Deputy Features Editor, Hannah Comiskey, points out the flaws in the way we approach healthcare in the United Kingdom, urging us to make simple lifestyle changes rather than pop pills.
Over the past year, the NHS has been pushed to its utmost limits dealing with COVID-19. Politician after politician has stood up and placed the issue on the podium alongside them as they continue to urge us to all play our part in reducing the strain on a system that has carried our country through war, through disasters and now, through a global pandemic. Yet while it is without a doubt one of the UK’s greatest assets, we cannot risk losing sight of the fact that the NHS has its flaws. And as we begin to exit the immediate peak of the pandemic, the newfound strains on the NHS – from the backlog of operations to the mentally drained staff – makes the need to recognise and reform more pressing than ever. These fresh pressures are only now threatening to break a system which was already shown its cracks.
The current pattern of experiencing a medical problem, sitting in the doctor’s chair and walking away with a prescription in hand has become the all-too-familiar structure of how our healthcare system operates. And it has culminated in an alarming annual rollout of over 1.1 billion prescription items, an eye-watering double of what it was a decade ago. With prescribed medicine being our answer for everything from the simple headache to high blood pressure, we are popping pills like they are sweeties with no regard for the cost, the side effects or the blatant ignorance surrounding the root cause of our nation’s poor health – an unhealthy lifestyle.
While the human population may be getting older, our years in good health are failing to keep up with the growth in the number of years the average person is living. Chronic diseases such as diabetes, cardiovascular disease and cancer are now commonplace amongst our aging population. Latest figures reveal that one-in-three patients who are admitted to hospital in an emergency have five or more serious health conditions for doctors to juggle, up from just one-in-ten a decade ago. Adding fuel to the fire, 63% of adults in England were also revealed to be overweight or obese in 2018. A sobering fact, considering that 80% of premature heart disease, stroke and type 2 diabetes could be prevented through maintaining a healthy weight via diet and exercise choices. Doing so would offer perhaps the most economically sustainable and holistic approach to tackling chronic disease – and the financial burden on the NHS – than any pill.
Yet with our ageing population continuing to collect multiple health issues as if they were fashionable accessories, the NHS is at breaking point under its current medication mania strategy, cutting out 70% of its Primary and Acute Care budget to treat chronic disease and spending £10 billion per year in diabetes costs alone. Amid the double assault presented by the pandemic, which has left huge swathes of the population with underlying health conditions extremely vulnerable, the NHS has never been closer to breaking point. Yet despite this growing chronic disease burden, we seem to be repeating the same old mistake in our response – continuing to provide an endless supply of pills and potions to keep us plodding along. And with annual growth rates of medication spending far outpacing that of the NHS budget itself, from £13 billion in 2010 to almost £17.4 billion in 2017, it is becoming increasingly clear that this pill-popping strategy is as ineffective as it is unsustainable.
As it stands, the NHS is failing to utilise one magic tool against the flood of disease and poor health currently rushing through its doors in all corners of the country, a tool which drastically reduces the chances of premature death or chronic disease, while at the same time boosting mental wellbeing and years spent in good health. It is free, it is effective and it comes without side effects and the hefty price tag attached to the current go-to treatments. It even boasts potential for a 34-year boost in disease-free life at age 50, taking you up to the age of 84 without diabetes, cancer or heart disease. Sold like that, it sounds like a pill I’d certainly be willing to swallow. Hence why its underuse begs the question: why are we not prescribing lifestyle changes as actively as we are pills?
Widespread research points to the fact that a healthy lifestyle comes hand in hand with a lower risk of diabetes, cardiovascular disease, and even cancer. It is arguably the most powerful preventative weapon against disease, and something we should be prescribing en masse. And while there is undoubtedly a need for pills and modern medicine in many cases, lifestyle changes offer a prevention, a complement and sometimes even a reversal in the need for pharmaceutical drugs. Comprehensive healthy lifestyle interventions in patients with type 2 diabetes have been reported in some cases to bring the disease into remission, as well as fully reversing coronary artery disease in others. In the case of treating high blood pressure or cholesterol, research has further shown that lifestyle changes improve the chances that medication will work. This highlights the need for medication as an addition to lifestyle changes, rather than simply a substitute.
