Sunday, June 4, 2023

US Surgeon-General identifies modern ills

What is the point of prescribing medicine when a patient can’t afford it? Terence Cosgrave suggests a new way of looking at healthcare

I went to my doctor recently and his advice was “Don’t eat anything fatty.” But health information is often poorly imparted, so I wanted to clarify. I asked him: “You mean like bacon, cakes and burgers?”

“No, Fatty,” he replied. “Don’t eat anything!”

Now this is an apocryphal story, obviously – my GP is a polite and helpful fellow who makes quality time for all his patients, and would never be so insulting… or truthful. But this popular joke illustrates that when it comes to health advice, there’s many a slip between the cup and the lip.

Take the recent story about the survey conducted by the Asthma Society on page 35 of this issue. Half the people who are prescribed medication for asthma can’t afford it. Half. 50 per cent. One in two!

It’s merely one example of a situation where we follow all the scientific rules – the diagnosis, the prescribing of a suitable medication, the instructions to the patient on how to take it – but in half the cases, we might as well be telling them to stick their inhalers… in a cream cake.

Or, if you prefer, you could have a look at page 19 of this issue where Dr Ronan Glynn warns us that there will definitely be another pandemic, and the biggest threat to us from same will be misinformation and disinformation.

These are just two of the situations where we know what the problem is, and we know how to solve the problem, but we’re dealing with humans, who have their own ideas.

Humans are a diverse bunch, and just because there are a few dedicated and intelligent people working to protect us, there are always the charlatans, the spoofers, the chancers and grifters, the quacks, the paranoiacs, the conspiracy theorists and the self-promoters who are keen to make money from people’s ignorance and gullibility

That is why we need a much better, more rounded approach to health and welfare, and doctors have a huge role to play in this. Armed with the experience of how the pandemic was handled here, we know that when another one comes, the biggest danger is not the science, or beating a virus, it’s providing people with the truth, and in a way that they will believe it.

The danger is that this important work will be left to the Department of Health – and while we might agree that the Department – and indeed most public health bodies – did a professional job with the pandemic and its fallout, they are not the appropriate body to dissuade the would-be fascists, extreme right-wingers or simple grifters trying to undermine public health messages with their, eh, manure.

My point here is that if we want to improve our health, our lives and our general well-being, it’s going to take more than just excellent medics, a strong public health service, and a well-thought-out strategic plan by the Minister and the Department. It’s going to require more than that.

Take another example. The US Surgeon-General – Dr Vivek H. Murthy – recently published a powerful and insightful essay about his struggles with loneliness, and how America in general needs to deal with the problem. He says that loneliness is more than just a ‘bad feeling’. He goes on to state: “When people are socially disconnected, their risk of anxiety and depression increases. So does their risk of heart disease (29 per cent), dementia (50 per cent) and stroke (32 per cent). The increased risk of premature death associated with social disconnection is comparable to smoking daily – and may be even greater than the risk associated with obesity

What’s the point of getting someone to stop smoking if a cigarette is their only way of creating a connection with other people? What’s the point of having a healthy diet or exercising if you are miserable, lonely and isolated?

Indeed, Dr Murthy goes further and makes the point that social disconnection is associated with reduced productivity in the workplace, worse performance in schools, and diminished civic engagement. When we are less invested in each other, we are more susceptible to polarization and less able to pull together to face modern challenges we cannot solve alone – such as climate change, economic inequality and, of course, future pandemics.

This is not a problem a doctor can easily solve when facing a patient who is isolated – physically and socially. It’s the job of politicians (local and national) to develop policies that keep people engaged in society and connected to their communities, families, clubs and institutions. It’s a little too late when the person arrives finally (if they ever do) in their doctor’s surgery.

Medicine and medics have a role to play, certainly. Primary Care is one area where we could do a lot to keep people engaged in their local communities by providing the medical and social help to keep people local for as long as possible. But we need more than that.

We have a situation where we have great medicine but poor health, and the extraordinary costs of this dichotomy are never examined or addressed. What about the extraordinarily high number of rapes that happen in this country? One in five people in this country is raped over the course of their lifetime. We’re still ignoring what a huge problem that is, and doing relatively little about it.

Dr Murthy says that what is needed is the strengthening of social infrastructure – the programmes, policies and structures that aid the development of healthy relationships.Se condly, he suggests, we need to renegotiate our relationship with technology – ‘creating spaces in our lives without our devices so we can be more present with each other’. (He adds that this also means choosing not to take part in online dialogues that amplify judgement and hate instead of understanding.)

And finally, we have to take small steps in our own lives to rebuild our connections to one another.

This is what Dr Murthy has called ‘medicine hiding in plain sight’. The evidence shows that connection is linked to better heart health, brain health and immunity. It could be spending a few minutes each day reaching out to people we care about, re-introducing ourselves to neighbours, friends or co-workers, who may be having a hard time.

And we need all government departments and community leaders to get involved in making it possible for people to live more connected lives, with better health and social outcomes, and not just to give them the drugs for what ails them.

Medicine – healthcare is more than that.

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