tag:theconversation.com,2011:/id/topics/healthy-lifestyle-10966/articleshealthy lifestyle – The Conversation2024-01-03T15:50:28Ztag:theconversation.com,2011:article/2204512024-01-03T15:50:28Z2024-01-03T15:50:28ZExpert advice to help young people keep their new year resolutions<figure><img src="https://images.theconversation.com/files/567686/original/file-20240103-27-8diqjr.jpg?ixlib=rb-1.1.0&rect=90%2C54%2C5916%2C3953&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/successful-man-raising-arms-after-cross-152853110">Dirima/Shutterstock</a></span></figcaption></figure><p><em>If you’re in need of some extra motivation to stick to your new year resolutions, there’s no better place to look than The Conversation’s archives. Our <a href="https://theconversation.com/uk/topics/quarter-life-117947">Quarter Life series</a> is full of expert advice to help readers in their 20s and 30s navigate life’s transitions. Read on for some pieces to help you reach your goals this year.</em></p>
<h2>Take care of your mental health</h2>
<p>If you have resolved to take better care of your mental health this year, you might as well start first thing in the morning. Saying <a href="https://theconversation.com/positive-affirmations-how-talking-to-yourself-can-let-the-light-in-199798">positive affirmations</a> aloud can help you get into a positive mindset and cancel out patterns of negative thinking. And they are easy to find – just look to your favourite books or songs. </p>
<p>Work can be a major source of stress and anxiety, but these three <a href="https://theconversation.com/three-mindfulness-and-meditation-techniques-that-could-help-you-manage-work-stress-208328">mindfulness and meditation techniques</a> may help you cope. If it’s available to you, you could also consider taking a mental health day – here’s how to <a href="https://theconversation.com/taking-a-mental-health-day-can-be-good-for-you-heres-how-to-make-the-most-of-one-186493">make the most of one</a>.</p>
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<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
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<p>If you are feeling persistently sad or lacking motivation, you may be thinking about starting therapy. But with so many different types of therapy, this can be daunting. Our <a href="https://theconversation.com/want-to-start-therapy-but-not-sure-what-type-will-be-right-for-you-here-are-four-to-consider-206524">guide to four popular types of therapy</a> can help you figure out what’s right for you.</p>
<h2>Live a healthier lifestyle</h2>
<p>If you’re taking advantage of those January gym membership deals, read this before you hit the treadmill: focusing on <a href="https://theconversation.com/focusing-on-functional-fitness-in-your-20s-and-30s-can-help-you-stay-ready-for-anything-and-many-exercises-can-help-you-achieve-it-216053">functional fitness</a> can help you stay mobile and fit as you start to get older. </p>
<p>If you are someone who deals with a period regularly, you may have heard of “cycle syncing”. As you move through the month, your energy levels may change due to hormonal fluctuations. <a href="https://theconversation.com/tailoring-workouts-to-your-menstrual-cycle-may-help-your-physical-fitness-but-only-if-done-properly-195773">Tailoring your workouts</a> around your menstrual cycle may make it easier to stick to your exercise routine.</p>
<p>The new year always brings a glut of diet advice, but eating healthily isn’t just about weight loss. If you’ve struggled with immunity in the past year, you are probably already thinking more about what you put into your body. Here’s what the <a href="https://theconversation.com/long-covid-a-range-of-diets-are-said-to-help-manage-symptoms-heres-what-the-evidence-tells-us-197821">evidence says</a> about some popular diets that are said to help manage symptoms of long COVID. </p>
<p>And trying to get more sleep is always a good goal – but if you don’t manage one night, don’t panic. <a href="https://theconversation.com/how-a-night-of-poor-sleep-can-affect-your-next-day-at-work-and-four-ways-to-function-better-201896">Here are some tips</a> on how to function better at work the next day. </p>
<h2>Be more eco-friendly</h2>
<p>Climate change is prompting many people to live a greener lifestyle. If your new year resolution is to be more eco-friendly but you’re not quite ready to give up travel, you can still make your next holiday <a href="https://theconversation.com/how-to-make-your-next-holiday-better-for-the-environment-203445">better for the environment</a>. </p>
<p>Veganuary (going vegan just for the month of January) is a popular way to start the year with a smaller carbon footprint. Keeping it going for the next 11 months is another story. You may want to try being a <a href="https://theconversation.com/as-veganism-grows-in-popularity-some-people-are-still-eating-meat-with-friends-could-a-social-omnivore-diet-work-for-you-199999">“social omnivore”</a> as a way to cut down on meat consumption without giving it up entirely.</p>
<p>Tackle two resolutions (saving the planet and saving money) by making your clothes last longer. Here’s a <a href="https://theconversation.com/how-to-make-your-clothes-last-longer-its-good-for-your-bank-account-and-the-environment-too-201823">guide to decoding</a> all those little symbols on clothing tags that will help you take better care of your clothes.</p>
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<img alt="Friends passing vegetarian dishes across a crowded table." src="https://images.theconversation.com/files/567689/original/file-20240103-19-gxm3y2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567689/original/file-20240103-19-gxm3y2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567689/original/file-20240103-19-gxm3y2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567689/original/file-20240103-19-gxm3y2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567689/original/file-20240103-19-gxm3y2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567689/original/file-20240103-19-gxm3y2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567689/original/file-20240103-19-gxm3y2.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">Could your diet save the planet (and your wallet) this year?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hands-cropped-unrecognisable-woman-man-passing-1021018564">LStockStudio/Shutterstock</a></span>
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<h2>Scroll less, read more</h2>
<p>I know I’m not alone in vowing to spend less time on Instagram and TikTok this year, and more time getting through the pile of books on my nightstand. But <a href="https://theconversation.com/why-a-social-media-detox-may-not-be-as-good-for-you-as-you-think-new-research-217484">new research shows</a> that quitting social media cold turkey may not be as good for you as you think. </p>
<p>With this in mind, there are steps you can take to <a href="https://theconversation.com/social-media-how-to-protect-your-mental-health-187935">improve your relationship</a> with the apps. For example, being more active – messaging and interacting – rather than passively doomscrolling and lurking can help you feel more connected to the social side of social media. And if you struggle with feelings of envy while looking at your feed, you may want to <a href="https://theconversation.com/three-steps-for-getting-over-social-media-envy-advice-from-a-psychologist-214446">unfollow or mute the accounts</a> that make you feel bad. </p>
<p>As for transferring your attention to books, TikTok can help with that. BookTok trends are having a powerful impact on the publishing industry, and may be <a href="https://theconversation.com/how-booktok-trends-are-influencing-what-you-read-whether-you-use-tiktok-or-not-213311">influencing what you read</a>. </p>
<h2>Be a better friend</h2>
<p>Making friends as an adult can be a challenge, especially in an era when many people are working from home. If your 2024 goal is to make new friends, try looking outside your age group. Research shows that <a href="https://theconversation.com/struggling-to-make-friends-as-an-adult-why-you-should-try-looking-to-older-generations-189814">intergenerational friendships</a> can be especially rewarding.</p>
<p>To nurture the friendships you have already, <a href="https://theconversation.com/how-to-be-a-good-listener-and-how-to-know-when-youre-doing-it-right-211556">this excellent read</a> can help you develop empathy and sharpen your listening skills. And if you need to have a difficult conversation, here are some <a href="https://theconversation.com/four-ways-to-have-hard-conversations-with-your-friends-without-making-things-worse-207675">tips to approach conflict</a> without hurting your friendship.</p>
<p>Finally, life is worth celebrating no matter the size of your accomplishments. This year, make an effort to toast to your friends (and yourself) for <a href="https://theconversation.com/its-not-just-weddings-how-celebrating-small-wins-and-unconventional-milestones-can-bring-joy-197755">little wins and unconventional milestones</a>.</p><img src="https://counter.theconversation.com/content/220451/count.gif" alt="The Conversation" width="1" height="1" />
These highlights from The Conversation’s Quarter Life series can help you stick to your goals in 2024.Avery Anapol, Commissioning Editor, Politics + SocietyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172032023-12-14T13:48:45Z2023-12-14T13:48:45ZHow much could the NHS save if people had healthier lifestyles? Hundreds of millions according to research<figure><img src="https://images.theconversation.com/files/565332/original/file-20231212-19-rf91na.jpg?ixlib=rb-1.1.0&rect=77%2C132%2C5106%2C3292&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-backpack-hiking-on-footpath-autumn-2377721871">encierro/Shutterstock</a></span></figcaption></figure><p>The NHS spends a lot of time and money looking after people who smoke, or drink too much or don’t do enough exercise. Hospital admissions and treatments are an expensive business. </p>
<p>So what would happen if these people were able to change their lifestyles, for example by switching to vaping, moderating alcohol intake and being more physically active? My research suggests that costs to the NHS could be significantly reduced. </p>
<p>One of <a href="https://www.magonlinelibrary.com/doi/abs/10.12968/bjhc.2023.0046">my studies</a> indicates that if half of England’s <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2022#smoking-prevalence-in-the-uk-by-sex-age-and-region">5 million smokers</a> switched to e-cigarettes or heated tobacco, the NHS would save more than £500 million a year. The shift away from cigarettes would lead to a decrease in cases of lung cancer, mouth cancer and heart disease. While the risks of vaping are still <a href="https://theconversation.com/how-bad-is-vaping-and-should-it-be-banned-197913">not entirely clear</a>, the damage caused by smoking has been firmly established.</p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S1090944323000613">Another study</a> I carried out in Italy reinforces this conclusion. It suggests that if half of Italy’s smoking population transitioned to alternative products, that country’s public health service could save over €700 million (£600 million) a year.</p>
<p>The larger figure comes from a slightly different cost structure for Italy’s health service, and the fact that more people smoke in Italy than in England. That study also delves into potential savings related to reducing excessive alcohol consumption and promoting increased physical activity.</p>
<p>My research <a href="http://dati.istat.it/Index.aspx?QueryId=16778&lang=en">used statistics</a> which suggest that just under 3% of Italians are currently considered heavy drinkers. Overindulging in alcohol can lead to many <a href="https://www.thelancet.com/pdfs/journals/lanrhe/PIIS2665-9913(23)00073-5.pdf">health problems</a>, including liver damage, heart defects, increased blood pressure, and a heightened risk of certain types of cancer.</p>
<p>I found that if a single heavy drinker (someone who consumes over four units of alcohol a day) out of every 1,000 Italians reduced their consumption to the recommended guidelines (two units a day for men, one a day for women), this would result in an annual saving to the health service of €60 million (£52 million). </p>
<p>Another finding was that if one physically inactive person out of every 100 Italians started to take the recommended level of at least 150 minutes of moderate physical activity, the gain would be €223 million (£193 million) per year. </p>
<p>Almost 40% of Italians do no exercise, which increases the risk of cardiovascular diseases, type 2 diabetes and obesity. It also <a href="https://www.who.int/news/item/04-04-2002-physical-inactivity-a-leading-cause-of-disease-and-disability-warns-who">elevates the risk</a> of colon cancer, high blood pressure, osteoporosis, depression and anxiety. </p>
<p>So overall, as the Italian government – in common with many wealthy countries – struggles with healthcare funding, close to €1 billion could be saved every year in direct costs if a relatively small number of people made fairly straightforward changes. </p>
<h2>Save lives, save money</h2>
<p>A similar impact could be had on the NHS (which has an annual budget of £182 billion) by targeting smokers, heavy drinkers and those who take no exercise. </p>
<p>The economic impact could in fact be far greater than my calculations suggest. For the savings predicted by my research do not account for the loss in productivity due to time off work connected to illness, treatment and recovery. </p>
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<img alt="Bottles of water held up in celebration." src="https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.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">Contains no alcohol.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cheers-healthy-couple-cheering-fresh-water-1134634340">AePatt Journey/Shutterstock</a></span>
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<p>Some may argue that given the risky nature of cigarettes and alcohol, a more straightforward – and economically beneficial – approach would be to implement an outright ban. After all, if successful, it could potentially result in even greater savings of lives and resources. </p>
<p>But banning people from doing things they like, even if those things are harmful, <a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">rarely works out well</a>. The idea of taking away the right to smoke or drink, or enforcing physical exercise would be a tough political sell. </p>
<p>Recognising that people are often inclined to engage in risky behaviour, the objective should be to reduce the excessive harm they cause themselves. A push towards encouraging and enabling people to smoke less, drink less and do more exercise would benefit them and significantly decrease the financial pressure on our healthcare systems.</p><img src="https://counter.theconversation.com/content/217203/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Francesco Moscone is affiliated with University of Ca' Foscari Venice </span></em></p>Small changes, big savings.Francesco Moscone, Professor of Business Economics, Ca' Foscari University of Venice, Brunel University LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2180032023-11-28T17:55:45Z2023-11-28T17:55:45ZLifestyle changes can reduce dementia risk by maintaining brain plasticity — but the time to act is now<figure><img src="https://images.theconversation.com/files/561624/original/file-20231125-24-4dpbbp.jpg?ixlib=rb-1.1.0&rect=0%2C704%2C5714%2C3742&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lifestyle changes may be our best hope of delaying dementia or not developing dementia at all.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/lifestyle-changes-can-reduce-dementia-risk-by-maintaining-brain-plasticity-but-the-time-to-act-is-now" width="100%" height="400"></iframe>
<p>Walk 10,000 steps a day, cut back alcohol, get better sleep at night, stay socially active — we’re told that changes like these can <a href="https://doi.org/10.1016/S0140-6736(20)30367-6">prevent up to 40 per cent of dementia cases worldwide</a>. </p>
<p>Given that dementia is still one of <a href="https://doi.org/10.1186%2Fs12889-023-15772-y">the most feared diseases</a>, why aren’t we pushing our doctors and governments to support these lifestyle changes through new programs and policy initiatives?</p>
