tag:theconversation.com,2011:/global/topics/health-goals-34945/articlesHealth goals – The Conversation2022-08-09T21:20:01Ztag:theconversation.com,2011:article/1876742022-08-09T21:20:01Z2022-08-09T21:20:01ZPower to the patient: Person-centred care and how you can take your health into your own hands<figure><img src="https://images.theconversation.com/files/477897/original/file-20220805-24-ttyy19.jpg?ixlib=rb-1.1.0&rect=465%2C0%2C5758%2C4118&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Putting patients at the centre of care means seeing them as a whole person and treating them as a partner in their journey to better health.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p><a href="https://doi.org/10.1371/journal.pone.0229923">Person-centred care</a> (also known as patient-centred care) is the philosophy of giving power back to patients and putting them “at the centre” of care. </p>
<p>It can lead to <a href="https://doi.org/10.1089/dis.2006.9.302">lower health-care spending</a> and <a href="https://doi.org//10.1002/14651858.CD003267.pub2">better patient health outcomes</a>. That’s why person-centred care has become a <a href="https://healthadvocates.cma.ca/news/public-and-health-professionals-agree-canada-needs-patient-centered-care">top priority</a> in Canada.</p>
<p>As a health services researcher working with an <a href="https://interrai.org/">international group of researchers</a>, my goal is to learn more about how person-centred care works and how we can use people’s voices and health information to make it happen. </p>
<p>I’m also a person who uses the health-care system, which is why I know it’s important for everyone to know what person-centred care is, where it came from and how each of us play a part in building a better health-care system. </p>
<h2>What is person-centred care?</h2>
<p>“Putting patients at the centre” is a really vague goal. That’s why your family doctor, pharmacist, physiotherapist and everyone in between probably has different ideas about how to be person-centred. Here are <a href="http://www.ejpch.org/ejpch/article/view/1337">three signs that the care you’re getting is person-centred</a>:</p>
<ol>
<li><p><strong>They see you as a whole person</strong>: You are unique and complex. You have wants, needs, friends and families. That’s why your health-care provider wants to hear what you have to say and respects your right to make choices about your own body.</p></li>
<li><p><strong>They treat you like a partner</strong>: Rather than tell you what to do, your health-care provider listens, teaches, and partners with you to build a care plan that aligns with your goals. Like any partnership, trust is key. You trust them, and they trust you.</p></li>
<li><p><strong>They help you navigate your journey to better health</strong>: They listen to your concerns and validate your feelings. They also give helpful advice using words you understand and point you to other resources when you need them.</p></li>
</ol>
<h2>Where did this idea come from?</h2>
<figure class="align-center ">
<img alt="A woman in a hospital gown and a woman in scrubs and a stethoscope looking at tablet together" src="https://images.theconversation.com/files/477901/original/file-20220805-7849-dgbox8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477901/original/file-20220805-7849-dgbox8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477901/original/file-20220805-7849-dgbox8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477901/original/file-20220805-7849-dgbox8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477901/original/file-20220805-7849-dgbox8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477901/original/file-20220805-7849-dgbox8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477901/original/file-20220805-7849-dgbox8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Patients were once expected to be passive in their own care. Person-centred care encourages patients to self-monitor, self-care and advocate for themselves.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>A hundred years ago in the western medical system, <a href="https://doi.org/10.1136%2Fbmj.318.7200.1756">patients were expected</a> to be passive. The health-care provider was the knowledge keeper for your body, so you did what they said without question. That’s why it was revolutionary when, in the 1950s, psychologists started saying that <a href="https://doi.org/10.2147%2FJMDH.S299765">people can cure their own problems when they get the right support</a>. </p>
<p>In the following decades, other experts (including several <a href="https://cdnmedhall.ca/patient-care">influential Canadians</a>) brought even more ideas, like how patients should be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2236836/">seen as unique human beings</a>. (<a href="https://cancer.ca/en/treatments/complementary-therapies/aboriginal-traditional-healing">Indigenous peoples understood this</a> long before colonizers did.)</p>
<h2>Three ways to push for person-centred care</h2>
<p><a href="https://doi.org/10.1136%2Fbmj.320.7234.526">Person-centred care has become essential</a>. Especially when it comes to <a href="https://www.who.int/news-room/fact-sheets/detail/ageing-and-health">chronic diseases</a>, you need to self-monitor, self-care and advocate for yourself. So what can you do to take your health into your own hands?</p>
<figure class="align-right ">
<img alt="Medical stethoscope with red paper heart on white surface" src="https://images.theconversation.com/files/476538/original/file-20220728-25-zyqwv3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/476538/original/file-20220728-25-zyqwv3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476538/original/file-20220728-25-zyqwv3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476538/original/file-20220728-25-zyqwv3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476538/original/file-20220728-25-zyqwv3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476538/original/file-20220728-25-zyqwv3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476538/original/file-20220728-25-zyqwv3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Learning about their own conditions and care can empower patients. Libraries, online resources, workshops and service directories can be useful resources.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/medical-stethoscope-with-red-paper-heart-on-white-surface-4386467/">Karolina Grabowska/Pexels</a></span>
</figcaption>
</figure>
<ol>
<li><p><strong>Do your research</strong>: Information is power. Learn as much as you can about your health condition(s) <a href="https://doi.org/10.2196%2Fjmir.5729">to gain confidence, make appointments more efficient and even improve your relationship with your health-care provider</a>. Don’t know where to start? <a href="https://medium.com/everylibrary/what-exactly-does-a-librarian-do-a75b89780370">Ask your local librarian</a> if they have any research tips or book suggestions. Join a virtual community and look for learning opportunities (like workshops or webinars at <a href="https://alzheimer.ca/en">the Alzheimer’s society</a>, <a href="https://www.diabetes.ca/resources/webinars?Categories=&SearchText=&Sort=&Page=1">Diabetes Canada</a> or other big organizations). If you have a health-care provider, Google them to find out what they do, if they speak your native language and what their training background is. If you don’t, service directories may help you find a health-care provider who meets your needs. For example, <a href="https://www.rainbowhealthontario.ca/lgbt2sq-health/service-provider-directory/">Rainbow Health Ontario</a> has a directory of LGBT2SQ-friendly care providers.</p></li>
<li><p><strong>Be prepared</strong>: Don’t be afraid to bring in a list of questions and concerns, and take notes <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539473/">to help you remember what the health-care provider said</a> (for example, jargon you’ll want to look up later). You can also bring in a support person, like a friend or family member, <a href="https://doi.org/10.4103/2249-4863.120767">for emotional support, to advocate for you, to help with decision-making or to take notes</a>. Show your health-care provider that you want to know more about your health and <a href="https://www.cbc.ca/news/canada/first-person-navigating-health-care-1.6514065">don’t be afraid to speak up if you’re feeling dismissed</a>. </p></li>
<li><p><strong>Give feedback</strong>: The challenge with person-centred care is that <a href="https://doi.org/10.1371/journal.pone.0229923">problems in the health system</a>, like staffing shortages, can make it harder to do. But you can help change the system. <a href="https://hbr.org/2021/05/frustrated-patients-are-making-health-care-workers-jobs-even-harder">Be kind to your health-care providers.</a> Share your opinions (on the good and the bad) by filling out patient surveys when you get them. You can also join a patient and family advisory council, committee or network. These are groups of people with lived experience that help improve the health-care system. As a member of a patient and family advisory council myself, I have given feedback on hiring decisions, safety planning, education and more. Look online to find a local, provincial or national group (like the <a href="https://www.patientadvisors.ca/">Patient Advisors Network</a>). </p></li>
</ol>
<p>While you might not be able to change the system on your own, always remember that your voice matters.</p><img src="https://counter.theconversation.com/content/187674/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda receives funding from the Ontario Government as part of the Ontario Graduate Scholarship (OGS) program. She is also affiliated with the Waterloo-Wellington Regional Cancer Program Patient and Family Advisory Council and is a member of the Patient Advisors Network.</span></em></p>Person-centred care sees the patient as a whole, unique individual and puts them at the centre of their health decisions.Amanda Aguilar da Nova, PhD Candidate, Faculty of Health, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1743682022-01-09T13:14:45Z2022-01-09T13:14:45ZFeeling powerless in the COVID-19 pandemic? 4 principles of self-determination can help you take back some control<figure><img src="https://images.theconversation.com/files/439450/original/file-20220105-25-pguqm.jpg?ixlib=rb-1.1.0&rect=414%2C31%2C3049%2C1980&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A man wearing a protective mask rides his bicycle past a face mask mural during the COVID-19 pandemic in Toronto. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette </span></span></figcaption></figure><p>The Omicron wave seemed to come like a rising tide — slowly, then suddenly, <a href="https://globalnews.ca/news/8488493/omicron-covid-hospitalizations-jan-4-2022/">in all directions and all at once</a>. Inside the health-care system, <a href="https://toronto.ctvnews.ca/head-of-william-osler-health-system-says-situation-slowly-getting-better-following-code-orange-1.5727178">skeleton crews</a> face impossible workloads and <a href="https://doi.org/10.1080/20008198.2021.1984667">moral distress</a>. </p>
