people get sick, in many cases the illness is temporary, and the individual regains full health, ‘like a teenager’. When old people get sick, in many cases the disease can’t be cured, but at best be controlled; the individual has good days and bad days. On a good day you feel like you’re in your 20’s, on a bad day your 120’s. Many older people have illness that interfere with every life, like painful joints that limit mobility and reduced eyesight that limits driving, going out, reading medicine instructions or even the ability to do many tasks at home.
If our medical services are struggling to cope with the load of disease now, the overweight and obesity statistics in our young people means that the health services will be even more challenged in the future. Even now the demand for health, mental and social services outstrips the supply. We certainly need to reset the direction of our health care: we are spending more and more, and are getting less and less. This can’t (or shouldn’t) go on indefinitely.
So to avoid the heart attack, the stroke, the dementia or the loss of independence in old age, persons must take an active interest in their health, and the health of their family members, from the womb to the tomb. It is not good enough to wait until you feel sick. Antenatal visits for pregnant mothers, childhood visits (including vaccinations) for our children, are essential. Targeted evaluations in our adolescents, including drug screening, screening for sexually transmitted infections (STI’s) and perhaps mental evaluations; and regular scheduled visits for all adults, young and old, are perhaps mandatory requirements for good health. Since obesity and its sequelae dominate our health profile, attention to body build, to dietary and physical activity habits, must attract specific attention.
This need for lifelong care highlights the role of family physicians, doctors who emphasize continuity of care, and who provide comprehensive care for individuals of all ages, genders and diseases. Family medicine is a relatively new specialty in this part of the world, and family physicians are doctors who receive additional specialist training after medical school to fulfil this important role. Since these NCDs have lifelong components, the family physician can offer lifelong care. We now have risk factor tables that can predict, years in advance, the risk of an individual developing a major cardiovascular event. Armed with this knowledge, an intervention can be designed for each individual to prevent full blown illness.