<p>The truth, however, is more complex. We know that <a href="https://theconversation.com/got-health-goals-research-based-tips-for-adopting-and-sticking-to-new-healthy-lifestyle-behaviours-173740">making lifestyle changes is hard</a>. Ask anyone who has tried to keep their New Year’s resolution to visit the gym three times a week. It can be doubly difficult when the changes we need to make now won’t show results for years, or even decades, and we don’t really understand why they work.</p>
<h2>Taking control of your health</h2>
<p>Anyone who has watched a loved one <a href="https://alzheimer.ca/en/about-dementia/what-dementia/common-questions-about-dementia">living with dementia</a>, facing the small and large indignities and declines that leave them eventually unable to eat, communicate or remember, knows it is a devastating disease. </p>
<p>There are <a href="https://alzheimer.ca/en/whats-happening/events/new-dementia-drugs-therapies-what-canadians-should-know">several new drugs</a> making their way to the market for Alzheimer’s disease (one of the most common forms of dementia). However, they are still far from a cure and are currently only effective for early-stage Alzheimer’s patients.</p>
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Read more:
<a href="https://theconversation.com/lecanemab-experimental-drug-is-a-ray-of-hope-for-alzheimers-disease-196719">Lecanemab: Experimental drug is a ray of hope for Alzheimer's disease</a>
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<p>So lifestyle changes may be our best hope of delaying dementia or not developing dementia at all. Actor <a href="https://www.vanityfair.com/hollywood/2022/11/chris-hemsworth-exclusive-interview-alzheimers-limitless">Chris Hemsworth</a> knows it. He watched his grandfather live with Alzheimer’s and is making lifestyle changes after learning he has two copies of the APOE4 gene. This <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/what-is-apoe4-how-does-it-relate-alzheimers-disease-2023-04-21/">gene</a> is a risk factor for Alzheimer’s, and having two copies significantly increases his risk of developing the same condition. </p>
<p>Research has identified <a href="https://doi.org/10.1016/S0140-6736(20)30367-6">modifiable risk factors</a> that contribute to increasing the risk of dementia:</p>
<ul>
<li>physical inactivity</li>
<li>excessive use of alcohol</li>
<li>less sleep</li>
<li>social isolation</li>
<li>hearing loss</li>
<li>less cognitive engagement</li>
<li>poor diet</li>
<li>hypertension</li>
<li>obesity</li>
<li>diabetes</li>
<li>traumatic brain injury</li>
<li>smoking</li>
<li>depression</li>
<li>air pollution</li>
</ul>
<p>Our understanding of the biological mechanisms for these risk factors is varied, with some more clearly understood than others. </p>
<p>But there is a lot we do know — and here’s what you need to know as well.</p>
<h2>Cognitive reserve and neuroplasticity</h2>
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<img alt="Two older men on a park bench, on of whom is straining to hear the other speaking" src="https://images.theconversation.com/files/561625/original/file-20231125-21-n964o8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561625/original/file-20231125-21-n964o8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561625/original/file-20231125-21-n964o8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561625/original/file-20231125-21-n964o8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561625/original/file-20231125-21-n964o8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561625/original/file-20231125-21-n964o8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561625/original/file-20231125-21-n964o8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&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">As a person‘s hearing decreases, it can make it difficult to socially engage with others, resulting in a loss of sensory input. The brain has to work harder to compensate for this.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1016/j.neurobiolaging.2019.03.022">Cognitive reserve</a> is the brain’s ability to withstand damage or neurodegenerative disease. If there is tissue or functional loss in one part of the brain, other brain cells (neurons) work harder to compensate. In theory, this means lifelong experiences and activities create a dam against the damages of disease and aging in the brain.</p>
<p><a href="https://doi.org/10.3928/02793695-20100302-01">Neuroplasticity</a> is the brain’s amazing ability to adapt, learn and reorganize, create new pathways or rewire existing ones to recover from damage. The key takeaway is that neuroplasticity can happen at any time and any age, which means learning and activities should be lifelong.</p>
<p>Many of the risk factors linked to dementia likely work in combination, which is why an overall lifestyle approach is crucial. For example, <a href="https://doi.org/10.1007/s11920-016-0721-2">studies have shown</a> that exercise, cognitive and social engagement stimulate your brain and maintain its plasticity by growing new neural connections and building cognitive reserve.</p>
<p>The mechanism behind this is a combination of factors: increased oxygen and blood flow to the brain, stimulating growth factors that keep neurons healthy and reduced inflammation.</p>
<p>The opposite is also true. Poor sleep, diet, social isolation and untreated depression are linked to <a href="https://doi.org/10.3928/02793695-20100302-01">decreased cognitive reserve</a>. </p>
<p>The same rationale applies to hearing loss, a key emerging risk factor for dementia. As a person‘s hearing decreases, it can make it difficult to socially engage with others, resulting in a loss of sensory input. The <a href="https://doi.org/10.1097%2FWAD.0000000000000325">brain has to work harder</a> to compensate for this, potentially drawing down its cognitive reserve and leaving it less able to withstand dementia.</p>
<h2>The role of stress and inflammation</h2>
<figure class="align-center ">
<img alt="Illustration of hand drawing a brain with multicoloured chalk on blackboard" src="https://images.theconversation.com/files/561626/original/file-20231125-17-6hps66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561626/original/file-20231125-17-6hps66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=222&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561626/original/file-20231125-17-6hps66.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=222&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561626/original/file-20231125-17-6hps66.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=222&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561626/original/file-20231125-17-6hps66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=279&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561626/original/file-20231125-17-6hps66.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=279&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561626/original/file-20231125-17-6hps66.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=279&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chronic or prolonged inflammation disrupts normal function and causes damage to the brain’s cells.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Stress responses and inflammation are the body’s complex answer to injury. Inflammation is an important component of the body’s immune system, helping defend against threats and repair tissue damage. While short-term inflammation is a natural and good response, chronic or prolonged inflammation disrupts normal function and causes damage to the brain’s cells.</p>
<p>For example, one of the commonalities between dementia and untreated depression is the <a href="https://doi.org/10.17219/acem/149897%22%22">inflammatory process</a>. Prolonged exposure to stress hormones can lead to chronic inflammation. Hypertension, physical inactivity, smoking and air pollution are also associated with chronic inflammation and stress, which can damage blood vessels and neurons in the brain.</p>
<p>In a newer area of research still being explored, <a href="https://globalnews.ca/news/10095898/loneliness-global-public-health-concern-who/">social isolation</a> has also been <a href="https://doi.org/10.1016/j.yfrne.2023.101061">linked to inflammation</a>. As we learned during the COVID-19 pandemic, the brain is wired to respond to social engagement as a means of bonding and emotional support, especially in times of distress. </p>
<p>With surveys showing more than <a href="https://www.thestar.com/opinion/contributors/we-have-a-loneliness-crisis-it-s-time-to-act/article_30e6c996-a9e2-588b-a776-58addc503762.html">one in three Canadians</a> feel isolated, the lack of social connection and loneliness can trigger the body’s stress response and neuroendocrine changes, and prolonged exposure to this inflammatory process can damage the brain.</p>
<h2>Similar pathways across multiple diseases</h2>
<figure class="align-center ">
<img alt="Three women walking in exercise clothes" src="https://images.theconversation.com/files/561627/original/file-20231125-27-f0h7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561627/original/file-20231125-27-f0h7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561627/original/file-20231125-27-f0h7c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561627/original/file-20231125-27-f0h7c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561627/original/file-20231125-27-f0h7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561627/original/file-20231125-27-f0h7c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561627/original/file-20231125-27-f0h7c.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">While there are benefits to being physically and socially active at any age, some research shows the payoff from those gains can be higher after age 40 when the body’s metabolism slows, risk factors increase and cognitive reserve becomes even more essential to help protect against cognitive decline.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Several of these risk factors, and their biological pathways, cut across multiple chronic diseases. Accumulating evidence of <a href="https://doi.org/10.1016/S1474-4422(19)30087-0">decades of research</a> supports the concept of “what’s good for your heart is good for your head.” </p>
<p>This means that making these lifestyle changes not only reduces your risk of dementia, but also your risk of diabetes, hypertension and heart concerns. This highlights the complex nature of dementia but also offers a united strategy to deal with multiple health concerns that may arise as people age.</p>
<h2>It’s never too late</h2>
<figure class="align-center ">
<img alt="A man asleep in bed" src="https://images.theconversation.com/files/561628/original/file-20231125-27-dyme8y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561628/original/file-20231125-27-dyme8y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561628/original/file-20231125-27-dyme8y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561628/original/file-20231125-27-dyme8y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561628/original/file-20231125-27-dyme8y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561628/original/file-20231125-27-dyme8y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561628/original/file-20231125-27-dyme8y.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">Factors like not sleeping enough, having a poor diet and lacking social and cognitive engagement can increase the risk of developing dementia.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>It’s never really too late to change. The human brain and body have a remarkable capacity for adaptation and resilience throughout life. </p>
<p>While there are benefits to being physically and socially active at any age, some research shows the <a href="https://doi.org/10.1016/j.smhs.2019.08.006">payoff from those gains can be higher</a> after age 40 when the body’s metabolism slows, risk factors increase and cognitive reserve becomes even more essential to help protect against <a href="https://doi.org/10.1212/WNL.0000000000007003">cognitive decline</a>.</p>
<p>If making lifestyle changes means you can watch your child navigate adulthood, stroll 20 blocks to your favourite café every day and continue to live in your own home, perhaps walking the daily 10,000 steps, changing diets and keeping your friendship network strong is worthwhile. At worst, you’ll be healthier and more independent with or without dementia. At best, you might completely avoid dementia and other major diseases and keep living your best possible life.</p><img src="https://counter.theconversation.com/content/218003/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Middleton receives funding from the Public Health Agency of Canada and the Canadian Institutes of Health Research.</span></em></p><p class="fine-print"><em><span>Saskia Sivananthan 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>Lifestyle-related dementia risks are complex, with factors like sleep, exercise, diet and social contact interacting with things like cognitive reserve, neuroplasticity and inflammation in the body.Saskia Sivananthan, Affiliate Professor, Department of Family Medicine, McGill UniversityLaura Middleton, Assistant Professor, Department of Kinesiology, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1909702022-10-19T19:05:36Z2022-10-19T19:05:36ZAfter breast cancer: 5 changes you can make to stay healthy<figure><img src="https://images.theconversation.com/files/487718/original/file-20221003-14-426efs.jpg?ixlib=rb-1.1.0&rect=50%2C30%2C6659%2C4436&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://images.pexels.com/photos/8172908/pexels-photo-8172908.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2">Pexels</a></span></figcaption></figure><p>Every year, more than <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/statistics">20,000 Australians</a> – mostly women – are diagnosed with breast cancer. If you’re one of them or know someone who is, the great news is that <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/statistics">92 out of every 100</a> women will survive for five years or more after their diagnosis.</p>
<p>But women are often surprised by the life-altering side effects from their cancer treatment that can continue for years after, such as pain and fatigue. And many live with the dread of their cancer returning, even after they pass the celebrated five-year survival mark.</p>
<p>So, what can you do to improve your chances of living a longer, healthier life after a breast cancer diagnosis? </p>
<h2>1. Stay physically active</h2>
<p>Move more and sit less. Ideally, this includes gradually progressing towards and then maintaining about 150 minutes (two and a half hours) of planned, regular <a href="https://www.cosa.org.au/media/332488/cosa-position-statement-v4-web-final.pdf">exercise a week</a>. This involves a mix of aerobic exercise (such as walking) and resistance exercises (that target specific muscle groups), done at a moderate or high enough intensity to make you huff and puff a bit. </p>
<p>Observational studies show associations between exercise and living longer and <a href="https://pubmed.ncbi.nlm.nih.gov/32337494/">prevention of cancer recurrence</a>. And there’s some <a href="https://www.jsams.org/article/S1440-2440(18)31270-2/fulltext#secsect0075">preliminary evidence</a> from clinical trials to support this too. </p>
<p>Women with breast cancer who exercise and are more active, have better quality of life, strength and fitness, and fewer and less severe side effects during <a href="https://pubmed.ncbi.nlm.nih.gov/32337494/">active treatment</a>.</p>
<h2>2. Eat a high quality diet</h2>
<p>Women with better diets – that include a high intake of vegetables, fruit, legumes, nuts, whole grains and fish – <a href="https://www.mdpi.com/2072-6643/14/2/348">have been shown</a> to live longer after a breast cancer diagnosis than those who have a diet high in refined or processed foods and red meat. </p>
<p>This is due mainly to the benefit of a good diet on reducing the risks of other health conditions, such as heart disease, rather than having a direct effect on the risk of dying from breast cancer. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="health salad bowl" src="https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487940/original/file-20221004-24-ci00sy.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">Women with higher dietary quality lived longer after breast cancer diagnosis.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1512621776951-a57141f2eefd?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=1740&q=80">Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Many women, particularly older women or those with early stage breast cancer, are actually at higher risk of dying from <a href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000556">heart disease</a> than their breast cancer. A high quality diet can help maintain a <a href="https://theconversation.com/health-check-six-tips-for-losing-weight-without-fad-diets-52496">healthy body weight</a> and <a href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000001031">heart health</a>.</p>