<p>Outside of it, people are feeling the weight of things like <a href="https://www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/the-big-picture">deferred care</a>, <a href="https://doi.org/10.1016/j.annepidem.2021.07.010">deprioritized essential workers</a>, <a href="https://bmjopen.bmj.com/content/11/1/e042871.abstract">online learning</a> and <a href="https://doi.org/10.1371/journal.pone.0257728">doomscrolling</a>. People are sick not just with COVID-19, but with isolation, inequity and polarization. </p>
<p>So it shouldn’t be a surprise if the recent announcements of <a href="https://www.cbc.ca/news/canada/toronto/covid-19-ontario-jan-3-2022-ford-public-health-measures-1.6302531">shuttered schools</a> and <a href="https://montrealgazette.com/news/covid-19-here-are-the-new-restrictions-in-quebec">renewed restrictions</a> have some people feeling it’s all just too much to sustain.</p>
<p>But there is a way through difficult stages of the pandemic. It’s possible to counter helplessness and build power by creating a sense of purpose and community amidst the confusion of COVID-19. </p>
<h2>Self-determination</h2>
<p>As a researcher of <a href="https://doi.org/10.3399/BJGPO.2020.0153">social prescribing</a> — the act of using health-care visits as a starting point to reconnect people with health-promoting community services — I want to share some steps we can all take today to get back to the basics of health promotion, using self-determination to help exert more control over our own individual and shared experiences.</p>
<p>Self-determination is a widely used approach in <a href="https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference">health promotion</a> that derives from <a href="https://doi.org/10.3138/9781442623873-014">two distinct bodies of research</a>: in psychology, about how we build well-being in our own lives, and in political science, about how together we govern the things that are most important to us. </p>
<p>The idea, in both traditions, is that by applying just four principles at <a href="http://doi.org/10.1177/1745691612447309">individual</a> and <a href="https://doi.org/10.1007/978-3-030-75201-9_10">collective</a> levels, people can increase control over and improve the conditions for their health and well-being.</p>
<h2>Autonomy</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/439452/original/file-20220105-25-srpbwu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person walks past a street mural of a health-care worker in PPE flexing a bicep" src="https://images.theconversation.com/files/439452/original/file-20220105-25-srpbwu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439452/original/file-20220105-25-srpbwu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=414&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439452/original/file-20220105-25-srpbwu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=414&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439452/original/file-20220105-25-srpbwu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=414&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439452/original/file-20220105-25-srpbwu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=520&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439452/original/file-20220105-25-srpbwu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=520&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439452/original/file-20220105-25-srpbwu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=520&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When it feels like so much control has been taken away, making a small decision of their own can help someone rediscover their autonomy.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>First, there is a need to rediscover autonomy: the ability to make decisions for yourself. When it feels like so much control has been taken away, making a small decision of your own can help you shift from worrying about “what’s the matter with me” to taking action on “what matters to me.” </p>
<p>In social prescribing, participants don’t wait for someone else to make a treatment plan. They voice their own well-being priorities and are supported to take more control over their own health goals. </p>
<p>This can start with something as small, but healthful, as <a href="https://www.euro.who.int/en/publications/abstracts/what-is-the-evidence-on-the-role-of-the-arts-in-improving-health-and-well-being-a-scoping-review-2019">picking up a drawing pencil</a> or going for <a href="https://www.apa.org/monitor/2020/04/nurtured-nature">a walk in nature</a>, or something more intensive like <a href="https://doi.org/10.1089/pop.2020.0154">accessing support for housing</a> or <a href="https://doi.org/10.1111/hsc.13516">volunteering with others</a> in your community. </p>
<p>Politically and at the community level, fostering autonomy can look like ensuring people have support to make <a href="https://doi.org/10.1126/science.abd2107">local economic decisions</a>, supporting <a href="http://www.toronto.ca/legdocs/mmis/2021/hl/bgrd/backgroundfile-173574.pdf">local public health and community organizations</a>, or ensuring <a href="https://www.torontoblackcovid.com/">vaccine outreach</a> is both scientifically accurate and culturally meaningful.</p>
<h2>Competence</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/439454/original/file-20220105-15-1f4cn8v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A couple walk past a colourful inspirational mural reading 'Keep on keeping on'" src="https://images.theconversation.com/files/439454/original/file-20220105-15-1f4cn8v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439454/original/file-20220105-15-1f4cn8v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439454/original/file-20220105-15-1f4cn8v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439454/original/file-20220105-15-1f4cn8v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439454/original/file-20220105-15-1f4cn8v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439454/original/file-20220105-15-1f4cn8v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439454/original/file-20220105-15-1f4cn8v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">During times of collective crisis, people can feel powerless in the face of forces larger than themselves.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn</span></span>
</figcaption>
</figure>
<p>Next, we need to value competence: our ability to influence outcomes and to show ourselves and others what we are capable of. </p>
<p>During times of collective crisis, people can feel powerless in the face of forces larger than themselves. In social prescribing, participants are supported to get back in touch with their own power, focusing less on what they can’t do and more on what they can, by <a href="https://www.cfp.ca/content/67/2/88">doing something they’re good at</a>. </p>
<p>For communities, valuing competence can mean taking a strengths-based or <a href="https://doi.org/10.1016/B978-0-12-821573-9.00005-9">asset-based approach</a> that recognizes the unique capacity and expertise within a community — such as <a href="https://www.toronto.ca/community-people/health-wellness-care/covid-19-wellness-during-the-pandemic/covid-19-seniors-vulnerable-people/">trusted relationships</a>, <a href="https://doi.org/10.4324/9781003141280">local ecological knowledge</a> and <a href="https://www.redcross.ca/blog/2021/2/doctor-from-ecuador-helps-lead-red-cross-response-to-covid-19">under-recognized training</a> — rather than focusing on community deficits.</p>
<h2>Beneficence</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/439453/original/file-20220105-15-v3ejr7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person seen from behind takes a picture of a mural depicting a white dove parachuting COVID-19 vaccine vials" src="https://images.theconversation.com/files/439453/original/file-20220105-15-v3ejr7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439453/original/file-20220105-15-v3ejr7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439453/original/file-20220105-15-v3ejr7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439453/original/file-20220105-15-v3ejr7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439453/original/file-20220105-15-v3ejr7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439453/original/file-20220105-15-v3ejr7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439453/original/file-20220105-15-v3ejr7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Regardless of our own constellations of ability, health and privilege, we all have something to give that can have a positive impact on others.</span>
<span class="attribution"><span class="source">(AP Photo/Gregorio Borgia)</span></span>
</figcaption>
</figure>
<p>Closely related to a sense of competence is finding beneficence: the sense of having a positive impact on others. There is a demonstrable <a href="https://books.google.ca/books?hl=en&lr=&id=CgDhJ-_sqFcC&oi=fnd&pg=PR7&dq=%22giver%27s+glow%22&ots=NRQF8Rwliu&sig=E94mNgNdFkcEKSSi9eYlF2Pe-zc&redir_esc=y#v=onepage&q=%22giver's%20glow%22&f=false">giver’s glow that comes from helping</a>; regardless of individual constellations of ability, health and privilege, everyone has something to give. </p>
<p>In social prescribing, participants who express a desire to give back are supported to take the lead in volunteering to help others or designing and implementing new programs and services. At a broader level, fostering collective beneficence might look like <a href="https://doi.org/10.3389/fpsyg.2021.579164">prosocial communications</a> approaches that remind us of how COVID-19 precautions help others, or opportunities to help others <a href="https://vaccinehunters.ca/">access vaccines</a> and supports.</p>
