Let us begin with recalling the definition of health set by WHO. The definition includes multi dimensional levels –physical, mental and social well being and not merely the absence of a disease.
Defining Future Health Care needs a analysis of the current issues, evaluating what is the root casue. By my opinion a highly unspoken issue today what compromises health is an “illness” called depression.
Definition of depression:
• persistent low mood,
• absence of positive affect (loss of interest and enjoyment in ordinary things and experiences),
• emotional, cognitive, physical, and behavioural symptoms
• dejection, accompanied by feelings of hopelessness and inadequacy.
• Lack of energy and difficulty in maintaining concentration or interest in life.
To demonstrate the size of the problem, I Googled the word depression, and found 79.5M hits, and I am sure your personal observation will back up this how unhappy people are today.
Depression is an important public health problem, it disables people, and leads to chronic disease.
Depression is not only comes alone but often the cause for chronic diseases such as diabetes and heart disease. 4.5% of the people worldwide are considered depressed and people spend 12% of their lifetime feeling depressed.
Depression is also find behind chronic illnesses such as asthma, angina, arthritis and Diabetes.
Economical outlook of our mental health in the 21st century (WHO, 2002)
Did you know that 80% of people who see doctors are depressed.
Depression occurs almost the same rate in man and women. It effects everyone, either themselves, a family member or friend or somebody they know. By 2020 depression 2ND Leading cause of disease. What is worse, that 80% of depressed people are not treated.
The WHO’s future health projection between 2002-2030 is that the projected deaths rate on the world due unhealthy living (cancer, heart disease and stroke) is projected to be 27 million by 2030.
How about depression in cancer ? Did you know that 57% of cancer patient are depressed. Once cancer diagnosed, we know exaclty what health care costs we are looking at.
Depression affects everyone in the environment and is behind choric and degenerative diseases ( arthritis, Diabetes, heart disease) and major cause of obesity. Obesity itself is a major health problem however it affects only the individual and obesity as part of metabolic syndrome, leading to diabetes and heart disease and contribute to a direct feed back to feel even more depressed.
What are the economic costs of Depression?
The severity of depression is associated with increased treatment costs, unemployment, absenteeism and with reduced performance at work.
Very little research has been done to estimate the economic burden of depression in Europe. In the United States, the total economic burden of depression was estimated to be US$ 83.1 billion in 2000, of which US$ 26.1 billion (31%) were direct medical costs, US$ 5.4 billion (7%) were suicide-related mortality costs and US$ 51.5 billion (62%) were workplace costs.
What does it cost the economy to employ depressed employees?
In Australia, absenteeism, or employees not showing up for work cost AU$1.2B per year. This means AU$10,000 per year per untreated employee. What happens when depressed employees show up at work, they function only 40% of their capability. Depressed phases last 6 months to 2 years, which translates into a los of AU$2.3B per year.
Furthermore, my intention is not to tell you about where unhappiness driven tension releasing activities such as addictions and excessive eating leads. I also wont talk about how smoking and alcohol and eating unhealthy foods taxes medical cost.
What do you think the solution should be?
Don’t you think the approach should to transform the root causes, and focus on:
• Providing opportunity for positive Life experiences to Elevate mood
• Bring enjoyment and fun
• Change physical and cognitive state
• Give hope, belonging, feeling of achievement
• Develop self-value
• Increase energy level
• Teach how to focus
• Teach Behavioral skills
• Give meaning in life
So what do we do?
· Research suggests that regular exercise may be effective in preventing depression and also in treating mild depression.
· A sedentary lifestyle increases the risk of depression, and depression increases the likelihood of a sedentary lifestyle.
· Regular exercise alters brain chemistry and leads to improved mood and feelings of wellbeing.
· People who suffer from anxiety also improve when they exercise regularly.
A structured exercise program may be as good or better than frequently prescribed drugs for some common cardiovascular ailments, a large meta-analysis has found.
The Future relies in the hands of the children – Childhood obesity is not an easy problem to tackle, because 7-49% of the children, who are obese, are also at risk for adulthood obesity.
Childhood obesity is risk factor for hyperlipidemia, hyperinsulinemia, hypertension and early atherosclerosis in children and also risk factor for cardiovascular disease in adulthood. In the USA 1 in 4 children are overweight and 60% exhibits at least one modifiable adult risk factor for coronary heart disease (CHD) by the age of 12 years.
Early-onset diabetes mellitus used to be exclusively Type 1 diabetes. Recently, the number of type 2. diabetes cases in children increasing world wide.
Extreme stress on the lower extremities due to the excess body weight of the children can cause typical orthopedic problems: „flat feet” and deformities in the hip.
Most frequent psychological consequence is low self-esteem and psychosocial discrimination. Obese children can become depressive and may require psychotherapy.
Preventative programs are the future of Health
Education for Healthy Parenting
Naturally, prevention is the most effective treatment of childhood obesity, which has presently gained more attention. Prevention of childhood obesity requires complex health promotion interventions based on population health principles.