<p>There has been <a href="https://www.breastcancer.org/research-news/intermittent-fasting-may-help-cancer-treatments-work-better">growing interest</a> in specific diets (such as <a href="https://www.curetoday.com/view/early-evidence-shows-fasting-keto-diet-may-make-chemo-and-some-other-cancrer-treatments-more-effective-and-easier-to-tolerate">ketogenic</a> or low-carbohydrate diets) and fasting during cancer treatment. But the most recent guidelines state <a href="https://ascopubs.org/doi/full/10.1200/JCO.22.00687">there’s no evidence yet</a> to say these are of significant benefit. </p>
<p>More research is being done following findings from a <a href="https://www.nature.com/articles/s41467-020-16138-3">2020 study</a>, which suggested a “fasting mimicking diet” (low calorie, low protein) on the days prior to and of chemotherapy, produced a better response to treatment. However, compliance with the diet was difficult – only one in five women in the study were able to stick to the fasting diet for all their chemotherapy treatments.</p>
<h2>3. Maintain a healthy weight</h2>
<p>Excess body weight has also been <a href="https://www.wcrf.org/diet-activity-and-cancer/cancer-prevention-recommendations/after-a-cancer-diagnosis-follow-our-recommendations-if-you-can/">linked to poorer survival</a> after breast cancer diagnosis. But so far there haven’t been <a href="https://ascopubs.org/doi/full/10.1200/JCO.2016.69.4026">any clinical trials</a> to show the opposite: that weight loss following a breast cancer diagnosis can improve survival. Trials are <a href="https://onlinelibrary.wiley.com/doi/10.1002/oby.23287">underway</a> to answer this question.</p>
<p><a href="https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.34343">Weight gain is common</a> following breast cancer treatment. The causes for this are complex and carrying extra weight can make some of the side effects of treatment worse. <a href="https://www.mdpi.com/2072-6643/13/11/4091">Our recent study</a> of women following breast cancer treatment, found that when they are supported to lose a modest amount of weight (5% of their body weight), they improved their physical quality of life and reduced their pain levels. They also reduced their risk of heart disease and diabetes. </p>
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Read more:
<a href="https://theconversation.com/cancer-in-the-under-50s-is-rising-globally-why-190302">Cancer in the under 50s is rising, globally – why?</a>
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<p>Besides these well-established tips, a small body of research suggests two more behaviours, related to our <a href="https://theconversation.com/your-body-has-an-internal-clock-that-dictates-when-you-eat-sleep-and-might-have-a-heart-attack-all-based-on-time-of-day-178601">body clock</a>, can impact health after a breast cancer diagnosis.</p>
<h2>4. Get good sleep</h2>
<p>Disrupted sleep – common among women with breast cancer – can remain for years after your treatment has ended. </p>
<p>Women with breast cancer who <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418457/#bib35">regularly struggle</a> to fall or stay asleep at night – compared those who rarely or never – are at greater risk of dying from any cause. </p>
<p>And it’s not just about how <em>well</em>, but also how <em>long</em> you sleep. <a href="https://pubmed.ncbi.nlm.nih.gov/28190251/">Sleeping longer</a> than nine hours per night – compared to seven to eight hours – is associated with a 48% increased risk of breast cancer returning. But, studies are yet to tease apart the possible reasons for this. Is increased risk of cancer recurrence a result of sleeping longer or is sleeping longer a consequence of progressing or recurrent disease?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman lies awake in bed" src="https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487941/original/file-20221004-22-ansjxv.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">Sleep can be challenging when you’re dealing with health worries.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1495546200065-d92a90266a1e?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=1470&q=80">Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>5. Be mindful of when you eat</h2>
<p>Preliminary research suggests when you eat matters. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982776/">Delaying the time</a> between the last meal of the day (dinner or supper) and first meal of the next (breakfast) may help reduce the chances of breast cancer returning.</p>
<p>When women reported fasting overnight for fewer than 13 hours – compared to 13 or more hours – after a breast cancer diagnosis, it was linked to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982776/">36% increased</a> risk of breast cancer coming back. But the study’s authors note randomised trials are needed to test whether increasing the amount of time fasting at night can reduce the risk of disease.</p>
<hr>
<p>
<em>
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Read more:
<a href="https://theconversation.com/olivia-newton-john-gave-a-voice-to-those-with-cancer-and-shifted-the-focus-to-the-life-of-survivors-188444">Olivia Newton-John gave a voice to those with cancer and shifted the focus to the life of survivors</a>
</strong>
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<h2>Small steps to big changes</h2>
<p>The World Cancer Research Fund has developed <a href="https://www.wcrf.org/diet-activity-and-cancer/cancer-prevention-recommendations/">a list of recommendations</a> to reduce cancer risk and reduce the risk of cancer coming back. But <a href="https://www.jandonline.org/article/S2212-2672(22)00076-4/fulltext">our research</a> has found most women aren’t meeting these recommendations after their breast cancer diagnosis. Changing habits after breast cancer <a href="https://www.jandonline.org/article/S2212-2672(20)31340-X/fulltext">can also be harder</a>, mainly due to fatigue and stress.</p>
<p>Starting exercise after treatment can be intimidating and even frightening. It’s a good idea to start small, for example: aim to increase exercise by 10 to 15 minutes each week. Having an exercise buddy really helps and there are lots of <a href="https://www.bcna.org.au/services-and-support-groups/services/31217">exercise programs</a> for people who’ve had breast cancer. </p>
<p><a href="http://exerciseismedicine.com.au/wp-content/uploads/2020/04/EIM-FactSheet_Breast-Cancer_Public-2020.pdf">Common questions</a> about exercising after a breast cancer diagnosis include how to avoid the swelling and discomfort of <a href="https://www.bcna.org.au/health-wellbeing/physical-wellbeing/lymphoedema/?gclid=CjwKCAjw7eSZBhB8EiwA60kCW4nqYq_XXsvaC29ijwWQRMGpvL563VMuExeCjZ39l-KAyQ-BukbSLBoCIZYQAvD_BwE">lymphoedema</a>, which develops in about 20% of breast cancer
survivors who have had lymph nodes removed. People also worry about exercise and wig discomfort or irritation from radiation. Specific <a href="http://exerciseismedicine.com.au/wp-content/uploads/2020/04/EIM-FactSheet_Breast-Cancer_Public-2020.pdf">advice</a> is available. </p>
<p>Similar to exercise goals, rather than striving for a perfect diet, you can aim to <a href="https://theconversation.com/4-plant-based-foods-to-eat-every-week-and-why-science-suggests-theyre-good-for-you-157235">eat more vegetables each week</a>.</p>
<p>Sleep can be challenging if you’ve been worrying about a cancer diagnosis or treatment but <a href="https://www.bcna.org.au/media/3757/bcna-fact-sheet-sleepless-nights-jan-2017.pdf">tips</a> for getting the recommended seven to nine hours sleep each night include exercising earlier in the day, avoiding snacks before bed and good sleep hygiene.</p><img src="https://counter.theconversation.com/content/190970/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marina Reeves receives funding from Medical Research Future Fund and World Cancer Research Fund. Marina Reeves has previously received funding from the National Health and Medical Research Council and National Breast Cancer Foundation. </span></em></p><p class="fine-print"><em><span>Caroline Terranova previously received funding from the University of Queensland Research Scholarships. </span></em></p><p class="fine-print"><em><span>Kelly D'cunha receives funding from an Australian Government Research Training Program (RTP) Scholarship.</span></em></p><p class="fine-print"><em><span>Sandra Hayes receives funding from Cancer Council Queensland, Medical Research Future Fund, and Cancer Australia. </span></em></p>Our research shows most women aren’t meeting lifestyle recommendations that can help prevent cancer recurrence.Marina Reeves, Professor, The University of QueenslandCaroline Olivia Terranova, Research Trial Coordinator, The University of QueenslandKelly D'cunha, PhD Candidate, The University of QueenslandSandra Hayes, Professor, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1847852022-06-21T10:12:45Z2022-06-21T10:12:45ZDo optimists really live longer? Here’s what the research says<figure><img src="https://images.theconversation.com/files/469985/original/file-20220621-16-b1wwi2.jpg?ixlib=rb-1.1.0&rect=13%2C20%2C4642%2C3078&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women who reported themselves to have high levels of optimism lived longer on average.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-senior-lady-sitting-on-wooden-458894395">FamVeld/ Shutterstock</a></span></figcaption></figure><p>Do you tend to see the glass as half full, rather than half empty? Are you always looking on the bright side of life? If so, you may be surprised to learn that this tendency could actually be good for your health.</p>
<p>A <a href="https://content.apa.org/record/2020-71981-001">number of studies</a> have shown that optimists enjoy higher levels of wellbeing, better sleep, lower stress and even better cardiovascular health and immune function. And now, <a href="https://pubmed.ncbi.nlm.nih.gov/35674052/">a recent study</a> has shown that being an optimist is linked to longer life. </p>
<p>To conduct their study, researchers tracked the lifespan of nearly 160,000 women aged between 50 to 79 for a period of 26 years. At the beginning of the study, the women completed a <a href="https://local.psy.miami.edu/people/faculty/ccarver/availbale-self-report-instruments/lot-r/">self-report measure of optimism</a>. Women with the highest scores on the measure were categorised as optimists. Those with the lowest scores were considered pessimists.</p>
<p>Then, in 2019, the researchers followed up with the participants who were still living. They also looked at the lifespan of participants who had died. What they found was that those who had the highest levels of optimism were more likely to live longer. More importantly, the optimists were also more likely than those who were pessimists to live into their nineties. Researchers refer to this as “exceptional longevity”, considering the average lifespan for women is about 83 years in developed countries. </p>
<p>What makes these findings especially impressive is that the results remained even after accounting for other factors known to predict a long life – including education level and economic status, ethnicity, and whether a person suffered from depression or other chronic health conditions. </p>
<p>But given this study only looked at women, it’s uncertain whether the same would be true for men. However, <a href="https://www.pnas.org/doi/abs/10.1073/pnas.1900712116">another study</a> which looked at both men and women also found that people with the highest levels of optimism enjoyed a lifespan that was between 11% and 15% longer than those who were the least optimistic. </p>
<h2>The fountain of youth?</h2>
<p>So why is it that optimists live longer? At first glance it would seem that it may have to do with their healthier lifestyle. </p>
<p>For example, <a href="https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.117.310828">research from several studies</a> has found that optimism is linked to eating a healthy diet, staying physically active, and being less likely to smoke cigarettes. These healthy behaviours are well known to improve heart health and <a href="https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases">reduce the risk</a> for cardiovascular disease, which is a <a href="https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)">leading cause of death</a> globally. Adopting a healthy lifestyle is also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3857242/">important for reducing the risk</a> of other potentially deadly diseases, such as diabetes and cancer. </p>
<figure class="align-center ">
<img alt="Two elderly women out for a walk together on a pier on a sunny day." src="https://images.theconversation.com/files/469986/original/file-20220621-11-wty41p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469986/original/file-20220621-11-wty41p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469986/original/file-20220621-11-wty41p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469986/original/file-20220621-11-wty41p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469986/original/file-20220621-11-wty41p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469986/original/file-20220621-11-wty41p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469986/original/file-20220621-11-wty41p.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">Optimists tend to have healthier lifestyle habits.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/action-portrait-elderly-women-jogging-together-162594119">karelnoppe/ Shutterstock</a></span>
</figcaption>
</figure>
<p>But having a healthy lifestyle may only be part of the reason optimists live a longer than average life. This latest study found that lifestyle only accounted for 24% of the link between optimism and longevity. This suggests a number of other factors affect longevity for optimists.</p>
<p>Another possible reason could be due to the way optimists manage stress. When faced with a stressful situation, optimists tend to deal with it head-on. They <a href="https://pubmed.ncbi.nlm.nih.gov/16859439/">use adaptive coping strategies</a> that help them resolve the source of the stress, or view the situation in a less stressful way. For example, optimists will problem-solve and plan ways to deal with the stressor, call on others for support, or try to find a “silver lining” in the stressful situation.</p>
<p>All of these approaches are well-known to reduce feelings of stress, as well as the biological reactions that occur when we feel stressed. It’s these <a href="https://www.apa.org/topics/stress/body">biological reactions to stress</a> –- such as elevated cortisol (sometimes called the “stress hormone”), increased heart rate and blood pressure, and impaired immune system functioning –- that can take a toll on health over time and increase the risk for developing <a href="https://www.sciencedirect.com/science/article/pii/S0889159115004316?via%3Dihub">life-threatening diseases</a>, such as cardiovascular disease. In short, the way optimists cope with stress may help protect them somewhat against its harmful effects. </p>
<h2>Looking on the bright side</h2>
<p>Optimism is typically viewed by researchers as a relatively stable personality trait that is determined by both <a href="https://www.cambridge.org/core/journals/twin-research-and-human-genetics/article/sex-differences-in-the-genetic-architecture-of-optimism-and-health-and-their-interrelation-a-study-of-australian-and-swedish-twins/58F21AA11943D44B4BA4C63A966E6AC7#">genetic</a> and early childhood influences (such as having a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541423/">secure and warm relationship</a> with your parents or caregivers). But if you’re not naturally prone to seeing the glass as half full, there are some ways you can increase your <a href="https://www.tandfonline.com/doi/abs/10.1080/17439760.2016.1221122?journalCode=rpos20">capacity to be optimistic</a>.</p>