<h2>Relatedness</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/439455/original/file-20220105-13-14phmse.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A cyclist passes a painted mural depicting cartoon panels of people in face masks talking on the phone, checking in on neighbours during the pandemic." src="https://images.theconversation.com/files/439455/original/file-20220105-13-14phmse.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439455/original/file-20220105-13-14phmse.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=333&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439455/original/file-20220105-13-14phmse.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=333&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439455/original/file-20220105-13-14phmse.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=333&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439455/original/file-20220105-13-14phmse.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=418&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439455/original/file-20220105-13-14phmse.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=418&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439455/original/file-20220105-13-14phmse.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=418&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Feelings of loneliness and social isolation have grown during the COVID-19 pandemic.</span>
<span class="attribution"><span class="source">(AP Photo/Eric Gay)</span></span>
</figcaption>
</figure>
<p>Finally, we need to value relatedness: the sense of connection and belonging with others and the world around us. Feelings of <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/211124/dq211124e-eng.htm">loneliness and social isolation</a> have grown during the COVID-19 pandemic, with significant <a href="https://doi.org/10.1016/j.psychres.2020.113648">impacts on health</a> and well-being. </p>
<p>In social prescribing, participants are afforded the time and space to develop relationships: with a community connector who listens, with friends and family, or with other participants who may have something in common. </p>
<p>Collectively and politically, recognizing relatedness can look like supporting policies that accommodate people as both <a href="https://doi.org/10.1080/13876988.2020.1846123">workers and carers</a>, ensuring the shared protection of <a href="https://doi.org/10.1056/NEJMp2103614">global vaccine equity</a> or taking action on the ecological and climate pressures that increase the risk of <a href="https://doi.org/10.1007/s42398-021-00165-x">zoonotic diseases</a>.</p>
<p>Self-determination means deciding for ourselves, feeling proud of a job well done, giving to others and feeling we belong. Social prescribing can’t be everything to everyone, but what it has shown is individual and collective well-being, psychological and political self-determination are deeply intertwined. </p>
<p>Starting with one phone call, walk in the park, poem or gift does make a difference, and can help kick-start the ability to get through these challenging times — together.</p><img src="https://counter.theconversation.com/content/174368/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate Mulligan consults for the Canadian Red Cross, National Collaborating Centre for the Determinants of Health and Pan American Health Organization. Her prior work on social prescribing received funding from the Ontario Ministry of Health. She is a member of the Toronto Board of Health.</span></em></p>People can counter the helplessness felt during the pandemic and build power by creating a sense of purpose and community amid the confusion of COVID-19.Kate Mulligan, Assistant Professor, Social & Behavioural Health Sciences, Dalla Lana School of Public Health, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1524722021-01-04T15:03:52Z2021-01-04T15:03:52ZFive tips to help you keep exercising this new year<figure><img src="https://images.theconversation.com/files/376989/original/file-20210104-21-dgryjd.jpg?ixlib=rb-1.1.0&rect=74%2C0%2C8313%2C5500&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Try choosing exercise you enjoy.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fit-family-doing-home-online-stretching-1706922184">Andrey_Popov/ Shutterstock</a></span></figcaption></figure><p><a href="https://yougov.co.uk/topics/lifestyle/articles-reports/2019/12/31/quarter-brits-will-make-new-years-resolution">Exercising more</a> is one of the most common new year resolutions people make. But more than a quarter of people <a href="https://yougov.co.uk/topics/lifestyle/articles-reports/2019/12/31/quarter-brits-will-make-new-years-resolution">fail to keep their resolutions</a>, and only half maintain some of them.</p>
<p>But if that still sounds daunting, here are five tips that may help you better keep exercising if that’s your goal this year.</p>
<h2>1. Have a plan and an end goal</h2>
<p>Resolutions can be great – don’t let me discourage you. But when you start out, set both your lofty goal, and a firm roadmap of the steps you need to follow to get there. This will help you <a href="https://pubmed.ncbi.nlm.nih.gov/31232517/">maximise your odds of success</a> in reaching that goal.</p>
<p>Want to run 2,021km in 2021? Breaking this larger goal down would mean you should plan on running 5.5km a day (every day) or about 8km every day before work if you work Monday-Friday. But also consider what happens if you get an injury – do you have redundancy built into your plan? You should also plan breaks to prevent overtraining. </p>
<p>Research shows that by combining ambitious goals with <a href="https://pubmed.ncbi.nlm.nih.gov/31232517/">multiple achievable sub-goals</a>, you’re more likely to be successful. Being able to tick off the goals as you go may also give you a positive motivational boost to keep going.</p>
<h2>2. Don’t take up running (unless you enjoy it)</h2>
<p>Running is great. Almost anyone can do it, it’s great for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1960188/">the whole body</a>, requires minimal equipment and you can do it almost anywhere. Running also improves cardiovascular health and <a href="https://pubmed.ncbi.nlm.nih.gov/11441731/">bone density</a>. That said, I hate running – so I don’t do it.</p>
<p>People often ask what type of exercise they should do, and I typically tell them that the answer depends on what they enjoy doing. This is because you’re much more likely to keep doing exercise you enjoy over activities <a href="https://www.scirp.org/journal/paperinformation.aspx?paperid=53271">you find yourself dreading</a>. </p>
<p>And somewhat surprisingly, research shows that it doesn’t seem to matter what type of exercise you do when it comes to health and longevity – <a href="https://academic.oup.com/biomedgerontology/article/57/5/M262/620575?">as long as you’re exercising</a> you’ll see benefits.
<a href="https://pubmed.ncbi.nlm.nih.gov/31104484/">Resistance training</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/31685526/">aerobics</a>, high-intensity interval training (<a href="https://pubmed.ncbi.nlm.nih.gov/24144531/">HIIT</a>) and possibly even <a href="https://pubmed.ncbi.nlm.nih.gov/24491402/">yoga</a> may all stimulate your body in different ways, but have positive outcomes in terms of health and longevity – especially when combined together.</p>
<p>But if you do want to take up jogging, you can also keep yourself motivated by joining group events – such as parkrun. </p>
<h2>3. Get an exercise buddy</h2>
<p>When England first went into lockdown in March, I started a new exercise programme with my partner. Nine months later, we’re still both stuck at home and still exercising together six days a week. That peer encouragement, motivation and occasional guilt trip from my better half has really helped. </p>
<p>And <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5156899/">plenty</a> of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657066/">research shows</a> that starting a new exercise programme <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6068491/">with someone else</a> will help you both to maintain your regime in the long term. This could be because the external peer pressure is helpful, or possibly because the positive social interactions from exercising with others makes it more fun.</p>
<figure class="align-center ">
<img alt="Person walkng their dachshund in the woods." src="https://images.theconversation.com/files/376988/original/file-20210104-19-1qemuyc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/376988/original/file-20210104-19-1qemuyc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/376988/original/file-20210104-19-1qemuyc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/376988/original/file-20210104-19-1qemuyc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/376988/original/file-20210104-19-1qemuyc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/376988/original/file-20210104-19-1qemuyc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/376988/original/file-20210104-19-1qemuyc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Your dog may also make a good exercise buddy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hostess-walks-dachshund-dog-autumn-park-1865355109">Svitlana Ozirna/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Daily lunchtime walks with someone in your bubble, the whole flat doing morning yoga before the workday starts, or weekday football with you mates are all great ways to help you start exercising in the new year – and stick to that goal. And since exercise is “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5199005/">infectious</a>”, starting a new type of regular activity may motivate those close to you to join in too. So, even if you can’t convince your flatmate to start with you, you might end up getting them to join in and you’ll both benefit. </p>
<h2>4. Remove as many barriers as possible</h2>
<p>What are the things that stop you from going for a walk, or to the gym? Is it because you’re too busy? Schedule time. Is it too expensive? Look for cheaper alternatives such as park exercises or YouTube workouts.</p>
<p><a href="https://www.heart.org/en/healthy-living/fitness/getting-active/breaking-down-barriers-to-fitness">Identifying the barriers</a> keeping you from achieving your goal will allow you to figure out <a href="https://pubmed.ncbi.nlm.nih.gov/21937904/">what you can do</a> to prevent them from stalling your progress. </p>