The first line of prevention should consider healthy body weight increase compared to the child’s age and height. Preventative programs shall include teaching mothers for healthy nutritional care and breast feeding. However, prevention of obesity begins during pregnancy. Preventative education programs needs to start in adolescent for teaching activity and healthy lifestyle, to prepare the body for healthy pregnancy.
Mother’s need to learn what is balanced diet and avoid excess high-calorie snacks, and follow weight increase closely. In preschool, providing early experiences with foods and flavors, helping to develop healthy food preferences, , monitoring the rate of weight increases and providing child and parent nutrition education with encouraging daily physical activity are the main goals.
Regular physical activity and exercise are also key factors in the prevention of obesity. The suggested daily physical activity for children as prevention was daily 30 minutes in the form of playing games in 2000. It is important to establish an environment for the child, which promotes activity and healthy lifestyle. Therefore, it is primal that parents serve as example and take responsibility over the child lifestyle. Especially overweight parents need to pay more attention for creating their own healthy lifestyle at home. It is important that nurses and health care professionals point out the problem early and discuss the excess body weight gain of the child with the parents. The school-based education for healthy lifestyle and nutrition should be another important task.
The second line of prevention should aim at the long-term changes in behavior, which may be achieved by not only the education of the overweight/obese child, but the parents and the entire family. Reducing screen-time (watching TV, computer) and focusing on physical activity and playing sports should be the center of recreational activities. Dietary goals for a growing/developing child should aim at the maintenance and not the reduction of body weight.
Regarding the exercise type, duration and intensity studies suggest that choosing enjoyable physical activity (roller skating, cycling, jogging and aerobic dance) is key importance in the adherence. Organized physical activity should include dynamic exercises.
School-based exercise programs since they provide an opportunity to develop healthy, active lifestyles in large numbers of children should be focused on for any society who likes to bring up healthy future generation. In addition, family based activity programs may be useful for long-term change, as parent activity level is a strong predictor of child’s activity. Inclusion of parents in the physical activity may improve long-term outcomes.
Increasing lifestyle exercise throughout the day and including the parents in the exercise is a better alternative than organized exercise program due to higher adherence in obese children.
A balanced diet, meeting nutrient goals, is possible to implement in obese children whose treatment began at 8-12 years of age and does not decrease their growth over 5 and10 year intervals. In order to design successful diet therapies the following factors should considered:
– The foundation of the diet therapy is the child’s willingness to participate and the support of the entire family. In childhood the dietary intake (what and how much) depends on the parents.
– Lifestyle measures should be addressed even in children who may need medication. In addition to increasing physical activity, appropriate carbohydrate intake in the form of low-GI and fiber rich foods are especially important for children with decreased glucose tolerance. The consumption of fruits, vegetables and legumes are important to decrease insulin resistance.
Besides changes in the diet, psychological factors play major role in the successful long-term treatment of childhood obesity. Support from the primary care physician or nutritionist and parents have been shown to be significantly powerful to induce eating behavioral changes and adherence in children. In preventative perspective, these education programs include lifestyle education of the physicians, so they will not only live healthy themselves but prescribe exercise and lifestyle congruently.
Behavior modification needs to build a mindset, which focuses away from excess eating, uses food to aid physical and mental performance. Parent’s behavior and lifestyle preferences are key importance. An obese child needs to learn the difference between hunger and appetite. It is important to pre set the time and portions for the regular meals and snack. Obese children don’t have regular meals and they tend to snack all day long. Parents need to promote activities for the children, which take her/his attention off from food and eating. Setting positive and achievable goals for the obese child is another important factor for the child to regain healthy self-esteem and self-value. Clearing up interpersonal emotional problems within the family is another key point in success. It is necessary for the child to be psychologically supported in the family and among his/her friends. Therefore, individual nutrition consultations should be extended to group education programs, where the child can meet others working for the same goals. Rehabilitation can be only achieved by long-term adherence to the therapy.
What about infrastructure?
Obviously healthy active lifestyle as prevention means providing infrastructure: age specific fitness playgrounds, public sport parks with futsal, basketball, volleyball courts, free grassy areas for yoga, Thai chi, martial arts, running/walking tracks, roller skating rings, community buildings for fitness aerobics, swimming pools. Developing gymnasiums for indoor fitness and physical education classes. Developing track and filed facilities for athletics.
What about the HR?
Infrastructure without properly trained staff is quiet ineffective. Developing HR, as fitness instructors, sport coaches, physical educators are key important in this chain. Establishing, Sport colleges, where short courses so as degree courses are available are vital.
Developing system for providing sport managers, who run the sport facilities and organizes sport programs are the second line of building prevention into successful healthy lifestyle.
Building the activity based culture starts with working on mindset change of the public especially parents, that its necessary for the child to take part in regular physical activity. Elevate the carrier status of the physical educators and sport coaches as they are the most important character builders in children/s life.
Sport and physical education will teach life skills which children are unable to learn sitting in the classroom. If a child learns to be active as a child he/she will remain as an adult.
For the future our aim should be building playgrounds and sport fields not hospitals.
Prevention is the Future of Health Care – Dr Zsu