<p>Research shows optimism can change over time, and can be cultivated by engaging in simple exercises. For example, visualising and then writing about your “<a href="https://www.psychologytoday.com/us/blog/what-matters-most/201303/what-is-your-best-possible-self">best possible self</a>” (a future version of yourself who has accomplished your goals) is a technique that studies have found can <a href="https://www.tandfonline.com/doi/full/10.1080/17439760.2016.1221122">significantly increase optimism</a>, at least temporarily. But for best results, the goals need to be both positive and reasonable, rather than just wishful thinking. Similarly, simply <a href="https://www.tandfonline.com/doi/abs/10.3200/SOCP.149.3.349-364">thinking about positive future events</a> can also be effective for boosting optimism.</p>
<p>It’s also crucial to temper any expectations for success with an accurate view of what you can and can’t control. Optimism is reinforced when we experience the positive outcomes that we expect, and <a href="https://psycnet.apa.org/record/1970-20680-001">can decrease</a> when these outcomes aren’t as we want them to be. Although more research is needed, it’s possible that regularly envisioning yourself as having the best possible outcomes, and taking realistic steps towards achieving them, can help develop an optimistic mindset. </p>
<p>Of course, this might be easier said than done for some. If you’re someone who isn’t naturally optimistic, the best chances to improve your longevity is by <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003332">living a healthy lifestyle</a> by staying physically active, eating a healthy diet, managing stress, and getting a good night’s sleep. Add to this cultivating a more optimistic mindset and you might further increase your chances for a long life.</p><img src="https://counter.theconversation.com/content/184785/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fuschia Sirois receives funding from Economic and Social Research Council, UK.</span></em></p>According to a recent study, optimists were more likely to live into their nineties.Fuschia Sirois, Professor in Social & Health Psychology, Durham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1812342022-04-18T11:52:27Z2022-04-18T11:52:27ZCardiac rehab for heart patients saves lives and money, so why isn’t it used more?<figure><img src="https://images.theconversation.com/files/458242/original/file-20220414-18-37ha6h.jpg?ixlib=rb-1.1.0&rect=0%2C120%2C2232%2C1473&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cardiac rehab is an outpatient chronic disease management program covering exercise, diet, lifestyle and psychosocial elements in hour-long sessions about twice per week over several months.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Aaron Vincent Elkaim</span></span></figcaption></figure><p>Despite all the attention on COVID-19, <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/220124/dq220124a-eng.htm">heart disease remains one of the biggest health threats</a>. Indeed, many people have <a href="https://doi.org/10.3390/ijerph19031108">not taken care of their heart health during the pandemic</a>, and are experiencing reduced quality of life because of it. If you’re reading this from the sofa with a bag of potato chips, this may include you.</p>
<p>Cardiac rehabilitation mitigates this, yet only <a href="http://dx.doi.org/10.1007/s11886-021-01543-x">10 to 25 per cent of heart patients</a> access it. It helps if patients and their loved ones are aware of cardiac rehab <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3176827/">and ask their doctor for a referral</a>, but there are <a href="https://doi.org/10.3390/jcm8020189">established strategies</a> to ensure patients access these programs that we desperately need to implement. </p>
<p>As a cardiac rehabilitation researcher for the past 20 years, I work with the preventive cardiology community to ensure more patients access these lifesaving programs.</p>
<h2>What cardiac rehab is all about</h2>
<p>Heart diseases are chronic and without cure, so they <a href="https://doi.org/10.1093/eurheartj/ehu505">often result in further cardiac events</a> such as readmission to the hospital or needing a stent — a tiny tube put in a vessel in your heart muscle to keep it open so oxygen and nutrient-rich blood can flow to it. But the chances of this can be drastically lowered with the <a href="https://doi.org/10.1016/j.mayocp.2016.12.024">low-cost, comprehensive cardiac rehab approach</a>.</p>
<figure class="align-right ">
<img alt="A stethoscope wrapped around an apple." src="https://images.theconversation.com/files/458223/original/file-20220414-18-xnpkkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/458223/original/file-20220414-18-xnpkkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458223/original/file-20220414-18-xnpkkt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458223/original/file-20220414-18-xnpkkt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458223/original/file-20220414-18-xnpkkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458223/original/file-20220414-18-xnpkkt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458223/original/file-20220414-18-xnpkkt.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">Cardiac rehab includes exercise, diet, lifestyle and psychosocial counselling.</span>
<span class="attribution"><span class="source">(Piqsels)</span></span>
</figcaption>
</figure>
<p>Cardiac rehab is an outpatient chronic disease management program, offering patients hour-long sessions about twice per week over several months. <a href="http://dx.doi.org/10.1136/heartjnl-2015-309209">Programs offer</a> structured exercise, patient education, as well as lifestyle (such as diet, tobacco use, medication adherence) and psychosocial (things like depression, anxiety, sleep, stress, sex, as applicable) counselling. Think of it as one-stop shopping for <a href="https://doi.org/10.1093/eurheartj/ehab484">all the proven recommendations to lower your heart disease risk</a>, delivered in a co-ordinated way with your acute care physicians and primary care provider over time. We are the middle link in a chain that supports patients to thrive.</p>
<p>Cardiac rehabilitation is “not just broccoli and running shoes” as our medical director likes to say; participation <a href="https://doi.org/10.1002/14651858.CD001800.pub4">reduces death and hospitalization by more than 20 per cent</a>, and also <a href="https://doi.org/10.1016/j.cjca.2018.11.013">improves well-being</a> and supports return to desired life roles. Yet few heart patients receive it, while other heart care recommendations like medication are <a href="https://doi.org/10.1016/j.ahj.2016.04.002">implemented over 80 per cent</a> of the time.</p>
<p>As a cardiac rehabilitation community, we have done the research to establish what can rectify this. This includes innovative health system payment models, <a href="https://doi.org/10.1038/nrcardio.2009.223">automatic electronic referral</a>, clinician training courses, and tech-based cardiac rehabilitation. <a href="https://doi.org/10.3399/bjgp08X342219">Unfortunately things have not changed</a> and patients are not getting the support they need. </p>
<h2>Paying for cardiac rehab</h2>
<p>In Canada and other countries, health-care providers cannot directly bill government health-care systems for cardiac rehabilitation like they can for a stent or a cardiologist visit, despite all the <a href="https://doi.org/10.1161/CIR.0b013e318235eb4d">clinical recommendations</a> for patients to get rehab. We <a href="https://doi.org/10.1186/s12913-016-1658-1">advocate for this reimbursement</a>, or other innovative payment models, to make it more financially viable to offer cardiac rehab and ensure enough cardiac rehab spots for all the patients who need it.</p>
<figure class="align-center ">
<img alt="A man on a treadmill with a trainer beside him" src="https://images.theconversation.com/files/458225/original/file-20220414-24-8vrlvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458225/original/file-20220414-24-8vrlvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458225/original/file-20220414-24-8vrlvr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458225/original/file-20220414-24-8vrlvr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458225/original/file-20220414-24-8vrlvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458225/original/file-20220414-24-8vrlvr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458225/original/file-20220414-24-8vrlvr.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">Automatically flagging stent patients for referral to cardiac rehab may help improve access rates.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>For example, if a patient gets a stent or heart bypass surgery, the hospital could be paid one <a href="https://www.commonwealthfund.org/publications/2020/apr/bundled-payment-models-around-world-how-they-work-their-impact">“bundled” fee</a> that includes money not only for the procedure, but also the rehabilitation that follows. <a href="https://www.health.gov.on.ca/en/pro/programs/ecfa/funding/ifm/">Bundled payments that include rehab have been rolled out now for hip and knee replacements in Ontario</a> for example, but we are still waiting for <a href="http://www.hqontario.ca/Portals/0/Documents/evidence/clinical-handbooks/heart-failure-02042015-en.pdf">heart procedures as promised</a>.</p>
<p>As a cardiac rehab advocate, I’ve heard the argument that heart risks are lifestyle-related, and government-funded health systems should not be in the business of individual health behaviour change. This is despite evidence that cardiac rehabilitation is cost-effective, results in <a href="https://doi.org/10.1002/14651858.CD010748.pub2">earlier return to work</a>, as well as <a href="https://doi.org/10.3390/jcm7120514">reductions in deaths and repeat visits to the hospital</a> (which are <a href="https://doi.org/10.1016/S0828-282X(09)70098-4">very expensive for the health system</a>).</p>
<p>Moreover, the same unhealthy lifestyle behaviours that underlie heart disease <a href="https://doi.org/10.1161/CIRCULATIONAHA.112.001183">are also associated with cancer</a>, but we don’t blame cancer patients for their condition. </p>
<p>Arguably, it is lack of public policy — to ensure citizens have access to safe <a href="https://doi.org/10.1371/journal.pone.0226524">green spaces</a> to exercise, <a href="https://doi.org/10.1161/JAHA.118.010694">sources of healthy food</a> and <a href="https://doi.org/10.1038/s41569-020-0371-2">clean air</a> in all neighbourhoods regardless of socio-economic status, as well as <a href="http://doi.org/10.1016/j.gheart.2015.04.007">better tobacco control</a> — that leads to heart disease; so governments clearly have an important role in lifestyle change. </p>
<figure class="align-center ">
<img alt="Illustration of an EKG heartbeat readout incorporating a figure running and a heart" src="https://images.theconversation.com/files/458224/original/file-20220414-18-ejdmfe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458224/original/file-20220414-18-ejdmfe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=258&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458224/original/file-20220414-18-ejdmfe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=258&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458224/original/file-20220414-18-ejdmfe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=258&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458224/original/file-20220414-18-ejdmfe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=324&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458224/original/file-20220414-18-ejdmfe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=324&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458224/original/file-20220414-18-ejdmfe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=324&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Participation in cardiac rehab reduces death and hospitalization by more than 20 per cent improves well-being and supports return to desired life roles.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>People need support to learn how to manage their condition and change multiple health behaviours, as well as to address their <a href="https://doi.org/10.1016/j.rehab.2016.09.002">high rate of psychosocial issues</a> that not only hinder their ability to manage their condition but also result in <a href="https://doi.org/10.1038/nrcardio.2016.181">poorer health outcomes</a>.</p>
<p>Other solutions include leveraging electronic health records so that, for example, when a heart patient gets a stent or bypass surgery, their file is flagged automatically for cardiac rehab because of its <a href="https://doi.org/10.1038/s41569-021-00611-7">clear benefits</a> in these patients. Systematic referrals such as these <a href="https://doi.org/10.1001/archinternmed.2010.501">increase rehab use eight times</a>, and this is augmented even further by <a href="https://globalcardiacrehab.com/CR-Utilization">training inpatient clinicians</a> to inform and encourage patients to enrol in cardiac rehabilitation at the bedside.</p>
<h2>Reaching the patients most in need</h2>
<p>Finally, we can also deliver cardiac rehab broadly <a href="https://doi.org/10.2196/18773">using technology</a> to reach all patients in need. The 10-to-25-per-cent rates of rehabilitation use are an average. Use is even lower in certain populations such as <a href="https://doi.org/10.1016/j.cjca.2013.11.007">women</a>, <a href="https://doi.org/10.1007/s40615-018-0478-x">rural and racialized people</a> as well as <a href="https://doi.org/10.1097/HCR.0000000000000646">people of low-income in Canada</a> and <a href="http://dx.doi.org/10.1136/heartjnl-2018-314486">around the world</a>. And this is particularly disconcerting because <a href="https://doi.org/10.1016/j.jacc.2020.11.010">in lower-income countries, heart disease rates are epidemic</a>.</p>
<p>Many middle-income countries are now developing cardiology programs as the burden of disease shifts from communicable to non-communicable. Disconcertingly, these advanced centres are <a href="http://usa.chinadaily.com.cn/china/2012-10/15/content_15816265.htm">placing stents at high rates</a>, but often <a href="https://doi.org/10.1016/j.ahj.2009.06.020">neglect cardiac rehabilitation</a>, <a href="http://dx.doi.org/10.1136/heartjnl-2017-312809">which is lower cost</a> and in many cases of <a href="https://doi.org/10.1093/eurjpc/zwab191">similar</a> or <a href="https://doi.org/10.1161/01.CIR.0000121360.31954.1F">better</a> benefit. Moreover, doctors prefer to specialize in interventional rather than preventive cardiology as it is <a href="https://doi.org/10.1001/jamainternmed.2018.8737">more lucrative</a>, such that there are few clinicians to deliver cardiac rehab. </p>
<p>Efforts are underway to increase <a href="https://doi.org/10.1097/HCR.0000000000000655">training of health-care professionals to deliver cardiac rehab</a> around the globe. We hope their cardiology systems don’t end up looking like those in high-income settings, with most of the focus and resources on acute care to the neglect of prevention and chronic care.</p>
<p>When we put all these strategies together, the cardiac rehab community can reach and care for the patients who need us most. If you or a loved one have heart disease, ask your doctor for a cardiac rehab referral — it can save your life.</p><img src="https://counter.theconversation.com/content/181234/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sherry L. Grace has received funding from the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, among other international funding agencies to support her research, but has not directly profited from it. She is affiliated with the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR; <a href="https://globalcardiacrehab.com/">https://globalcardiacrehab.com/</a>). </span></em></p>Cardiac rehabilitation is a low-cost approach with proven benefits for heart patients, that drastically lowers future cardiac risks. So why do only 10 to 25 per cent of heart patients access it?Sherry L. Grace, Professor & Sr. Scientist, Faculty of Health, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1751422022-01-24T03:14:46Z2022-01-24T03:14:46ZA healthier heart can protect your brain too. 5 lifestyle changes to prevent dementia<p>When we think of dementia, we often <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995109/">fear</a> a loss of control. But the reassuring news is up to 40% of dementias can be <a href="https://pubmed.ncbi.nlm.nih.gov/32738937/">prevented or delayed</a> if we change our health habits.</p>