<h2>5. Get a dog</h2>
<p>This last one isn’t for everyone – I get that. But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693989/">multiple peer-reviewed papers</a> suggest that <a href="https://pubmed.ncbi.nlm.nih.gov/31592726/">dog owners live longer</a>. We do know that dog owners <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4422-5?sf174129844=1">walk about 3,000 steps more per day</a>, so it could be a simple as being more physically active than non-dog owners. </p>
<p>If you don’t have a dog, try thinking of reasons to walk more anyway. Small amounts of physical activity done throughout the day really do add up. Things like avoiding the lift and <a href="https://pubmed.ncbi.nlm.nih.gov/30649897/">taking the stairs a few times per day</a> or standing up every ad break really does lead to <a href="https://pubmed.ncbi.nlm.nih.gov/25977572/">positive changes over time</a>.</p>
<p>Exercise is good for, and will help you live a longer and healthier life. Even if you think you don’t like exercise, perhaps you just haven’t found the right type yet. And if that’s not the case, breaking your goals down, removing any barriers and finding a buddy (with two legs or four) to exercise with will help you maintain your new exercise routine throughout the new year.</p><img src="https://counter.theconversation.com/content/152472/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bradley Elliott receives funding from the Endocrine Society, the Quintin Hogg Trust, and private philanthropy to support his academic research. He is affiliated with The Physiological Society as a society representative.</span></em></p>How to avoid being in the quarter of people who fail to keep their resolutions.Bradley Elliott, Lecturer in Physiology, University of WestminsterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1491722020-12-31T20:19:47Z2020-12-31T20:19:47ZWant to exercise more? Try setting an open goal for your New Year’s resolution<figure><img src="https://images.theconversation.com/files/368153/original/file-20201108-21-12b1zh0.jpg?ixlib=rb-1.1.0&rect=16%2C24%2C5447%2C3612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>It’s that time of year when many of us are setting goals for the year ahead. The most common New Year’s resolution – set by <a href="https://today.yougov.com/topics/lifestyle/articles-reports/2018/12/13/new-years-resolutions-2019-exercise-healthy-eating">59%</a> of us - is to exercise more.</p>
<p>But our <a href="https://www.tandfonline.com/doi/full/10.1080/17437199.2019.1706616">research</a> suggests the way we typically set goals in exercise <a href="https://bjsm.bmj.com/content/52/8/485">often doesn’t work</a>. So, what should we do instead? </p>
<p>Our research interviewing elite athletes suggests one possibility is to set open goals instead. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-trying-to-meet-specific-exercise-goals-put-us-off-being-active-altogether-84062">Can trying to meet specific exercise goals put us off being active altogether?</a>
</strong>
</em>
</p>
<hr>
<h2>Specific goals can actually put us off</h2>
<p>Generally we’re <a href="https://www.nytimes.com/guides/smarterliving/resolution-ideas">advised</a> to set specific, or SMART, goals (where SMART stands for specific, measurable, achievable, realistic and timebound). Aiming to walk 10,000 steps per day is a common example. </p>
<p>This advice is typically based on <a href="https://www.google.com.au/books/edition/A_Theory_of_Goal_Setting_Task_Performanc/MHR9AAAAMAAJ?hl=en&gbpv=0&bsq=locke%20latham%201990">goal-setting theory</a> from the 1990s. However, that theory has now <a href="https://books.google.com.au/books?id=UDgKbOkYbEgC&printsec=frontcover&dq=locke+latham+2013&hl=en&newbks=1&newbks_redir=0&sa=X&ved=2ahUKEwj-qIeL6rrtAhWqwzgGHaFYDr8Q6AEwAHoECAUQAg#v=onepage&q=locke%20latham%202013&f=false">evolved</a>, with research now suggesting specific goals in some cases can actually put us off. </p>
<p>One problem is specific goals are <a href="https://www.tandfonline.com/doi/full/10.1080/17437199.2019.1706616">all-or-nothing</a>: you either achieve the goal or you fail. </p>
<p>That’s why you might feel you’ve failed after “only” recording 9,000 steps when your goal was 10,000. In reality, 9,000 steps might actually be an achievement (especially on a busy day) — but because you didn’t reach your specific target, it can feel disappointing.</p>
<p>When you stop making progress towards your goal, or start to feel like you’re failing, it’s easy to give up — just like <a href="https://today.yougov.com/topics/lifestyle/articles-reports/2018/12/13/new-years-resolutions-2019-exercise-healthy-eating">many</a> of us do with New Year’s resolutions. </p>
<p>Used incorrectly, specific goals even cause unethical behaviour (like using devices to artificially increase our step counts and <a href="https://metro.co.uk/2019/05/16/fitness-app-users-trying-cheat-step-counters-simple-hack-9570167/">benefit from lower insurance premiums</a>!). </p>
<p>One alternative is to set what’s known as an open goal.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man runs in a park." src="https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The problem is specific goals are all-or-nothing: you either achieve the goal or you fail.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What are open goals?</h2>
<p>Open goals are non-specific and exploratory, often phrased as aiming to “see how well I can do”. For example, professional golfers in one <a href="https://www.researchgate.net/publication/283564015_Psychological_States_underlying_Excellent_Performance_in_Professional_Golfers_Letting_it_Happen_vs_Making_it_Happen">study</a> described performing at their best when aiming to “see how many under par I can get”. </p>
<p>When colleagues and I <a href="https://www.tandfonline.com/doi/full/10.1080/10413200.2016.1272650">interviewed elite athletes about exceptional performances</a>, a Mount Everest climber described how:</p>
<blockquote>
<p>I was just thinking, ‘Oh I’ll just see how it goes and take it as it comes.’ I climbed higher and higher and the climb had got more and more engrossing and difficult and all-encompassing really […] until I discovered that I’d climbed like 40 metres without consciously knowing what I was doing.</p>
</blockquote>
<p>Open goals don’t just work for elite athletes – they work well in exercise too. <a href="https://www.sciencedirect.com/science/article/abs/pii/S1469029219305874">One study</a> found insufficiently active people performed better (in this study that meant they walked further) when pursuing open goals than they did with SMART goals. </p>
<p>The fitness industry is already starting to use open goals. For example, the <a href="https://www.lesmills.com/fit-planet/health/goal-setting/">Les Mills</a> fitness brand now recommends open goals (“to see how active you can be”), and the <a href="https://support.apple.com/en-au/guide/watch/apd673ee7114/watchos">Apple Watch</a> now incorporates open goals as a workout option. </p>
<h2>Psychological benefits of open goals</h2>
<p>Open goals aren’t just good for performance — they’re also much more psychologically beneficial than SMART goals. </p>
<p>Indeed, the elite athletes who first reported open goals described how they were an important part of experiencing <a href="https://www.youtube.com/watch?v=fXIeFJCqsPs">flow</a> – the enjoyable, rewarding state when everything just seems to click into place and we perform well without even needing to think about it. </p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S1469029219305874">Follow-up studies</a> found open goals – compared to SMART goals — make walking more enjoyable, make people more confident and make them feel they performed better. That boosts motivation and suggests open goals can help people stick with exercise routines longer. </p>
<p>One participant said open goals “took away the trauma of failing”.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman goes walking in a field." src="https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Open goals aren’t just good for performance - they are also much more psychologically beneficial than SMART goals.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Why do open goals work differently to SMART goals?</h2>
<p>There’s another important difference between open and SMART goals. When you set a SMART goal, you’re identifying something <em>in the future</em> you want to achieve (“I want to be able to walk 10,000 steps every day”). </p>
<p>So pursuing SMART goals is about reducing the gap between where you are now and where you want to get to – you’re always lagging behind where you want to be. That can make it feel like your progress is slow, and <a href="https://www.researchgate.net/profile/Charles_Carver/publication/232551850_Origins_and_Functions_of_Positive_and_Negative_Affect_A_Control-Process_View/links/56606c5f08ae4931cd5977dd.pdf">slow progress doesn’t feel good</a>. </p>
<p>When you set an open goal, your focus is on your starting point. If your goal is to “see how many steps I can reach today”, then as your step count rises, it will feel like you’re making progress. You may start to think, “Oh, I’m already on 2,000 steps… Now it’s 3,000 steps… Let’s see how many I can get to.” </p>
<p>Rather than comparing against where you <em>should</em> be, you’re constantly building on your starting point. </p>
<p>That makes the process much more positive - and <a href="https://academic.oup.com/abm/article-abstract/49/5/715/4562772">the more positive we feel</a> during exercise, the more we’ll want to do it again and again.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man runs on a treadmill" src="https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When you set an open goal, your focus is on your starting point, from which you can only build and make progress.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>To set your own open goals, think first about what you want to improve (for example “being more active”). Then identify what you want to measure, such as your daily average step count. </p>
<p>Phrase your goal in an open-ended, exploratory way: “I want to see how high I can get my average daily step count by the end of the year.” </p>
