What does good health mean to you?

 

 

Working in an Emergency Department means that I see many, very unwell patients. Some are able to tell me about their acute problem, or the exacerbation of their chronic disease, and others have their story told by family and friends. I always ask about the specific reason my patient came to hospital at that time, and then work backwards to find out about anything else that has been going on, their medical, psychiatric, social and medication history. 

 

During an examination, I like to ask the person how they feel in themselves and a lot of the time I am told "I'm normally very healthy" or conversely, "I'm not in very good health, doctor". Interestingly when I ask what they mean by that, it is infrequent for patients to refer to their medical problems.

 

This has got me thinking…what really is the meaning of good health? 

my grandma and me at her birthday party! 

my grandma and me at her birthday party! 

My grandma is 88 years old, and my hero. Until about a year ago she would walk a mile to the local hotel, spend an hour in their gym, then go swimming, and then walk home. 3 times a week! She is fully independent, lives alone in a house with stairs, and now loves to sit in her recliner playing candy crush on her Ipad.

She takes less medication than me, and when I asked her what her idea of good health is, she talked about good diet and exercise as the most important things. To this day, she still walks around her cul-de-sac for 20 minutes everyday come rain, or shine (but not wind!). 

 

"Everything in moderation", she says. 

 

I extended my question to family, colleagues and even some patients and I was surprised that so few mentioned their diagnosed medical problems at all. Every comment related to diet, exercise, appearance, relationships, and feeling of happiness. 

 

I have picked out the main points that came up during my research. i hope you find this interesting.

“HEALTH IS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY.”
— WORLD HEALTH ORGANIZATION. CONSTITUTION OF THE WORLD HEALTH ORGANIZATION. IN: BASIC DOCUMENTS, FORTY-FIFTH EDITION, SUPPLEMENT. 2006. AVAILABLE: WWW.WHO.INT/GOVERNANCE/EB/WHO_CONSTITUTION_EN.PDF 

 

The WHO reports that good health is determined by circumstance and environment, yet access to and engagement in health services, has a lesser impact. People that live in lower socio-economic areas, who have low education and/or poor social support, are far more likely to be classed as less 'healthy' <1>, but do they feel it?

 

In the US, the Office of Disease Prevention and Health Promotion have launched a fascinating project called Healthy People 2020 <2>, whose goal is to ‘create social and physical environments that promote good health for all.’ If anyone is interested, I would be more than happy to summarise the report in a separate blog post.

 

Diet

Everyone has stared into an empty fridge at some point on a late Sunday afternoon, whilst on the phone to the local takeaway - I certainly have! At the time, it feels amazing to eat that crispy duck in pancakes or fish and chips (my two favourites!), but sometimes afterwards we can feel bloated, gluttonous, and wish we’d been bothered to cook something more nutritious.

food prep for before night shifts help me avoid fast food. 

food prep for before night shifts help me avoid fast food. 

A ‘healthy diet’ is based on balanced food groups, macro- and micro-nutrients, not exceeding calories, and being careful of sugars. I find it amazing that my grandma, who was a teenager in the second world war and experienced a diet based around ration provisions, can be so mindful of what is deemed ‘healthy’ in 2017, yet I have had a conversation with a body-conscious 19 year old in the Emergency department, as to why eating a McDonald’s 4 times a week may not be good for her health in the long-term. I feel this is where school education, social support and public health are essential.

 

Exercise

We all know we should be active. The more active we are, the greater the risk reduction of diabetes and cardiovascular disease <3>. Hundreds of studies show that with exercise, hormones such as serotonin, oestrogens, progesterone and other endorphins will be released, which in turn has a positive effect on our mental health.

 

I was very surprised to see that a study done in 2016, illustrated the lack of awareness by UK General Practitioners about the national physical activity and health guidelines. Of those aware, even less implement their knowledge to their patients <4>. i hope that after the publication of this study, we will all try harder to educate our patients and show them what is available. 

 

When I am well and feel healthy, I am active. Back in April when I couldn’t even clean my teeth, I was very immobile and this, along with subsequent weight gain, affected my mood. The NHS have a whole guideline for exercise, which is based on age and ability, to help us all maintain the ‘healthiest’ life we can. I have attached the link here - http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-adults.aspx and below is the DoH infographic.

DoH infographic (2011)

DoH infographic (2011)

 

 

Positive Relationships and Good Mental Health

When I felt at my lowest, I also felt very lonely.

I live with my husband, my family are on the end of the phone, and I have some very special and kind friends, but I still felt alone. I think this was because I didn’t feel anyone truly understood what I was feeling, but equally, I didn’t want to bore or burden them with attempting an explanation. So I didn’t.