<p>Nearly half a million Australians are <a href="https://www.dementia.org.au/information/statistics/prevalence-data">living with dementia</a>. Without a cure, this number is expected to reach 1.1 million by 2058. </p>
<p>Dementia shares key risk factors with cardiovascular (of the heart and blood vessels) disease, including high blood pressure, high blood sugar, being overweight and smoking. Inflammation and oxidative stress (where protective antioxidants are losing their fight with damaging free radicals) follow. This damages blood vessels and reduces the flow of blood and oxygen to the brain. </p>
<p>Without enough oxygen, brain cells can’t function effectively, and eventually die. Reduced blood flow also leaves the brain vulnerable to the <a href="https://www.alz.org/alzheimers-dementia/what-is-alzheimers/brain_tour_part_2">plaques and tangles</a> seen in forms of dementia.</p>
<p>But by changing our habits, we can both improve heart health and reduce the risk of dementia. Here are five lifestyle changes we can make now … </p>
<h2>1. Eat 2–3 serves of oily fish each week</h2>
<p>Oily fish, like salmon, sardines and mackerel are rich in omega-3 polyunsaturated fatty acids. Omega-3’s have anti-inflammatory effects and have been shown to significantly <a href="https://pubmed.ncbi.nlm.nih.gov/24610882/">reduce blood pressure</a>. </p>
<p>Omega-3s are also needed to support the structure and function of our brain cells and are “essential nutrients”. This means we need to get them from our diet. This is especially true as we age, because reductions in omega-3 intake have been <a href="https://pubmed.ncbi.nlm.nih.gov/28466678/">linked</a> to faster rates of cognitive decline. </p>
<h2>2. Eat plant foods with every meal</h2>
<p>Plant foods – like leafy greens, extra virgin olive oil, blueberries, nuts and pulses - contain a range of vitamins and minerals, including polyphenols, flavonoids, carotenoids, vitamin C and vitamin E. These micronutrients have both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5456284/">antioxidant and anti-inflammatory effects</a> that protect and improve our blood vessel functioning.</p>
<p>Diets high in plant foods, like the Mediterranean diet, have been shown to improve blood pressure, glucose regulation and body composition, and have also been <a href="https://pubmed.ncbi.nlm.nih.gov/28212320/">linked</a> to lower rates of cognitive decline, better markers of <a href="https://alz-journals.onlinelibrary.wiley.com/doi/abs/10.1002/alz.045349">brain health</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015034/">lower risk</a> of dementia.</p>
<h2>3. Eat less processed food</h2>
<p>On the other hand, saturated fats, refined carbohydrates and red and processed meats are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6269634/">believed to trigger</a> inflammatory pathways and highly processed foods have been linked to <a href="https://pubmed.ncbi.nlm.nih.gov/27927627/">hypertension</a>, <a href="http://ijmpnet.com/journals/ijmp/Vol_8_No_1_June_2020/1.pdf">type 2 diabetes</a> and <a href="https://www.nature.com/articles/s41387-020-00141-0">obesity</a>. </p>
<p>Eating more of these foods means we’re also likely to miss out on the benefits of other foods. Whole grains (like whole oats, rye, buckwheat and barley) provide fibre, vitamin B, E, magnesium and phytonutrients which have anti-inflammatory and antioxidant properties. Refined grains (like white bread, rice and pasta) are highly processed, meaning many of these beneficial nutrients are removed. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-people-with-dementia-dont-all-behave-the-same-100960">Why people with dementia don't all behave the same</a>
</strong>
</em>
</p>
<hr>
<h2>4. Get physical and make it fun</h2>
<p>Physical activity can <a href="https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.116.08398">reduce inflammation and blood pressure</a>, while improving blood vessel functioning. This helps the body deliver more oxygen to the brain, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0378512219301203">improving memory and other cognitive functions</a> affected by dementia. </p>
<p>Guidelines suggest adults should engage in physical activity on most days, break up long bouts of inactivity (like watching TV) and incorporate some resistance exercises.</p>
<p>The key to forming long-term exercise habits is choosing physical activities you <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646077/">enjoy</a> and making small, <a href="https://pubmed.ncbi.nlm.nih.gov/26857881/">gradual increases</a> in activity. Any movement that raises the heart rate can be classified as physical activity, including gardening, walking and even household chores.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aiming-for-10-000-steps-it-turns-out-7-000-could-be-enough-to-cut-your-risk-of-early-death-167447">Aiming for 10,000 steps? It turns out 7,000 could be enough to cut your risk of early death</a>
</strong>
</em>
</p>
<hr>
<h2>5. Quit smoking</h2>
<p>Smokers are <a href="https://pubmed.ncbi.nlm.nih.gov/32738937/">60% more likely to develop dementia</a> than non-smokers. This is because smoking increases inflammation and oxidative stress that harm the structure and function of our blood vessels.</p>
<p><a href="https://www.cancercouncil.com.au/cancer-prevention/smoking/quitting-smoking/">Quitting smoking</a> can begin to reverse these effects. In fact, former smokers have a significantly <a href="https://pubmed.ncbi.nlm.nih.gov/30349854/">lower risk of cognitive decline and dementia</a> compared to current smokers, similar to that of people who have never smoked.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19-has-offered-us-an-unexpected-opportunity-to-help-more-people-quit-smoking-146747">COVID-19 has offered us an unexpected opportunity to help more people quit smoking</a>
</strong>
</em>
</p>
<hr>
<h2>Is it too late?</h2>
<p>It’s never too early, or too late, to begin making these changes. </p>
<p>Obesity and high blood pressure in midlife are key predictors of dementia risk, while diabetes, physical inactivity and smoking are stronger predictors later in life. Regular physical activity earlier in life can reduce blood pressure and decrease your risk of diabetes. Like giving up smoking, changes at any stage of life can reduce inflammation and change your dementia risk. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="brains scans" src="https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/442123/original/file-20220124-21-1yd61jt.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">PET scans show the brain changes seen in Alzheimer’s disease, the most common form of dementia.</span>
<span class="attribution"><a class="source" href="https://photos-cdn.aap.com.au/Image/20180410001341633387?path=/aap_dev9/device/imagearc/2018/04-10/80/17/9b/aapimage-6znbjhqxi15mvg4kp3i_layout.jpg">AP Photo/Evan Vucci</a></span>
</figcaption>
</figure>
<h2>Little by little</h2>
<p>It can be overwhelming to change your whole diet, start a new exercise program and quit smoking all at once. But even small changes can lead to significant improvements in health. Start by making manageable swaps, like:</p>
<ul>
<li> use extra virgin olive oil in place of butter, margarine and other cooking oils</li>
<li> swap one serve of processed food, like chips, white bread, or commercial biscuits, for a handful of nuts</li>
<li> swap one serve of meat each week for one serve of oily fish</li>
<li> swap five minutes of sedentary time for five minutes of walking and slowly increase each day.</li>
</ul><img src="https://counter.theconversation.com/content/175142/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ashleigh Elizabeth Smith receives funding from the National Health and Medical Research Council (NH&MRC) and the Hospital Research Foundation. </span></em></p><p class="fine-print"><em><span>Maddison Mellow receives funding from the Dementia Australia Research Foundation (PhD scholarship). </span></em></p><p class="fine-print"><em><span>Alexandra Wade 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>Heart health is strongly linked to brain health and risk of dementia. That means improving one can protect us from the other.Alexandra Wade, Research associate, University of South AustraliaAshleigh E. Smith, Senior Lecturer - Exercise Physiology, University of South AustraliaMaddison Mellow, PhD candidate, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1543732021-03-14T18:53:25Z2021-03-14T18:53:25ZA very special episode: how TV shows can be powerful tools for public health<figure><img src="https://images.theconversation.com/files/384364/original/file-20210216-21-1onvgyo.jpg?ixlib=rb-1.1.0&rect=12%2C0%2C4200%2C2835&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>We all know what we should do. We should eat well and exercise. But then there’s ice cream and alcohol and the couch …</p>
<p>But what if watching TV could actually <a href="https://www.youtube.com/watch?v=JLzXfghGfTg">be good for you</a> — if your favourite TV show could inspire and support you to be healthier? </p>
<p>In 2012, on <a href="https://www.imdb.com/title/tt1225901/">90210</a> (a reboot of the 90s’ <a href="https://www.imdb.com/title/tt0098749/">Beverly Hills, 90210</a>), 18-year-old Erin Silver (Jessica Stroup) was confronted with the choice to test for BRCA gene mutations. Her mother died from breast cancer, and if Erin had a mutation she was at elevated risk of cancer herself.</p>
<p>The show’s creators worked with <a href="https://hollywoodhealthandsociety.org/">Hollywood, Health & Society</a>, an organisation established to provide the entertainment industry with expert information on health, safety and security. </p>
<p>In getting the health information right, 90210 was able to tell a compelling and dramatic story while engaging viewers with their own health.</p>
<p>After the show aired, a study found 12% of female viewers <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6084479/">reported</a> scheduling a doctor’s appointment to discuss their breast cancer risk, 13% talked about the BRCA gene with a woman they knew and 17% searched for more information about breast cancer online.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Teen sits next to her mother's hospital bed." src="https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=250&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=250&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=250&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=314&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=314&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384362/original/file-20210216-16-yej3rk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=314&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">After the death of her mother, Silver was forced to confront if she should get tested for the BRCA gene.</span>
<span class="attribution"><span class="source">CW</span></span>
</figcaption>
</figure>
<p>Many non-communicable diseases, such as diabetes, cardiovascular disease and certain cancers can be can be <a href="https://www.aihw.gov.au/reports/burden-of-disease/abds-impact-and-causes-of-illness-death-2011/contents/highlights">prevented by modifying behaviour</a> such as tobacco use, dietary habits and physical activity. But the rise of such diseases shows current methods of health communication are <a href="https://ourworldindata.org/burden-of-disease">inadequate</a>.</p>
<p>Television can not only provide you health information, but can also motivate you to do what’s good for you.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-tested-women-and-men-for-breast-cancer-genes-only-18-percent-knew-they-had-it-103717">We tested women and men for breast cancer genes – only 18 percent knew they had it</a>
</strong>
</em>
</p>
<hr>
<h2>Entertainment can harm</h2>
<p>Entertainment that canvases health issues can lead to misinformation. This can be really harmful.</p>
<p>Mental illness is commonly <a href="https://scholarworks.gvsu.edu/cgi/viewcontent.cgi?article=1036&context=honorsprojects">misrepresented</a> in films and on television, contributing to <a href="https://www.tandfonline.com/doi/full/10.1080/10410236.2011.560787">stigma</a> which can have a profoundly negative impact of the <a href="https://pubmed.ncbi.nlm.nih.gov/23032675/">well-being of people living with mental illness</a>. </p>
<p>A particularly sobering example was seen after the release of <a href="https://www.imdb.com/title/tt1837492/">13 Reasons Why</a>, a Netflix series about the aftermath of a suicide. In the month following the first season release in 2017, the suicide rates in Americans between the ages of 10 and 17 <a href="https://www.jaacap.org/article/S0890-8567(19)30288-6/fulltext?rss=yes">increased 28.9%</a> and remained elevated for a further two months.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A teen talks into a tape recorder." src="https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384363/original/file-20210216-21-1547iy9.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">13 Reasons Why was criticised for not following media guidelines.</span>
<span class="attribution"><span class="source">Beth Dubber/Netflix</span></span>
</figcaption>
</figure>
<p>13 Reasons Why was <a href="https://www.smh.com.au/opinion/netflix-needs-to-conform-to-australian-standards-for-streaming-of-13-reasons-why-20170828-gy5kmi.html">criticised</a> for overlooking media guidelines against stories promoting simplistic explanations of suicidal behaviour or depicting suicide as a means of <a href="https://www.jaacap.org/article/S0890-8567(19)30288-6/fulltext?rss=yes">accomplishing a goal</a>. </p>
<p>If the series had followed best practice guidelines in telling this story, the outcomes may not have been so devastating.</p>
<h2>The positive power of narrative</h2>
<p>But entertainment can also have a powerful positive impact on health. </p>
<p>In 2001, Hollywood, Health & Society worked with <a href="https://www.imdb.com/title/tt0092325/?ref_=fn_al_tt_1">The Bold and the Beautiful</a> on a story where Antonio Dominguez (Paulo Benedeti) learned he was HIV positive. An HIV/AIDS hotline was presented at the conclusion of the episode, and <a href="https://learcenter.org/pdf/BBHotline.pdf">calls increased dramatically</a>.</p>
<p>In 2006, the organisation worked with <a href="https://www.imdb.com/title/tt0433309/?ref_=fn_al_tt_1">Numbers</a> on an episode where Charlie Eppes (David Krumholtz) changes his position on organ donation, telling his family he would like to be a donor.</p>
<p>After the episode aired, audiences were found to be more likely to <a href="https://hollywoodhealthandsociety.org/sites/default/files/for-public-health-professionals/research-and-evaluation/cases_1_08.pdf">register as organ donors</a> and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1460-2466.2008.01408.x">encourage others</a>.</p>
<h2>Confidence in the truth</h2>
<p>In decision making, we naturally give greater weight to narrative evidence than statistical evidence. This is increased in situations of high emotional engagement such as <a href="https://econpapers.repec.org/article/eeejobhdp/v_3a160_3ay_3a2020_3ai_3ac_3ap_3a51-67.htm">related to health</a>. </p>
<p>By embedding health storylines in popular narratives we can reach audiences where they are. But the spread of contested health information has led to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494502/">growing public scepticism</a>.</p>
<p>It is important to present accurate information in a way that is responsible and adheres to best practice to build audience confidence.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-telling-stories-could-be-a-more-powerful-way-of-convincing-some-people-to-take-a-covid-vaccine-than-just-the-facts-155050">Why telling stories could be a more powerful way of convincing some people to take a COVID vaccine than just the facts</a>
</strong>
</em>
</p>
<hr>
<p>While Hollywood, Health & Society does important work in providing information to the entertainment industry, viewers don’t know if this content is trustworthy, and there is no method to ensure stories are told in the most impactful way. </p>
<p>If we had a widely used methodology to guide the development of entertainment produced in partnership between the entertainment industry, health and science experts and consumers to promote health, we could make a big difference.</p>
<p>Scripted television and movies could be the next big thing in health promotion. But we need artists, health experts and audiences working together. </p>
<h2>Creating a road map</h2>