<p>And then get started! With an open goal, you’re more likely to see progress, enjoy the experience, and stick with it until you’re ready to set — and achieve — more specific goals.</p><img src="https://counter.theconversation.com/content/149172/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christian Swann has a consultancy role with Movember, and is a member of the British Association of Sport and Exercise Sciences, Exercise and Sports Science Australia, and the Australasian Society for Physical Activity. </span></em></p>You might feel you’ve failed after ‘only’ recording 9,000 steps when your goal was 10,000. In reality, 9,000 steps might be an achievement. Is it time to ditch specific goals in favour of open goals?Christian Swann, Associate Professor in Psychology, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1290682020-01-15T19:08:18Z2020-01-15T19:08:18ZDon’t die wondering: apps may soon be able to predict your life expectancy, but do you want to know?<figure><img src="https://images.theconversation.com/files/310160/original/file-20200115-151844-1ole8rh.jpg?ixlib=rb-1.1.0&rect=46%2C23%2C3833%2C2681&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Monaco and Japan have some of the highest life expectancies in the world. But calculating an individual's life expectancy will require taking data analysis several steps further.</span> <span class="attribution"><span class="source">SHUTTERSTOCK</span></span></figcaption></figure><p><em>When will I die?</em></p>
<p>This question has endured across cultures and civilisations. It has given rise to a plethora of religions and spiritual paths over thousands of years, and more recently, <a href="https://apps.apple.com/us/app/when-will-i-die/id1236569653">some highly amusing apps</a>. </p>
<p>But this question now prompts a different response, as technology slowly brings us closer to accurately predicting the answer. </p>
<p>Predicting the lifespan of people, or their “Personal Life Expectancy” (PLE) would greatly alter our lives. </p>
<p>On one hand, it may have benefits for policy making, and help optimise an individual’s health, or the services they receive. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/were-not-just-living-for-longer-were-staying-healthier-for-longer-too-118588">We're not just living for longer – we're staying healthier for longer, too</a>
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</em>
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<p>But the potential misuse of this information by the government or private sector poses major risks to our rights and privacy.</p>
<p>Although generating an accurate life expectancy is currently difficult, due to the complexity of factors underpinning lifespan, emerging technologies could make this a reality in the future.</p>
<h2>How do you calculate life expectancy?</h2>
<p>Predicting life expectancy is not a new concept. <a href="http://www.bbc.com/travel/story/20170807-living-in-places-where-people-live-the-longest">Experts do this</a> at a population level by classifying people into groups, often based on region or ethnicity. </p>
<p>Also, tools such as <a href="https://www.nature.com/articles/s41598-018-23534-9">deep learning</a> and <a href="https://mipt.ru/english/news/scientists_use_ai_to_predict_biological_age_based_on_smartphone_and_wearables_data">artificial intelligence</a> can be used to consider complex variables, such as biomedical data, to predict someone’s biological age. </p>
<p>Biological age refers to how “old” their body is, rather than when they were born. A 30-year-old who smokes heavily may have a biological age closer to 40.</p>
<p><a href="https://www.mdpi.com/2227-7080/6/3/74/htm">Calculating a life expectancy reliably</a> would require a sophisticated system that considers a breadth of environmental, geographic, genetic and lifestyle factors – <a href="https://www1.health.gov.au/internet/publications/publishing.nsf/Content/oatsih-hpf-2012-toc%7Etier1%7Elife-exp-wellb%7E119">all of which have influence</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/310166/original/file-20200115-151848-pc2cam.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/310166/original/file-20200115-151848-pc2cam.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/310166/original/file-20200115-151848-pc2cam.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/310166/original/file-20200115-151848-pc2cam.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/310166/original/file-20200115-151848-pc2cam.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/310166/original/file-20200115-151848-pc2cam.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/310166/original/file-20200115-151848-pc2cam.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/310166/original/file-20200115-151848-pc2cam.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The use of devices such as fitness trackers will become crucial in predicting personal life expectancy in the future.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/healthy-lady-run-away-angel-death-329261456">Shutterstock</a></span>
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</figure>
<p>With <a href="https://builtin.com/artificial-intelligence/machine-learning-healthcare">machine learning</a> and artificial intelligence, it’s becoming feasible to analyse larger quantities of data. The use of deep learning and cognitive computing, such as with <a href="https://www.ibm.com/watson-health">IBM Watson</a>, helps doctors make more accurate diagnoses than using human judgement alone. </p>
<p>This, coupled with <a href="https://www.cio.com/article/3273114/what-is-predictive-analytics-transforming-data-into-future-insights.html">predictive analytics</a> and increasing computational power, means we may soon have systems, or even apps, that can calculate life expectancy.</p>
<h2>There’s an app for that</h2>
<p>Much like <a href="https://www.mdanderson.org/for-physicians/clinical-tools-resources/clinical-calculators.html">existing tools</a> that predict cancer survival rates, in the coming years we may see apps attempting to analyse data to predict life expectancy.</p>
<p>However, they will not be able to provide a “death date”, or even a year of death.</p>
<p>Human behaviour and activities are so unpredictable, it’s almost impossible to measure, classify and predict lifespan. A personal life expectancy, even a carefully calculated one, would only provide a “natural life expectancy” based on generic data optimised with personal data.</p>
<p>The key to accuracy would be the quality and quantity of data available. Much of this would be taken directly from the user, including gender, age, weight, height and ethnicity.</p>
<p>Access to real-time sensor data through fitness trackers and smart watches could also monitor activity levels, heart rate and blood pressure. This could then be coupled with lifestyle information such as occupation, socioeconomic status, exercise, diet and family medical history. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/your-local-train-station-can-predict-health-and-death-54946">Your local train station can predict health and death</a>
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</em>
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<p>All of the above could be used to classify an individual into a generic group to calculate life expectancy. This result would then be refined over time through the analysis of personal data, updating a user’s life expectancy and letting them monitor it.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/308303/original/file-20191230-11891-nswi58.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/308303/original/file-20191230-11891-nswi58.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=176&fit=crop&dpr=1 600w, https://images.theconversation.com/files/308303/original/file-20191230-11891-nswi58.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=176&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/308303/original/file-20191230-11891-nswi58.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=176&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/308303/original/file-20191230-11891-nswi58.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=221&fit=crop&dpr=1 754w, https://images.theconversation.com/files/308303/original/file-20191230-11891-nswi58.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=221&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/308303/original/file-20191230-11891-nswi58.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=221&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This figure shows how an individual’s life expectancy might change between two points in time (F and H) following a lifestyle improvement, such as weight loss.</span>
</figcaption>
</figure>
<h2>Two sides of a coin</h2>
<p>Life expectancy predictions have the potential to be beneficial to individuals, health service providers and governments.</p>
<p>For instance, they would make people more aware of their general health, and its improvement or deterioration over time. This may motivate them to make healthier lifestyle choices.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/faster-more-accurate-diagnoses-healthcare-applications-of-ai-research-114000">Faster, more accurate diagnoses: Healthcare applications of AI research</a>
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</em>
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<p>They could also be used by insurance companies to provide individualised services, such as how some car insurance companies use <a href="https://www.theguardian.com/money/2017/dec/16/motoring-myths-black-boxes-telematics-insurance">black-box technology</a> to reduce premiums for more cautious drivers.</p>
<p>Governments may be able to use predictions to more efficiently allocate limited resources, such as social welfare assistance and health care funding, to individuals and areas of greater need.</p>
<p>That said, there’s a likely downside. </p>
<p>People <a href="https://www.theatlantic.com/health/archive/2017/11/the-existential-slap/544790/">may become distressed</a> if their life expectancy is unexpectedly low, or at the thought of having one at all. This raises concerns about how such predictions could impact those who experience or are at risk of mental health problems. </p>
<p>Having people’s detailed health data could also let insurance companies more accurately profile applicants, <a href="https://www.abc.net.au/news/2019-07-08/fitness-tracker-used-to-set-health-insurance-premiums/11287126">leading to discrimination against groups or individuals</a>. </p>