I can be very good at strapping on a big grin and saying I feel ok, but really I do not.

 

For a while, I chose to not utilise the fortunate support network that I had, but when I couldn’t hide it anymore and started talking and communicating more freely, I felt happier and lighter, as if a weight was lifted from my shoulders. Aside from a few people who were not interested in listening, everyone else was wonderful and a lot did not realise what had been going on in my life at all.

i took this photo on my way to sit outside with our neighbours and enjoy some sunshine, when i was poorly & couldn't leave the house.

i took this photo on my way to sit outside with our neighbours and enjoy some sunshine, when i was poorly & couldn't leave the house.

Rheum For Improvement has helped my support network further, by helping me to connect with people who really do know how I feel, because they’ve experienced it themselves! I cannot recommend talking enough….or typing to me so that we can discuss how you feel!

Mind, the mental health charity, has a wonderful document on their website about improving your mental wellbeing through lots of different ways. I have put a link to it here and really recommend you all giving it a read.

 

Finances

Research shows that higher socioeconomic families have less health problems, with higher quality and life expectancy. Tragically, based on research from 2001-2009 by crisis, the average life expectancy of a homeless person in Manchester, is believed to be 47 for a man and 43 for a woman, which is 30 years less than the average UK citizen. the report can be read here.

 

We’re all told that money doesn’t make us happy, and as British people we’re all very coy when it comes to talking about it. There is no doubt however, that when you are struggling financially, it has a huge impact on your life. I don’t think I will ever pay off my medical school debt, which is tens of thousands of pounds, and for a long time this caused me a lot of distress. But I realise, as long as I keep chipping away at it, and I don’t deny myself some of life’s small pleasures in between, then I can be content with that.

 

Gym memberships, spin studios, yoga classes and local food produce are all expensive, and to maintain the idealised ‘healthy lifestyle’ can potentially cost hundreds of pounds a month, particularly in London. We all have to be very careful about how we spend our money, and prioritise what is really important to our families and us. I shall be writing more posts soon on how to keep up with your goals, without breaking the bank!

 

Stimulating Work and Education

Having a project to work on, or a job to go out to, is brilliant for our mental health and wellbeing.

When I was off work I found myself bored, unenthused and had no stimulation. With a lack of people around me in the day, it was much more difficult to feel positive about my own abilities. Once I was able to drive again I went and did non-clinical office work, just so that I could see my colleagues and be in a working environment.

 

Rheum For Improvement is designed to help give you some ideas and encouragement to pick-up or restart a hobby, and maybe switch back on your brain if it has been dialled down for a while. check out the hobbies page and see if something takes your fancy.

 

Sleep

Back in 1995, A study was carried out looking at fatigue in patients with Rheumatoid Arthritis compared to healthy subjects. It found that ‘Fatigue scores were significantly higher in people with RA compared to healthy controls... Fatigue was strongly associated with poor sleep, functional disability, greater pain, and more depressive symptoms’ <5>.

 

By the time I finish a set of night shifts, having slept about 5hours a day, I am cranky, spotty and have no energy. Last week before my fourth night shift I went spinning. It was after a broken day’s sleep and my legs were like dead weights and I had no energy at all, so had to stop.

this shows that the better our sleep, the better our energy, abilities and attitude. It helps us to replenish our reserves, regain the strength we have to start a new day, and reset out brains for some more learning. In 1989, Pittsburgh University created the Pittsburgh Sleep Quality Index3, which has now been used in studies all over the world. You can click here, to do the test yourself and see how well you sleep! <6>.

 

so, there we have it. my thoughts on what good health really means. I would love to hear from you in the comments below, through social media and email. let me know what you think, and what good health means to you! 

Harriet, x

 

 

References

<1> http://www.who.int/hia/evidence/doh/en/

<2> https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health - overview of the 2020 plan.

<3> https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/541233/Physical_activity_infographic.PDF

<4>  Chatterjee R1, Chapman T2, Brannan MG2 (2017): GPs' knowledge, use, and confidence in national physical activity and health guidelines and tools: a questionnaire-based survey of general practice in England. Br J Gen Pract. 2017 Aug 14. pi1.

<5> Belza BL (1995): Comparison of self-reported fatigue in rheumatoid arthritis and controls. The Journal of Rheumatology 01 Apr 1995, 22(4):639-643

<6> Buysse,D.J., Reynolds,C.F., Monk,T.H., Berman,S.R., & Kupfer,D.J. (1989). The Pittsburgh Sleep Quality Index (PSQI): A new instrument for psychiatric research and practice. Psychiatry Research, 28(2), 193-213