<p>We lack a pathway for health experts, health bodies and people with lived experience to create stories to promote health. </p>
<p>My research team is working on identifying the characteristics of entertainment which can successfully influence health behaviours. This could be having characters key audiences can identify with, and having those characters engage in healthy behaviours related to their well-being. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6016%2C4016&q=45&auto=format&w=1000&fit=clip"><img alt="Happy young two black women lying down in the couch watching tv" src="https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6016%2C4016&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384359/original/file-20210216-16-33gh7o.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>
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<span class="caption">With a little bit of work, television could be good for you.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<p>We are establishing a consortium of policy makers, health experts, entertainment industry professionals and audiences to guide the production of entertainment-driven content to promote health. </p>
<p>Television episodes and films produced following this method will be certified as scientifically accurate. When you watch it, you will know the information delivered is trustworthy.</p>
<p>It will be produced using the best knowledge about how to support people to take charge of their health. It will impact attitudes and behaviours that can improve health.</p>
<p>And in this, television will improve lives. </p>
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<p><em>If this article has raised issues for you or you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/154373/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michaela Pascoe 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>We know we should exercise more and sit on the couch less … but what if television was actually healthy for you?Michaela Pascoe, Senior Research Fellow in Mental Health, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1364812020-05-13T18:58:03Z2020-05-13T18:58:03ZWant to sleep like a baby during the coronavirus crisis? Here are 10 ways to do it<figure><img src="https://images.theconversation.com/files/328550/original/file-20200416-192744-11yabmo.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1343%2C665&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A good quality sleep of a sufficient duration is essential to being able to function well both physically and mentally.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/">(Shutterstock)</a></span></figcaption></figure><p>The crisis created by the COVID-19 pandemic has resulted in a generalized climate of anxiety, which has increased stress levels and which can lead to insomnia even in people who do not usually suffer from it. While it is true that good sleep is essential to health in normal times, it becomes even more so in this period of confinement.</p>
<p>Sleep is a <a href="https://link.springer.com/chapter/10.1007%2F978-1-4939-6578-6_2">natural recurrent state of unconsciousness</a> from the outside world, accompanied by a progressive decrease in muscle tone that occurs at regular intervals.</p>
<p>The average human spends one-third of their life sleeping. Sleeping well is essential <a href="https://doi.org/10.1016/B978-0-323-24288-2.00002-7">for many good reasons</a>. Sleep of good quality and of sufficient duration is essential to being mentally and physically functional.</p>
<p>Conversely, poor sleep can gradually put a person at risk. Lack of sleep, whether or not it is caused by a physiological or behavioural disorder, increases <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5334748/">obesity</a>, reduces <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768894/pdf/ajcei0006-0092.pdf">immunity</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367516/pdf/emss-71882.pdf">impairs job performance</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3768102/">memory</a> and <a href="https://link.springer.com/book/10.1007%2F978-1-4939-6578-6">many other functions</a>.</p>
<p>In my research in sleep medicine and social epidemiology, I analyze sleep disorders in atypical cases, such as people with Parkinson’s disease, call centre and <a href="https://s3-sa-east-1.amazonaws.com/publisher.gn1.com.br/sleepscience.org.br/pdf/aop343.pdf">customer service workers</a>.</p>
<p>Here are 10 recommendations to promote sleep, based on both my observations and the scientific literature:</p>
<p><strong>1. Establish a regular schedule.</strong> Regular bedtime and wake-up times will help you maintain a healthy sleep routine.</p>
<p><strong>2. Keep in contact with natural light.</strong> Open your windows and expose yourself to sunlight as much as possible. This can be good for improving your mood and <a href="https://doi.org/10.1016/B978-0-323-24288-2.00002-7">regulating your body clock</a>. In addition, it is an opportunity to get some fresh air in a controlled manner for a short period of time.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/326250/original/file-20200407-112311-tny7uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/326250/original/file-20200407-112311-tny7uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/326250/original/file-20200407-112311-tny7uw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/326250/original/file-20200407-112311-tny7uw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/326250/original/file-20200407-112311-tny7uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/326250/original/file-20200407-112311-tny7uw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/326250/original/file-20200407-112311-tny7uw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&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">Don’t stay in bed if you’re having trouble sleeping. Get up, engage in a relaxing activity and go back to bed when signs of sleepiness appear.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p><strong>3. Maintain daily physical activity.</strong> Staying active during social distancing helps you build up enough body fatigue to fall asleep more easily and <a href="https://link.springer.com/book/10.1007%2F978-1-4939-6578-6">get a deeper sleep</a>.</p>
<p><strong>4. Limit naps.</strong> Unless you have had very little sleep the previous night, it is important to avoid sleeping during the day or in the afternoon, as this reduces <a href="https://dx.doi.org/10.21037%2Fjtd.2017.03.168">sleep pressure</a> and increases the risk of <a href="https://dx.doi.org/10.1093%2Fsleep%2F30.6.781">insomnia</a>.</p>
<p><strong>5. Maintain a social life.</strong> Bad news in the media can create anxiety. It is important to use <a href="https://dx.doi.org/10.1089%2Fcyber.2014.0070">your online social networks</a> to seek support from friends and family to keep your spirits up and maintain your mental health. This is especially important when living alone or away from family.</p>
<p><strong>6. Be disciplined in your diet.</strong> Avoid drinking coffee in the afternoon as it can cause nervousness and delay sleep in the evening. Eating <a href="https://link.springer.com/book/10.1007%2F978-1-4939-6578-6">large, overly rich meals</a> before going to bed can also delay sleep. Some people have no problem sleeping, even if they drink a lot of coffee and eat a lot. It is nevertheless recommended to control the quantities and times of consumption during the day because anything in excess may harm sleep.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/326246/original/file-20200407-50491-kucwcq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/326246/original/file-20200407-50491-kucwcq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/326246/original/file-20200407-50491-kucwcq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/326246/original/file-20200407-50491-kucwcq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/326246/original/file-20200407-50491-kucwcq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/326246/original/file-20200407-50491-kucwcq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/326246/original/file-20200407-50491-kucwcq.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">Exposure to natural light is not only good for your mood, it also helps regulate your body clock.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p><strong>7. Avoid backlit devices before bedtime.</strong> <a href="https://dx.doi.org/10.1089%2Fcyber.2014.0070">New technologies</a> are an integral part of our lives and we’re all a little addicted to our smartphones, tablets and laptops. It is absolutely important to set them aside at least 30 minutes before your scheduled sleep time. If you’re worried you won’t be able to do that, you can set the device to “night mode” to reduce its brightness. By reducing the brain’s lag with the natural cycle of day and night, this will prevent disturbances in the biological clock and will be beneficial for the <a href="https://www.sleepfoundation.org/articles/why-electronics-may-stimulate-you-bed">quality of sleep</a> in the long term.</p>
<p><strong>8. Avoid staying in bed if you don’t sleep.</strong> The brain is like a computer, which associates certain events with certain functions. The brain will associate bed and darkness with sleep and trigger the whole process of falling asleep. The brain will not be able to do this if it is distracted by other activities such as video games, homework, physical activity and alcohol. It is best to read a book, listen to soft music, do deep breathing exercises or <a href="https://www.ncbi.nlm.nih.gov/pubmed/22502620">yoga</a>, or any other relaxing activity. Do not stay in bed for more than half an hour after going to bed if you are not sleeping. When sleep is delayed, it is best to get out of bed, do a quiet activity, and return to bed only when signs of fatigue — heavy eyelids, yawning, etc. — appear.</p>
<p><strong>9. Accept that not all our nights of sleep are perfect or restful.</strong> We are all subject to stress and each of us has our own stress management techniques. We must avoid worrying if we haven’t slept well for a few days. Before you get upset about poor sleep, I suggest you review the eight recommendations above. Often, people have trouble sleeping because of a trivial problem, an argument with a loved one, or work-related anxiety. Identifying your stress and learning how to manage it is a good start.</p>
<p><strong>10. Avoid sleeping pills.</strong> Generally, the easy solution is the one that carries the most risk. Prolonged use of sleep aids, such as benzodiazepines or anxiolytics, without consulting health-care professionals <a href="https://www.aafp.org/afp/2013/0815/p224.html">could worsen a situation</a> that was not initially serious. It is better to adopt a healthy lifestyle than to resort to medication, both in normal situations and during confinement due to COVID-19.</p>
<p>Remember that to be able to work effectively, eat healthily, have fun, pay bills and take care of your loved ones, in normal times or during periods of confinement, you need to sleep well!</p>
<p><em>This is an updated version of a story originally published May 13, 2020. The earlier story made reference to the author’s research on sleep disorders experienced by people who play video games. The story linked to a study published by the academic journal “Scientific Reports.” That journal has subsequently <a href="https://www.nature.com/articles/s41598-020-66798-w">retracted its article after concerns were raised about the research on video gamers</a>. This updated story removes the reference to video gamers and the link to the article in “Scientific Reports.”</em></p><img src="https://counter.theconversation.com/content/136481/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Faustin Etindele ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>Getting a good night’s sleep during COVID-19 confinement can be challenging, but there are ways to get enough shut-eye.Faustin Etindele, chercheur en médecine du sommeil et épidémiologie sociale, Université du Québec à Montréal (UQAM)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1372552020-05-01T04:45:53Z2020-05-01T04:45:53ZWhile we wait for a coronavirus vaccine, eating well, exercising and managing stress can boost your immune system<figure><img src="https://images.theconversation.com/files/331606/original/file-20200430-155226-pvnnck.jpg?ixlib=rb-1.1.0&rect=143%2C278%2C5847%2C3709&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>Social distancing may remain necessary during the <a href="https://edition.cnn.com/2020/03/31/us/coronavirus-vaccine-timetable-concerns-experts-invs/index.html">18 months or more</a> we’ll have to wait for a <a href="https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12325814">coronavirus vaccine</a>.</p>
<p>This can feel like we have little control, but there are several evidence-based protective measures we can take in the interim to ensure we are as healthy as possible to fight off infection and prevent mental health problems that escalate with uncertainty and stress.</p>
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Read more:
<a href="https://theconversation.com/5-ways-nutrition-could-help-your-immune-system-fight-off-the-coronavirus-133356">5 ways nutrition could help your immune system fight off the coronavirus</a>
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<h2>Coronavirus and underlying medical conditions</h2>
<p>There is recent evidence that some younger people <a href="https://www.washingtonpost.com/health/2020/04/24/strokes-coronavirus-young-patients/">suffer strokes after contracting the virus</a>, but the majority of people who end up hospitalised, in intensive care or dying from COVID-19 have an underlying medical condition. <a href="https://www.ncbi.nlm.nih.gov/pubmed/32298251">One study</a> showed 89% of those hospitalised in the US had at least one.</p>
<p>These underlying medical conditions include high blood pressure, high blood sugar (especially type 2 diabetes), excessive weight and lung conditions. <a href="https://www.europeanscientist.com/en/article-of-the-week/covid-19-and-the-elephant-in-the-room/">An analysis</a> of data from the UK National Health Service shows that of the first 2,204 COVID-19 patients admitted to intensive care units, 72.7% were either overweight or obese.</p>
<p>All of these health issues have been <a href="https://www.nature.com/articles/s41598-018-24778-1">associated with our lifestyle</a> including poor diet, lack of exercise, smoking, excessive alcohol and high stress. </p>
<p>It’s obvious we have created a society where being active, eating healthily, drinking less and keeping our stress under control is difficult. Perhaps it’s time to push back. This may be important for major conditions like heart disease and diabetes as well as the added threat we face from <a href="https://www.nature.com/articles/nature06536/">emerging infectious diseases</a>.</p>
<p>One <a href="https://www.liebertpub.com/doi/10.1089/met.2018.0105">study</a> shows only 12% of Americans are in optimal metabolic health, which means their blood pressure, blood glucose, weight and cholesterol are within a healthy range. This rate is likely similar in many Western countries. </p>
<p>There is now a body of evidence linking our unhealthy lifestyle with viral, especially respiratory diseases. <a href="https://www.sciencedaily.com/releases/2015/08/150806151354.htm">High blood sugar</a> reduces and impairs immune function. Excessive body fat is known to disrupt immune regulation and lead to <a href="https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/obesity-inflammation-and-the-immune-system/BBA951027B413AEE76E3DA11A81173F1">chronic inflammation</a>. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6666404/">Insulin resistance</a> and pre-diabetes can delay and weaken the immune response to respiratory viruses.</p>
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Read more:
<a href="https://theconversation.com/regular-exercise-has-long-term-benefits-for-immunity-its-important-to-stay-active-135836">Regular exercise has long-term benefits for immunity – it's important to stay active</a>
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<h2>Improving immunity through lifestyle choices</h2>
<p>If we are going to restrict and change our lifestyles for 12 to 18 months while we wait for a vaccine, and if we want to protect ourselves better now and in the future, we could address these lifestyle factors. They not only affect our recovery from viruses and respiratory infections, but are also the <a href="https://www.nejm.org/doi/full/10.1056/nejmra1201534">biggest cost to the quality of life</a> in most countries.</p>