<p>Also, pharmaceutical companies could coordinate targeted medical campaigns based on people’s life expectancy. And governments could choose to tax individuals differently, or restrict services for certain people.</p>
<h2>When will it happen?</h2>
<p>Scientists have been working on ways to <a href="https://towardsdatascience.com/what-really-drives-higher-life-expectancy-e1c1ec22f6e1">predict human life expectancy</a> for many years. </p>
<p>The solution would require input from specialists including demographers, health scientists, data scientists, IT specialists, programmers, medical professionals and statisticians.</p>
<p>While the collection of enough data will be challenging, we can likely expect to see advances in this area in the coming years.</p>
<p>If so, issues related to data compliance, as well and collaboration with government and state agencies will need to be carefully managed. Any system predicting life expectancy would handle highly sensitive data, raising ethical and privacy concerns.</p>
<p>It would also attract cybercriminals, and various other security threats.</p>
<p>Moving forward, the words of Jurassic Park’s Dr Ian Malcolm spring to mind:</p>
<blockquote>
<p>Your scientists were so preoccupied with whether or not they could, they didn’t stop to think if they should.</p>
</blockquote><img src="https://counter.theconversation.com/content/129068/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Predicting life expectancy remains in the realm of science fiction, but it may soon be possible. Are we prepared for such information? And who else would benefit from this knowledge?James Jin Kang, Lecturer, Edith Cowan UniversityPaul Haskell-Dowland, Associate Dean (Computing and Security), Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/838672017-10-03T23:28:39Z2017-10-03T23:28:39ZFriendly competition motivates men to get healthy on the job<p>Workplace wellness programs are typically designed for office settings. These programs have many components that encourage physical activity, such as email prompts to “stand up” every hour. But they tend to <a href="http://dx.doi.org/10.1186/1479-5868-6-26">engage more women than men</a>.</p>
<p>Men are also interested in healthy lifestyle behaviours, however. They want to become more active, eat healthy and reduce stress. But many men work in resource-based industries, such as energy, mining, and forestry, which <a href="https://www.nrcan.gc.ca/publications/key-facts/16013">account for 1.74 million jobs in Canada</a> and may not lend themselves to typical workplace wellness programs. Because men access health services at low rates, the workplace is also an ideal setting to engage men in health.</p>
<p>As the principal investigator and the research coordinator in a research team from the University of British Columbia and Athabasca University, we created a unique workplace wellness program targeted at men in blue-collar careers. We developed this program — <a href="http://www.powerplayatwork.com/">called POWERPLAY</a> — in collaboration with the Canadian Cancer Society, BC Cancer Agency and Northern Health. </p>
<p>We discovered that when a workplace health promotion program considers the unique context of male-dominated industries and incorporates men’s preferences, men can make healthy lifestyle changes.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/186667/original/file-20170919-22626-1dt15ap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/186667/original/file-20170919-22626-1dt15ap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/186667/original/file-20170919-22626-1dt15ap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/186667/original/file-20170919-22626-1dt15ap.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/186667/original/file-20170919-22626-1dt15ap.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/186667/original/file-20170919-22626-1dt15ap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/186667/original/file-20170919-22626-1dt15ap.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/186667/original/file-20170919-22626-1dt15ap.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Male-dominated industries offer challenges to workplace wellness programs, but also opportunities to leverage strength and engage masculine ideals like friendly competition.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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</figure>
<h2>Step up and team up</h2>
<p>The POWERPLAY program was designed with men for men. The program creates an opportunity for men to get involved in their health in a way that is both fun and acceptable to them. So-called “gender-sensitive” interventions like POWERPLAY represent a growing trend in workplace health towards reaching more men by considering their needs and preferences.</p>
<p>In the initial stages, researchers met with groups of men to <a href="http://dx.doi.org/10.1177/1557988315619372">discuss the best ways to support healthy eating and physical activity during their working days</a>. Most men want to stay healthy so they can keep working and provide for their families. But often the nature of their jobs makes healthy eating and getting enough physical activity a challenge.</p>
<p>The gender-sensitized POWERPLAY program we developed from the findings of our study includes healthy eating, physical activity and well-being components. For example, men are challenged to “STEP Up” and team up to virtually walk more than 2,775 kilometres — the distance of the <a href="https://www.hellobc.com/driving-routes/10/great-northern-circle-route.aspx">Great Northern Circle Route</a>. </p>
<p>POWERPLAY was designed with a competitive theme, so co-workers could form teams and compete against each other. It provides motivational and creative messages, as well as positive incentives, online resources and flexible program and policy suggestions for employers.</p>
<h2>Striving to attain goals</h2>
<p>We introduced POWERPLAY to four northern British Columbia workplaces: two transportation companies, a coal shipping terminal and a municipal work crew. The majority of men from these four workplaces were interested in learning about the wellness topics included in the POWERPLAY program.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/186670/original/file-20170919-22632-1ggia19.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/186670/original/file-20170919-22632-1ggia19.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/186670/original/file-20170919-22632-1ggia19.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=275&fit=crop&dpr=1 600w, https://images.theconversation.com/files/186670/original/file-20170919-22632-1ggia19.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=275&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/186670/original/file-20170919-22632-1ggia19.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=275&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/186670/original/file-20170919-22632-1ggia19.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=345&fit=crop&dpr=1 754w, https://images.theconversation.com/files/186670/original/file-20170919-22632-1ggia19.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=345&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/186670/original/file-20170919-22632-1ggia19.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=345&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The majority of men from four northern, male-dominated worksites were interested in workplace wellness.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Men that participated in the program <a href="http://dx.doi.org/10.1097/JOM.0000000000000793">reported increases in physical activity</a> and <a href="http://dx,doi.org/10.1123/jpah.2016-0111">greater awareness of the importance of healthy eating</a> while the participating workplaces <a href="https://doi.org/10.1177/1557988317728354">implemented changes to support the men’s healthy choices at work</a>.</p>
<p>“You could see that they were striving to attain more goals. You know, fit that extra vegetable in,” said one workplace lead at a transportation company.</p>
<h2>Prizes and friendly competition</h2>
<p>POWERPLAY has become a multiple award-winning, workplace health promotion program. It leverages men’s preferences, peer support and friendly competition to support health lifestyle behaviour change among men working in male-dominated industries.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/lAco4S6oHaU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Employees from two transportation companies describe the benefits of workplace health promotion.</span></figcaption>
</figure>
<p>Workplace participants suggested that while prizes encourage participation among male employees, friendly competition is the bigger motivator. As one human resources advisor from a regional municipality described: “The prizes are just to get people to go and sign up, and that’s half the battle. Every week there was a prize, sometimes two prizes and sometimes prizes for the entire team. I think that was fine but I don’t think that really motivated people. I think it was competing with each other — that’s what started to get everyone going.” </p>
<p>In fact, close to 20 per cent of the men who participated in POWERPLAY mentioned the friendly competition as their favourite part of the program. For example, one truck driver explained: “It gave guys a really great idea, built up a little competition and helped bring people together in the workplace.” </p>
<h2>Healthy workplace month</h2>
<p>Investing in employee health and wellness results in <a href="http://www.sunlife.ca/Canada/sponsor/Group+benefits/Group+benefits+products+&+services/Health+and+wellness/Wellness+ROI+Study?vgnLocale=en_CA">reduced absenteeism</a>, <a href="http://www.sunlife.ca/static/canada/Sponsor/About%20Group%20Benefits/Group%20benefits%20products%20and%20services/Health%20and%20wellness/2013-Sun-Life-Buffett-National-Wellness-Survey-EN.pdf">improved productivity and fewer disability claims</a>. Our goal is to assist more employers to use POWERPLAY to create workplace environments where men support each other in making lifestyle changes.</p>