The associated improvements in health from lifestyle prescriptions would not only leave us with a healthier, more productive and happier population, but would drastically reduce the burden on a healthcare system we all cherish so dearly, both through driving down prescription costs and improving general levels of health. On the other hand, continued failure to take lifestyle change seriously leaves us vulnerable to sleepwalking into the bleak inevitability of a deepening chronic disease crisis. And with smoking, poor diet, inactivity and heavy alcohol consumption currently contributing to 60% of premature deaths and up to 20 years loss in life expectancy, lifestyle changes are as much a ‘magic pill’ as they are a lifeline for the UK.
The doubling of the number of prescription drugs dispensed in the last decade points to a growing dependency on medication being used as a band-aid to patch up issues, without confronting the deeper driving force. The huge pressure on the NHS and demand for quick fix pills are ultimately being fuelled by bad diets, stagnant inactivity, smoking and excessive alcohol consumption. A growing number of doctors, such as Rangan Chatterjee, are advocating the idea that to fully address disease we must address the factors driving disease, such as obesity. And within that, confront lifestyle factors such as exercise, diet, sleep and stress, or even psychological factors such as loneliness, which are also believed to cause obesity. But with as many as 20 prescriptions now being written per head of the population, and nearly half of adults in England having taken at least one prescribed medication in the last week, it is clear that we are a far way off this holistic approach.
While providing a pill may treat the individual symptoms, until we commit to tackling the root causes – treating patient’s health as products of their lifestyles rather than focusing solely on treating isolated health issues – the rate of diseases will keep mounting as the NHS simultaneously crumbles under the growing pressure.
Simple lifestyle changes such as moderate exercise also have the potential to alleviate symptoms without the issue of negative side effects associated with more traditional medication, which in themselves are increasing the burden on the NHS. One study revealed that traditional medication causes a quarter of hospital admissions in the elderly via adverse drug reactions. Conversely, the extensive research pointing to the fact that exercise improves sleep, energy, weight loss, depression and Alzheimers, makes it clear that this lifestyle habit should be viewed as much as a medication as the pills we are gobbling for our various ailments. And considering the fact that regular exercise lowers the risk of type 2 diabetes by 50%, osteoarthritis by 83%, heart disease and strokes by 35% and depression by 30%, it stands as the most powerful preventative cure out there.
Furthermore, exercise provides a clear-cut way to reduce obesity its side effects like diabetes and other chronic diseases.Combined with other lifestyle changes, it also goes a step beyond ‘doctors orders’- instead offering patients the chance to become accountable for their own health, without the cost to the NHS and the threat of side effects. Yet despite the wide body of research on the powerful benefits, some doctors are reluctant to prescribe lifestyle changes such as exercise, or healthy eating, for fear of appearing judgemental or discriminatory. Other factors such as a lack of time, funding and emphasis on lifestyle alternatives in medical training can also be blamed for the dependency on hard drugs for tackling health issues. Fewer than 10% of doctors reporting they felt adequately trained to give patients advice on physical activity, despite 90% stating they would like more training on it.
Within mental health specifically, half of doctor’s advocate talking therapy as the best cure for moderate depression. Yet within the 10-minute window of a GP appointment and waiting lists that drag on for months, there is little scope to explore alternative options. And an alarming three-quarters of those who go to the Doctors about depression are automatically prescribed antidepressants. Even in the face of the endless list of potential negative side effects: dizziness, anxiety, low sex drive or insomnia, these pills are often chosen as the default above therapy or lifestyle changes. And with 60% of people visiting their doctor for depression not even being offered counselling, or being faced with desperately long waiting lists, the current system is pushing someone into medication who might have otherwise not needed to take it.
This is despite the growing body of research pointing to the fact that regular exercise may be a more effective treatment for mild depression than antidepressants. With its powerful effect on boosting serotonin and dopamine levels in the brain, as well as added benefits of improved self-esteem, sleep, energy and overall health. If prescribed seriously, exercise has the potential to be a substitute for medication for some, or a powerful booster in others. Yet unfortunately, the pressure to prescribe ‘quick-fix’ treatments to treat deep-rooted feelings of unhappiness, ultimately characterizes how the NHS is treating our nation’s poor health on a fundamental level.
In failing to adapt the way in which our healthcare system operates on a deep and transformative level, we stand to lose an immeasurable amount of both a personal and national level. the NHS is too far gone to simply stick on a band-aid and expect the problem to go away in a few weeks. Shifts in training, practises and attitudes are required to tackle the deepening chronic disease crisis we currently face. Simple lifestyle changes are the golden ticket to ensure that our increased years of life are spent really living.