<p>Optimising the health of the nation must be at the forefront. And this is long overdue. There has been a <a href="https://academic.oup.com/ije/article/35/2/492/694781">substantial under-investment by most developed countries</a> in preventive medicine to reduce chronic diseases and improve both longevity and quality of life through healthy lifestyles. </p>
<p>Healthy organisms are naturally resistant to infections. This is true in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6071103/">plants</a>, <a href="https://www.hindawi.com/journals/jobe/2020/1508764/">animals</a> and <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext?fbclid=IwAR3Hyjh3ax53XAGCxWpC3aNWx1k8_VEPxiOlfptMkVUinaN_MWHodgsIy1k">people</a>. Maintaining optimal health is our best defences against a pandemic until a vaccine is available.</p>
<p>We identify three modifiable risk factors:</p>
<p><strong>1. Diet</strong></p>
<p>Research shows better nourished people are less likely to develop both mental and physical problems. Certain nutrients, such as vitamins C and D and zinc have been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019735">identified</a> as <a href="https://www.ncbi.nlm.nih.gov/pubmed/30336639">essential</a> for improving immunity across the lifespan. A better diet is associated with a lower chance of developing mental health problems in both <a href="https://www.ncbi.nlm.nih.gov/pubmed/31004047">children</a> and <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-10-149">adults</a>. Low levels of specific nutrients, such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/32299148">vitamin D</a>, have been recognised as risk factors for COVID-19. These nutrients are easy (and cheap) to replenish.</p>
<p>What does it mean to be better nourished? Eating real whole foods – fruits and vegetables, nuts, legumes, fish and healthy fats and reducing the intake of ultra-processed foods. </p>
<p><strong>2. Exercise</strong></p>
<p>Being physically fit adds years to your life - and <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2707428">quality of life</a>. High cardiorespiratory (lung and heart) fitness is also associated with less respiratory illness, and better survival from such <a href="https://www.ncbi.nlm.nih.gov/pubmed/28698945">illnesses</a>.</p>
<p>How do you get fit? Set aside time and prioritise walking at a minimum, and more vigorous activity if possible, every day. Ideally, you would get outside and be with important others. The more the better, as long as you are not overdoing it for your individual fitness level.</p>
<p><strong>3. Stress</strong></p>
<p>Stress impairs our immunity. It disrupts the regulation of the <a href="https://www.ncbi.nlm.nih.gov/pubmed/28578301">cortisol response</a> which can suppress immune function. Chronic stress can decrease the body’s lymphocytes (white blood cells that help fight off infection). The lower your lymphocyte count, the more at risk you are of catching a virus.</p>
<p>How do we lower stress? Meditation, yoga, mindfulness, cognitive-behaviour therapy, optimising sleep and eating well can <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.851.7680&rep=rep1&type=pdf">all</a> help in mitigating the negative impact of stress on our lives. Taking additional nutrients, such as the B vitamins, and the full breadth of minerals like magnesium, iron and zinc, during times of <a href="https://www.ncbi.nlm.nih.gov/pubmed/22782571">stress</a> has a positive impact on overall stress levels. </p>
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Read more:
<a href="https://theconversation.com/sleep-wont-cure-the-coronavirus-but-it-can-help-our-bodies-fight-it-134674">Sleep won't cure the coronavirus but it can help our bodies fight it</a>
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<p>Modifying lifestyle factors won’t eliminate COVID-19 but it can reduce the risk of death and help people to recover. And these factors can be in our control if we and our governments take the initiative.</p><img src="https://counter.theconversation.com/content/137255/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julia J Rucklidge receives or has received funding from Vic Davis Memorial Trust, University of Canterbury Foundation, The GAMA Foundation, Foundation for Excellence in Mental Health Care, Nurture, Canterbury Medical Research Foundation, Waterloo Foundation, and the National Centre for Growth and Development (GRAVIDA). </span></em></p><p class="fine-print"><em><span>Grant Schofield is receives or has received grant funding from the Health Research Council of NZ and other NZ grant funding agencies. He receives royalties for his book series "What the Fat?", and is a shareholder in Prekure, a social enterprise for improving the health literacy around eating, sleeping and moving as determinants of health. </span></em></p>Eating healthy food, exercising regularly and reducing stress are all measures we can take to stay as healthy as possible to fight off infection while we wait for a coronavirus vaccine.Julia J Rucklidge, Professor of Psychology, University of CanterburyGrant Schofield, Professor of Public Health and Director of the Human Potential Centre, Auckland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/831222017-10-17T23:52:36Z2017-10-17T23:52:36ZOne step at a time: Simple nudges can increase lifestyle physical activity<figure><img src="https://images.theconversation.com/files/188229/original/file-20170929-23041-em2kcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A man taking stairs at Washington-Dulles International Airport in 2013. </span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Escalator_and_stairs_(8744453585).jpg">Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>You’ve heard this before, right? Physical activity is good for <a href="http://dx.doi.org/10.1016/s0140-6736(12)61031-9">your heart</a>, <a href="http://dx.doi.org/10.1017/s1368980099000567">your overall health</a> – and, believe it or not, even <a href="http://dx.doi.org/10.1016/s0140-6736(16)30383-x">your bank account</a>. While physical activity used to be unavoidable, over the years, those “helpful” modern conveniences like washing machines, elevators, even electric toothbrushes, have made it that <a href="http://dx.doi.org/10.1146/annurev.publhealth.26.021304.144437">much harder to be active</a>. </p>
<p>In the United States today, it’s therefore not surprising that most adults (<a href="http://dx.doi.org/10.1161/CIR.0000000000000485">50</a>-<a href="http://dx.doi.org/10.1249/mss.0b013e31815a51b3">95</a> percent) do not meet <a href="https://health.gov/dietaryguidelines/2015/guidelines/appendix-1/">national physical activity recommendations.</a> It’s well-established that inactive Americans are at a <a href="http://dx.doi.org/10.1016/s0140-6736(12)61031-9">higher risk of heart disease, Type 2 diabetes and reduced life expectancy</a>, but additionally there are <a href="http://dx.doi.org/10.1016/s0140-6736(16)30383-x">negative impacts on the economy</a>. While those who are most inactive have the greatest health risks, they also have <a href="http://dx.doi.org/10.1001/jamainternmed.2015.0533">the most to gain</a> from increased physical activity. So, what can be done to “nudge” people to be more physically active? </p>
<p>A <a href="http://dx.doi.org/10.1007/s10935-017-0491-6">recent study</a>, led by co-author John Bellettiere and a team at San Diego State University, found that stair use increased when signs nudging people to take the stairs were placed at the base of a staircase/escalator at the San Diego International Airport. The study was published Sept. 21 in the Journal of Primary Prevention.</p>
<p>It was encouraging that these prompts were effective for adults who exercise regularly as well as those who never exercise, signifying that simple nudges may be an effective motivator for <a href="http://dx.doi.org/10.1001/jamainternmed.2015.0533">those who have the most to gain</a> from such interventions. </p>
<p>Stair use nudges, such as point-of-choice prompts, can include things like signs, posters and more novel approaches such as <a href="https://www.youtube.com/watch?v=2lXh2n0aPyw">staircases that make music</a> to the step of the user – all designed to get people to move more. </p>
<p>While this study was among the first to demonstrate this effect at an airport setting, <a href="http://dx.doi.org/10.1177/1403494810375865">a number of studies</a> indicate similar successes in a <a href="http://doi.org/10.1016/j.ypmed.2014.11.001">variety of other public settings</a>. This mounting body of evidence supports the use of nudges to increase lifestyle physical activity. </p>
<h2>Do we run before we can walk?</h2>
<p>When you picture someone engaged in physical activity, do you conjure an image of someone sweat-drenched, gasping for breath and, well, miserable? If so, we’ve got good news. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/188233/original/file-20170929-21580-14hg11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/188233/original/file-20170929-21580-14hg11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/188233/original/file-20170929-21580-14hg11.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/188233/original/file-20170929-21580-14hg11.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/188233/original/file-20170929-21580-14hg11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/188233/original/file-20170929-21580-14hg11.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/188233/original/file-20170929-21580-14hg11.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&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">Increasing our activity level does not have to mean exhausting ourselves.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/exhausted-senior-man-gym-threadmill-679339558?src=GfJWq6wxLk6axOuwBP9TqQ-1-35">9nong/Shutterstock.com</a></span>
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<p>Even <a href="https://link.springer.com/article/10.1007%2Fs40279-017-0724-0">mild forms of activity have a positive impact</a>. According to <a href="https://health.gov/paguidelines/guidelines/">U.S. physical activity guidelines</a>, “some physical activity is better than none, and adults who participate in any amount of physical activity gain some health benefits.” <a href="http://dx.doi.org/10.1007/s10935-017-0491-6">This latest stair use study</a> simply sought to encourage people to take the stairs rather than an escalator when the opportunity presented itself.</p>
<p>Daily activity is shaped by our <a href="http://dx.doi.org/10.1146/annurev.publhealth.27.021405.102100">physical</a> <a href="http://dx.doi.org/10.1016/S0749-3797(03)00011-4">and social</a> environment. To increase physical activity on a large scale, <a href="https://doi.org/10.4278/0890-1171-10.4.270">ecological approaches</a> that target not only the individuals involved but also the relationships, societal and policy factors they encounter are needed. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/189891/original/file-20171012-9782-1x6rqnw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/189891/original/file-20171012-9782-1x6rqnw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/189891/original/file-20171012-9782-1x6rqnw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/189891/original/file-20171012-9782-1x6rqnw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/189891/original/file-20171012-9782-1x6rqnw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/189891/original/file-20171012-9782-1x6rqnw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/189891/original/file-20171012-9782-1x6rqnw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&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">The PA4E1 program wheel shows the student at the center, but acknowledges a multi-pronged approach toward increasing physical activity. One of these prongs is nudging, in the form of email prompts.</span>
<span class="attribution"><span class="source">Matthew Mclaughlin</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>Matthew Mclaughlin’s Ph.D. project is one such example of an ecological approach. Alongside the team of researchers at Hunter New England Population Health (NSW Australia) led by Professor John Wiggers, they are scaling up a previously successful whole-school multi-component physical activity program, <a href="https://doi.org/10.1016/j.amepre.2016.02.020">Physical Activity for Everyone (PA4E1)</a>. In this ongoing project, researchers are using seven strategies to increase physical activity, one of which is the use of email nudges to prompt physical education teachers to deliver the physical activity program. Stay tuned for those results. </p>
<h2>Even adults can benefit from baby steps</h2>
<p>Adults, even those who do not regularly exercise, can be nudged to choose climbing stairs over taking an escalator. </p>
<p>Climbing a single set of stairs is hardly going to have a major effect on a person’s health. However, take into consideration that at least one study has found that nudges at one set of stairs in a shopping mall increased stair use not only at the intervention site but <a href="http://dx.doi.org/10.4278/0890-1171-22.2.114">at other staircases as well</a>. Perhaps taking the stairs was rewarding, and this led to taking the next set of stairs? Add to that the finding that people are <a href="https://doi.org/10.4278/0890-1171-21.2.101">more likely to take the stairs when they see others around them choosing the stairs</a>, and it becomes apparent how a simple nudge here and there can have a big cumulative impact.</p>
<p>It’s not realistic to think that someone would go from couch potato to marathon runner overnight. But taking the stairs is a practical and attainable first step toward improving one’s health. Pragmatically, such nudging interventions can serve as effective motivators to get the U.S. climbing up that stairway to health. #SitLess #MoveMore</p><img src="https://counter.theconversation.com/content/83122/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Mclaughlin consults with Active Working™ C.I.C., Get Britain Standing™ and Cuckoo Workout.</span></em></p><p class="fine-print"><em><span>John Bellettiere was funded in part by training grants provided by the National Institutes of Health (T32HL079891-11 and TL1TR001443).</span></em></p><p class="fine-print"><em><span>Natasha Bliss 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>Dropping old, bad habits is hard, but starting new, good ones may not be so difficult. Or so a recent study suggests. Read how a simple sign at an airport made a difference.Matthew Mclaughlin, Ph.D. Student, University of NewcastleJohn Bellettiere, Postdoctoral Research Fellow, University of California, San DiegoNatasha Bliss, Researcher in Public Health, San Diego State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/819422017-08-30T20:05:56Z2017-08-30T20:05:56ZExplainer: what is chronic kidney disease and why are one in three at risk of this silent killer?<figure><img src="https://images.theconversation.com/files/182897/original/file-20170822-5178-7hj97i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If you have high blood pressure, smoke or have diabetes, you're at risk of chronic kidney disease.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/548566606?src=x-GEGjPymnWjtBM2loJSTw-1-7&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>A 42-year-old man – a father, a husband, a son – has come to the emergency department with a splitting headache. It’s been there for months, slowly getting worse. Today it’s unbearable. </p>
<p>He has no significant past medical history to explain the headaches and takes no regular medications. But he smokes and his <a href="https://www.heartfoundation.org.au/your-heart/know-your-risks/blood-pressure/is-my-blood-pressure-normal">blood pressure</a> is sky high – 210/100 mmHg (good blood pressure is <a href="https://www.heartfoundation.org.au/your-heart/know-your-risks/blood-pressure/is-my-blood-pressure-normal">considered under</a> 120/80 mmHg).</p>
<p>A series of investigations including blood and urine tests reveal significant kidney damage – stage four chronic kidney disease. Stage five kidney disease would mean he needs dialysis or a kidney transplant. This is serious.</p>
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Read more:
<a href="https://theconversation.com/kidneys-are-amazing-for-all-they-do-be-sure-to-look-after-yours-30966">Kidneys are amazing for all they do, be sure to look after yours</a>