<p>October is <a href="http://healthyworkplacemonth.ca/en/">Canada’s healthy workplace</a> month, making it a good time to reflect on how we can strengthen health promotion efforts that target men.</p><img src="https://counter.theconversation.com/content/83867/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joan L. Bottorff receives funding from the Canadian Cancer Society</span></em></p><p class="fine-print"><em><span>Cherisse Seaton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new workplace wellness program leverages masculine interests and targets blue-collar men - with success.Joan L. Bottorff, Professor, University of British ColumbiaCherisse Seaton, Research Coordinator in Health Promotion, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/719672017-02-09T03:50:08Z2017-02-09T03:50:08ZHow Democrats can help Trump make the ACA’s replacement ‘terrific’<p>One of the <a href="https://www.nytimes.com/2017/01/10/us/repeal-affordable-care-act-donald-trump.html?_r=0">top priorities</a> of the Republican-led Congress and the Trump administration is repealing and replacing the Affordable Care Act (ACA), President Barack Obama’s landmark health care law. </p>
<p>Even <a href="http://www.huffingtonpost.com/entry/how-obama-would-fix-obamacare_us_56bcd8d6e4b0c3c550506e19">supporters of the ACA</a> want to repair its flaws, such as a lack of competition in some state insurance marketplaces. But because the ACA has also made major improvements to the health sector, it will be very difficult to craft a replacement that doesn’t disrupt insurance markets or increase the ranks of the uninsured. </p>
<p>During the campaign, President Donald Trump <a href="http://thehill.com/policy/healthcare/249697-trump-replace-obamacare-with-something-terrific">promised</a> that the ACA’s successor will be “terrific,” an adjective that may have reassured some voters. After all, except for the individual mandate to purchase insurance, most parts of the ACA are <a href="http://kff.org/health-reform/press-release/after-the-election-the-public-remains-sharply-divided-on-future-of-the-affordable-care-act/">popular with the public</a>. </p>
<p>But the word “terrific” also hints at the best way Democrats can influence the revision of the ACA, as well as ensure that any problems that emerge can be fixed by Congress. </p>
<h2>The ACA’s results</h2>
<p>In many respects, the ACA has been a success. </p>
<p>Last December, the Obama administration’s Council of Economic Advisers released a long <a href="https://www.whitehouse.gov/blog/2016/12/13/economic-record-obama-administration-reforming-health-care-system">report</a> that extensively documented the positive effects of the ACA. That’s an assessment backed up by <a href="https://theconversation.com/love-it-or-hate-it-obamacare-has-expanded-coverage-for-millions-66472">independent experts</a>, such as the <a href="http://kff.org/uninsured/report/the-uninsured-a-primer-key-facts-about-health-insurance-and-the-uninsured-in-the-wake-of-national-health-reform/">Kaiser Family Foundation</a>.</p>
<p>Few people know, however, that the Obama administration established <a href="https://www.hhs.gov/sites/default/files/fy2017-performance-plan_remediated.pdf">official goals for the ACA</a> and reported data on how well those goals were met.</p>
<p>This was required under the <a href="http://www.gpo.gov/fdsys/pkg/BILLS-111hr2142enr/pdf/BILLS-111hr2142enr.pdf">GPRA Modernization Act</a> (GPRAMA), which was passed in 2010 to improve the 1993 Government Performance and Results Act (GPRA). </p>
<p>The 1993 law required departments to prepare strategic plans and report on performance. This helped the executive branch measure results and manage operations, but it did not encourage coordination over goals that crossed jurisdictional boundaries. </p>
<p>Congress crafted GPRAMA to reduce that problem by formalizing mechanisms for better coordination. And so now the executive branch must declare its priority goals across all major departments, and their leaders must hold quarterly reviews of the extent of <a href="http://performance.gov">progress toward those goals</a>. </p>
<p>Some of the goals the Obama administration set for the health sector included how many people it aimed to enroll in the new health insurance marketplaces, the share of the non-elderly population still uninsured and hospital readmission rates.</p>
<p>As one example, the Health and Human Services Department wanted to get 10 million people enrolled in ACA health insurance marketplaces in 2016, up from its target of 9 million the year before. In March 2016, the department <a href="https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf">reported</a> that it had surpassed its goal by 2.7 million. (This doesn’t count the additional millions who received insurance through the expansion of Medicaid.)</p>
<h2>The Byrd rule roadblock</h2>
<p>While Republicans are eager to ax the ACA – having voted in the House <a href="http://www.reuters.com/article/us-usa-obamacare-idUSKBN14X1SK">more than 60 times</a> to do so – they <a href="http://www.vox.com/policy-and-politics/2017/1/27/14417272/republicans-obamacare-secret-tape-leak">seem flummoxed</a> about how to proceed with its replacement. </p>
<p>The House GOP’s 2016 “A Better Way” plan for <a href="https://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf">health care</a> promised generally to “provide all Americans with more choices, lower costs and greater flexibility.” It proposed many changes to the ACA, but – unlike the Obama administration’s targets – did not specify any expected outcomes from their plan.</p>
<p>Some Republican health policy experts who oppose the ACA <a href="http://healthaffairs.org/blog/2017/01/03/the-problems-with-repeal-and-delay/">recently warned</a> that repealing the law but delaying a replacement would disrupt insurance markets. Democratic defenders of the law <a href="https://www.brookings.edu/opinions/why-republicans-cant-and-wont-repeal-obamacare/?utm_campaign=Economic+Studies&utm_source=hs_email&utm_medium=email&utm_content=41255242">argue</a>, with much logic, that it will be very hard to develop better alternatives to most of the ACA’s <a href="http://kff.org/health-reform/press-release/after-the-election-the-public-remains-sharply-divided-on-future-of-the-affordable-care-act/">popular provisions</a>, such as free preventive services and the prohibition against excluding people with preexisting conditions from coverage.</p>
<p>In January, the GOP took a first step toward repealing the ACA, passing a fiscal year 2017 budget resolution that aims to “fast-track” the process by instructing committees to <a href="http://budget.house.gov/UploadedFiles/Final_FY17_Budget_Resolution_1_page_Summary.pdf">use a budget procedure</a> known as “reconciliation.” In the modern Senate, because the minority can threaten a filibuster, it takes 60 votes to pass important bills. Reconciliation, in contrast, requires only a simple majority.</p>
<p>Democrats themselves used reconciliation in 2010 to pass part of the ACA after they lost their 60-vote majority.</p>
<p>But there is a limit to how Republicans can use reconciliation to get around Democratic objections. Reconciliation bills must comply with the <a href="https://fas.org/sgp/crs/misc/RL30862.pdf">Byrd rule</a>, a three-decade old Senate rule. </p>
<p>Like many Senate rules, the Byrd rule is complicated enough that the Senate parliamentarian will be called upon to interpret what it allows and what it does not. Primarily, it aims to ensure reconciliation bills are budgetary in nature by affecting spending or revenue. But one of its elements also says that provisions with a different purpose from the bill in question – such as, in the ACA repeal’s case, killing a health care regulation – have to be excluded. And since the health sector is very complex, any effort to repeal and replace the ACA would have many provisions that would be prohibited by the Byrd rule.</p>
<p>This means that at least part of any attempt to repeal and replace the ACA will have to go through regular legislative procedure, allowing Democrats to amend the proposed bill. </p>
<p>One caveat: It’s possible that Republicans will simply nix the Byrd rule, similar to how <a href="http://www.politifact.com/truth-o-meter/article/2017/feb/03/6-questions-answered-about-nuclear-option-filibust/">they’re considering “going nuclear”</a> by getting rid of the Senate filibuster for Supreme Court nominations. But let’s assume for the moment that they don’t.</p>
<h2>Making the ACA replacement ‘terrific’</h2>
<p>This procedural roadblock is what creates the opportunity for Democrats to insist that a replacement of the ACA be, in fact, “terrific.” </p>
<p>In the Senate, Democrats could propose amendments to a replacement bill that would set specific goals of access, cost and quality – essentially requiring Trump to take responsibility for his promises that the replacement will be, <a href="https://www.washingtonpost.com/politics/trump-vows-insurance-for-everybody-in-obamacare-replacement-plan/2017/01/15/5f2b1e18-db5d-11e6-ad42-f3375f271c9c_story.html">in his words</a>, “insurance for everybody.” </p>
<p>Following a <a href="http://healthaffairs.org/blog/2017/01/17/first-do-no-harm-a-physician-secretary-of-hhs-and-the-reach-of-hippocrates/">“first do no harm”</a> principle, these goals could be based on projected levels under current law.</p>
<p>After many years of vociferously criticizing the ACA, Republicans should be willing to be held accountable for the results of repealing and replacing it. </p>
<h2>A third ‘R’: Repeal, replace and revise</h2>
<p>The new law should also set up a process for reviewing attainment of those goals and for revising the law if it turns out to be flawed.</p>
<p>When Congress considers a replacement for the ACA, the nonpartisan Congressional Budget Office <a href="https://www.nytimes.com/2017/01/10/opinion/seven-questions-about-health-reform.html?emc=eta1">will project</a> the new law’s likely effects. But given the complexity of the health sector, even projections from these expert analysts will inevitably be <a href="http://www.commonwealthfund.org/publications/issue-briefs/2015/dec/cbo-crystal-ball-forecast-aca">wrong</a>. </p>
<p>So though repeal and replacement will be a stressful experience, Congress should not then expect years of rest and relaxation. In order to conduct oversight on the transition to a new health system, Congress should insist that the Trump administration declare goals, conduct quarterly reviews of results and report on its performance to Congress and the public. </p>
<p>To reassure the <a href="http://www.usnews.com/news/articles/2017-01-06/poll-on-obamacare-americans-want-to-see-replacement-before-repeal">many people worried</a> about the GOP’s “cure” being worse than the disease, Congress could also promise – in the repeal-and-replace legislation – to hold votes on revising the law during the next session of Congress, which begins in 2019. That is, if a provision is found to come up short of its goals or desperately needs revision, there would be a fast-track process to fix any problem or revert to the ACA original. </p>
<p>While including this process would not amount to an ironclad promise – because the majority can effectively determine the rules for each Congress – it would be a commitment that would be broken only in bad faith.</p>
<h2>Repair with results</h2>
<p>Some revision of the ACA is inevitable and even desirable. </p>
<p>If Democrats and Republicans jointly agree on establishing specific goals for the reform, building on the existing process for monitoring attainment of those targets, it could lead to measurable improvements in the health system. In doing so, the “repeal and replace” campaign slogan could be transformed into “repair with results.”</p>
<p>The alternative could be attractive to politicians who wish to avoid responsibility for their actions. However, many negative outcomes from the new system will be more than obvious to the patients who lack quality health insurance. </p>
<p>If that happens, they won’t be tweeting the word “terrific.” Instead they will more likely to be “SAD!” and “MAD!”</p><img src="https://counter.theconversation.com/content/71967/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roy T. Meyers does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A 2010 law that requires the executive branch to set goals and an obscure Senate rule may be the Democrats’ best chance to influence GOP plans to repeal and replace Obamacare.Roy T. Meyers, Professor of Political Science and Affiliate Professor of Public Policy, University of Maryland, Baltimore CountyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/713842017-01-19T10:59:16Z2017-01-19T10:59:16ZStruggling with your New Year’s resolutions? Here’s how you can hang on in there<figure><img src="https://images.theconversation.com/files/152933/original/image-20170116-9018-1divbl3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Pexels</span></span></figcaption></figure><p>Oh, those New Year’s resolutions. By this point you may well be struggling to stick to those precious promises you made to yourself only a few weeks ago. And you might have even sneaked in a few chocolates or crisps when you thought no one was watching. </p>
<p>But don’t worry, because a lot of people fail to follow through with their New Year’s health resolutions – with approximately <a href="https://www.couponcabin.com/blog/new-survey-fitness-costs-and-gym-memberships-in-2012/">80% of gym goers</a> who join in the New Year quitting their membership by the second week in February. So much for more exercise, right?</p>
<p>Statistics also indicate that more generally, <a href="https://www.couponcabin.com/blog/new-survey-fitness-costs-and-gym-memberships-in-2012/">50% of people quit their gym memberships</a> within six months of starting, and <a href="http://www.which.co.uk/news/2011/01/brits-waste-37m-on-unused-gym-memberships--242448/">waste almost £500 a year</a> on unused gym memberships and equipment. </p>
<p>Clearly, when it comes to New Year’s health resolutions, good intentions are not enough. But fear not, because insights from psychological science can help you identify and understand how to avoid the pitfalls that lead to health goal failures. So rather than beating yourself up about what you should be doing, with the tips below, you can successfully adopt a healthier lifestyle for the year ahead. </p>
<p>Here, we have the five most common reasons people struggle with their health goals, along with the solutions for staying on track.</p>
<h2>1. Taking on too much at once</h2>
<p>Trying to take on too much healthy change at once, or aiming for a health goal that seems unattainable can be overwhelming. This erodes confidence and feelings of competence, which in turn <a href="http://eprints.whiterose.ac.uk/91813/1/Sirois%20PAID%202004.pdf">can weaken intentions</a> to follow through with health behaviours.</p>
<p><strong>Solution:</strong> Start with one small health change at a time, such as increasing exercise levels slowly, or making diet changes in small steps. The confidence you experience from each smaller success can accumulate, and help you <a href="http://www.tandfonline.com/doi/abs/10.1080/08870440512331317670">bridge the gap</a> between intentions and actions. And this in turn can help you to make and maintain more challenging health behaviour changes.</p>
<h2>2. Lack of specificity</h2>
<p>Health goals that are too vague, such as “lose weight” or “get in better shape” are usually doomed to fail. Vague goals make it difficult to monitor how much progress is being made, and can leave you ill prepared for the inevitable temptations and bad habits that can derail best laid plans.</p>
<p><strong>Solution:</strong> Be specific when setting your health goals – such as “I will lose 10lbs in two months” – along with how you plan to achieve this – “I will substitute crisps for vegetables at lunchtime”. <a href="http://www.tandfonline.com/doi/abs/10.1080/08870440701864538">Research</a> has found that this formula of stating specific “if-then” plans for increasing your “five a day” was more effective for increasing fruit and vegetable intake compared to making no plans.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/152935/original/image-20170116-9058-13g8rma.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/152935/original/image-20170116-9058-13g8rma.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=445&fit=crop&dpr=1 600w, https://images.theconversation.com/files/152935/original/image-20170116-9058-13g8rma.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=445&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/152935/original/image-20170116-9058-13g8rma.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=445&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/152935/original/image-20170116-9058-13g8rma.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=559&fit=crop&dpr=1 754w, https://images.theconversation.com/files/152935/original/image-20170116-9058-13g8rma.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=559&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/152935/original/image-20170116-9058-13g8rma.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=559&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘By the end of the year, my arms will be the size of my head’.</span>
<span class="attribution"><span class="source">Pexels</span></span>
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</figure>
<h2>3. Going it alone</h2>
<p>Taking a “lone wolf” approach to reach health goals means you don’t have a motivational backup on those off days when following through with your health goals is more challenging. </p>
<p><strong>Solution:</strong> Get an exercise or diet partner to stay motivated and get healthy with. In <a href="http://link.springer.com/article/10.1007/s11031-015-9523-9">one study</a>, having an exercise partner predicted more effort and progress towards improving fitness levels. </p>
<h2>4. Being overcritical</h2>
<p>It’s a common misconception that being hard on yourself after missing a gym session or eating crisps instead of vegetables will help you stay on track. But <a href="http://journals.sagepub.com/doi/abs/10.1177/0146167211410246">evidence</a> shows that reacting harshly to yourself after such violations can make you less, not more, likely to be successful in reaching your goals. </p>
<p><strong>Solution:</strong> Accept your imperfections and practice self kindness to stay motivated after the inevitable lapses that occur on the path to a healthier lifestyle. In <a href="http://psycnet.apa.org/journals/hea/34/6/661/">one analysis</a> of over 3,200 people, it was found that being <a href="http://self-compassion.org/wptest/wp-content/uploads/2014/10/SCtheoryarticle.pdf">self-compassionate</a> on a regular basis was associated with the practice of a variety of health promoting behaviours – such as eating fruits and vegetables, regular exercise, and avoiding junk food. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/152934/original/image-20170116-9046-1clobg6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/152934/original/image-20170116-9046-1clobg6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/152934/original/image-20170116-9046-1clobg6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/152934/original/image-20170116-9046-1clobg6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/152934/original/image-20170116-9046-1clobg6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/152934/original/image-20170116-9046-1clobg6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/152934/original/image-20170116-9046-1clobg6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Two’s company.</span>
<span class="attribution"><span class="source">Pexels.</span></span>
</figcaption>
</figure>
<h2>5. Living for the present self</h2>
<p>Living in the moment can make you more susceptible to temptations that satisfy your present self – and more likely to neglect the implications of poor choices for the future self. According to <a href="http://eprints.whiterose.ac.uk/91793/1/Compass%20Paper%20revision%20FINAL.pdf">one review</a>, this shortsightedness is a key factor in why people procrastinate on their goals.</p>
<p><strong>Solution:</strong> Think about how “future you” can benefit from your health goals to overcome the lure of temptations and curb health procrastination. <a href="http://www.sciencedirect.com/science/article/pii/S0191886915003840">Research</a> has shown that people who feel closer to their “future self” are less likely to procrastinate in general. And that embracing the “future self” is associated with <a href="https://www.tpcph2016.com/schedule/connecting-to-the-future-self">engaging in positive health behaviours</a>.</p><img src="https://counter.theconversation.com/content/71384/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fuschia Sirois does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Old habits die hard.Fuschia Sirois, Reader in Health Psychology, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.