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<p>Kidney disease is silent. Currently <a href="http://kidney.org.au/cms_uploads/docs/state-of-the-nation--kidney-health-week-2016--chronic-kidney-disease-hot-spots.pdf">one in ten Australian adults</a> have evidence of chronic kidney disease, with many unaware of it. It’s not <a href="http://www.aihw.gov.au/chronic-kidney-disease/what-is-ckd/">until 90%</a> of kidney function is lost that symptoms become apparent.</p>
<p>While symptoms like nausea, loss of appetite, lethargy and poor concentration are hallmarks of kidney failure, they are quite non-specific. Most people will have had these symptoms at some stage.</p>
<p>Fluid retention - swollen ankles and puffiness around the eyes - can be a marker of kidney disease. That’s because the kidneys are key to regulating fluid in the body and a diseased kidney cannot do that as efficiently.</p>
<p><a href="https://theconversation.com/blood-tests-and-diagnosing-illness-what-can-blood-tell-us-about-whats-happening-in-our-body-80327">Doctors confirm kidney disease</a> using a blood and urine test. The blood test (serum electrolyes) gives you a “percent of kidney function”. And the urine test (urinanalysis) tests for blood and protein in the urine, markers of damage and inflammation.</p>
<h2>What happens when your kidneys don’t work well?</h2>
<p>Kidneys are responsible for removing fluid and waste from your body that accumulate each day. </p>
<p>But when kidney function declines, fluid accumulates in the body. So, your legs can swell, and fluid can build up in the lungs, making it difficult to breathe.</p>
<p>Impaired kidneys also mean you cannot efficiently get rid of waste products, so these accumulate too. Such toxins in the body account for much of the symptoms of fatigue, nausea and loss of appetite.</p>
<p>Loss of kidney function and the build-up of fluid may lead to high blood pressure, which in turn may further speed up decline in kidney function. High pressures pulsating through the kidney damages their delicate filters and cause scar tissue to form.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=325&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=325&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=325&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=408&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=408&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=408&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">Loss of kidney function can lead to high blood pressure, which in turn can further speed up kidney disease.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/623268185?src=hOUHJYLNjSQ_6L_Pk8mtqA-1-26&size=medium_jpg">from www.shutterstock.com</a></span>
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</figure>
<p>People with chronic kidney disease are <a href="http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/216833">20-times</a> more likely to die from a heart attack or stroke. So, many people will die from heart disease before reaching end-stage kidney disease, the final stage of chronic kidney disease in which the kidneys no longer function well enough to meet your body’s daily needs.</p>
<p>When healthy, kidneys secrete the hormone erythropoietin (or EPO), which stimulates red blood cells to form. But as kidney function declines, production of this hormone is impaired and anaemia (a low red blood cell count), follows. So, patients need to be injected with EPO to restore their red blood cell count. </p>
<p>The kidneys are also pivotal in maintaining calcium and phosphate levels in the blood. As phosphate builds up, severe itchiness can develop; calcium levels drop and, without attention, this can lead to fragile bones.</p>
<h2>Who is at risk?</h2>
<p>Kidney disease is related to and caused by a number of different factors and conditions. As many as <a href="http://kidney.org.au/your-kidneys/prevent/check-your-kidneys">one in three Australians</a> have at least one risk factor for chronic kidney disease.</p>
<p>Indigenous Australians are at risk with this risk increasing the more remotely they live. People with a family history of kidney disease are particularly vulnerable to it. Diabetes, high blood pressure, smoking, obesity, high cholesterol, heart disease, stroke and being over 60 are additional risks.</p>
<p>The number of people with chronic (long-term) kidney disease is forecast to increase by <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129547200">60% by 2020</a>, largely due to diabetes and obesity becoming more common.</p>
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Read more:
<a href="https://theconversation.com/kidney-disease-in-aboriginal-australians-perpetuates-poverty-15031">Kidney disease in Aboriginal Australians perpetuates poverty</a>
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<p>Anyone who has had an episode of acute kidney injury is also at risk of later developing chronic kidney disease. </p>
<p>Less common causes of kidney disease are inflammation of the kidney, or glomerulonephritis. We don’t known what causes many forms of glomerulonephritis. But sometimes an infection triggers it.</p>
<p>For instance, while streptococcal infection that leads to glomerulonephritis is rarely seen in non-Indigenous people, this is a <a href="https://espace.library.uq.edu.au/view/UQ:275287/UQ275287_preprint.pdf">significant concern</a> in Indigenous Australian children living in remote communities, with 15-20% suffering from it.</p>
<p>In other cases, someone’s own immune system damages the kidney tissue (an autoimmune disease) to cause glomerulonephritis. This may be triggered by an infection such as hepatitis B or C or from a yet unidentified source.</p>
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Read more:
<a href="https://theconversation.com/dr-g-yunupingus-legacy-its-time-to-get-rid-of-chronic-hepatitis-b-in-indigenous-australia-81672">Dr G. Yunupingu's legacy: it's time to get rid of chronic hepatitis B in Indigenous Australia</a>
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<p>Taking certain medications for a long time can cause or hasten progressive kidney decline. That’s what happened with <a href="https://medicalsciences.med.unsw.edu.au/node/302500715">Bex</a>, the painkiller popular in the 1960s, advertised widely with the slogan:</p>
<blockquote>
<p>Have a cup of tea, a Bex and a good lie down.</p>
</blockquote>
<p>Bex was ultimately associated with <a href="http://www.news.com.au/national/cancer-council-nsw-bex-powder-killed-more-than-pain/news-story/7637adcfe85ce4aa20e1bc267b8113ac">serious kidney injury (and cancer)</a> and is no longer in use.</p>
<p>Anti-inflammatory medications are the current curse of people with kidney disease as they restrict blood flow to the kidney, possibly leading to acute kidney failure.</p>
<p>Other less well known causes for kidney disease include the growth of cysts on the kidneys (polycystic kidney disease), congenital abnormalities of the
kidney or urinary tract and damage due to the backward flow of urine into the kidneys (reflux nephropathy).</p>
<h2>How is kidney disease managed?</h2>
<p>Chronic kidney disease cannot be cured. And once started, it’s difficult to halt its progression. So, awareness of kidney disease and its <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089661/">early detection</a> offers the best opportunity to alter it course.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.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>
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<span class="caption">The number of people needing dialysis in Australia is forecast to increase.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>Making lifestyle changes including losing weight, stopping smoking, controlling blood sugar levels and making healthy dietary choices cannot be emphasised enough as these factors slow progression of kidney disease, mainly through improved blood pressure control.</p>
<p>Reducing levels of protein in the diet <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089661/">may slow disease progression</a>. However, people can have trouble sticking to a low-protein diet.</p>
<p>People with chronic kidney disease also need to be monitored, not just for declining kidney function but also so they don’t develop complications such as anaemia, bone disease, malnutrition and heart disease.</p>
<h2>Dialysis or a transplant is the only hope for some</h2>
<p>Concern of progressive kidney decline to end-stage kidney disease is real. It’s at this point that some people will receive dialysis or a kidney transplant, which is estimated to <a href="http://kidney.org.au/cms_uploads/docs/state-of-the-nation--kidney-health-week-2016--chronic-kidney-disease-hot-spots.pdf">cost Australia A$1 billion a year</a>.</p>
<p>And the number of people requiring dialysis or a kidney transplant is forecast to increase by <a href="http://kidney.org.au/cms_uploads/docs/state-of-the-nation--kidney-health-week-2016--chronic-kidney-disease-hot-spots.pdf">60% by the year 2020</a>.</p>
<p><a href="https://www.healthdirect.gov.au/dialysis">Dialysis</a> is needed when kidney disease has progressed to the point where toxins cannot be cleared from the blood and fluid builds up. A machine essentially cleans the blood of excess wastes and removes fluid. Although a lifesaving treatment, its demands and impact on quality of life are significant.</p>
<p>Compared to the general population, the life expectancy of people on dialysis is significantly compromised. The <a href="http://kidney.org.au/cms_uploads/docs/state-of-the-nation--kidney-health-week-2016--chronic-kidney-disease-hot-spots.pdf">five-year survival</a> on dialysis is only 46% - a much grimmer outlook compared to a lot of common cancers.</p>
<p>End-stage kidney disease can also lead to a kidney transplant. But there continues to be a shortage of donor organs. In 2015, despite 949 transplants being performed, <a href="http://www.anzdata.org.au/anzdata/AnzdataReport/39thReport">over 1,000 people</a> remained on the transplant waiting list. The median time to receive a transplant was 2.4 years then. An increasing demand coupled with static supply suggests this waiting time will increase substantially.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-quarter-of-kidney-donors-are-living-what-you-need-to-know-to-be-a-donor-78041">A quarter of kidney donors are living: what you need to know to be a donor</a>
</strong>
</em>
</p>
<hr>
<p>Transplantation improves both quality and quantity of life compared to those who remain on dialysis. However the life expectancy of people who have had a transplant <a href="http://www.anzdata.org.au/v1/report_2016.html">still lags behind</a> an age matched population. People who have had a kidney transplant are at increased risk of heart disease and cancer afterwards.</p>
<p>So, if you are the one in three Australians with at least one risk factor for kidney disease, discuss this with your doctor. It could save your life.</p><img src="https://counter.theconversation.com/content/81942/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Dwyer is a member of the Australian and New Zealand Society of Nephrology (ANZSN) and the Transplantation Society of Australia and New Zealand (TSANZ).</span></em></p><p class="fine-print"><em><span>Ashani Lecamwasam is a member of the Australian New Zealand Society of Nephrology (ANZSN) and member of the International Society of Nephrology (ISN).
Currently on a partial PhD scholarship through the Medical Faculty of Deakin University.</span></em></p>The number of Australians with chronic kidney disease is set to rise, but there’s no cure for most people. Here’s what you need to know about this silent killer.Karen Dwyer, Deputy Head, School of Medicine, Deakin UniversityAshani Lecamwasam, PhD student, Faculty of Health, School of Medicine, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/791152017-06-21T20:02:45Z2017-06-21T20:02:45ZBeyond Medicare levies: joining the dots to create places that are good for our health<figure><img src="https://images.theconversation.com/files/174632/original/file-20170620-22129-1g1ovm2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Airds Bradbury residential development has open spaces but these lack the amenities of public parks.</span> <span class="attribution"><span class="license">Author provided</span></span></figcaption></figure><blockquote>
<p>We have lots of open space, but no real parks. – <strong>participant in <a href="http://soacconference.com.au/wp-content/uploads/2016/02/Thompson.pdf">Airds Bradbury study</a></strong> </p>
<p>When you build a park, put a cafe there and a newsagent, or something, people will buy coffee and a newspaper and sit and read and that’s encouraging that interaction. Or even chess sets, things like that, activities to encourage people. <strong>– participant in Victoria Park <a href="https://cityfutures.be.unsw.edu.au/documents/375/Victoria_Park_Study_Findings.pdf">study</a></strong></p>
</blockquote>
<p>Two basic classifications in health distinguish between diseases we catch from each other – communicable – and those associated with our lifestyles and genetic inheritance – non-communicable. </p>
<p>It’s relatively easy to justify government funding for communicable diseases as these very quickly affect a lot of people. We obviously need medical infrastructure to deal with the patients, as well as environmental improvements to prevent outbreaks in the first place – such as access to sunlight and fresh air, clean water and waste disposal. </p>
<p>Non-communicable diseases are different. These include the many chronic conditions that plague modern Australians and cost our health system dearly – heart and respiratory diseases, obesity, diabetes, cancers and mental illness. </p>
<p>Contributory factors are complex, however, and include personal preferences, such as patterns of eating and drinking, and levels of physical activity. Many then argue that preventive intervention is “nanny”-like and should not be the responsibility of the state.</p>
<p>This is a <a href="http://www.cc.gatech.edu/fac/ellendo/rittel/rittel-dilemma.pdf">wicked problem</a> – its <a href="https://theconversation.com/death-by-suburban-sprawl-better-urban-planning-will-combat-sedentary-lifestyles-3395?sr=7">complex and interrelated causes and consequences</a> are hard to pin down. As a result, it isn’t easy to allocate responsibility. But governments are implicated in many ways. </p>
<h2>Where does government come into this?</h2>
<p>Governments organise employment arrangements that dictate work-life balance. They fund “sedentary” car-based transport over “active” transport – walking, cycling and public transport. </p>
<p>They <a href="https://theconversation.com/a-healthy-approach-how-to-turn-what-we-know-about-liveable-cities-into-public-policy-50185">plan urban areas</a>, which should increase walking and cycling and provide inviting spaces for physical and social activity and restorative “greenness”. Governments can also influence access to nutritious foods.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/174124/original/file-20170616-493-1kbsm9j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/174124/original/file-20170616-493-1kbsm9j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/174124/original/file-20170616-493-1kbsm9j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/174124/original/file-20170616-493-1kbsm9j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/174124/original/file-20170616-493-1kbsm9j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/174124/original/file-20170616-493-1kbsm9j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/174124/original/file-20170616-493-1kbsm9j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/174124/original/file-20170616-493-1kbsm9j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Healthy physical and social activity happens in public spaces that are designed to encourage this.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/just1snap/7863133712/in/photolist-cYQBGU-ap7vzc-abk3dR-64q1iG-aywZL6-3aYfrD-owGWb-8nmYpa-T5sDpf-QH4JPz-fKjzKf-4aLdKf-apa6v3-26MZe-eLFfK9-ayCuZZ-8pRjAR-apa71N-52m6ZM-6Vz8dy-ap7yR4-bJQRpk-mj71S-r7ReG-tFSYe-C8Q4ii-onLQB4-sEW1GZ-34Snsq-JKPzy-apu3EN-ap765p-5N4HRE-9vPB8k-cBzmP-bJ3rXz-apagYY-ap6ZnV-6a3hr9-b12M6M-NEmHG-ap7udK-5KNRyE-apa6ey-ap75KX-5meAyR-eUDs8A-bzewSy-Q9uWTc-aptH6S">just1snap/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>However, in a move seemingly towards reduced state responsibility, the New South Wales government has deleted a well-conceived objective of “health” <a href="https://theconversation.com/the-mysterious-disappearance-of-health-from-new-south-wales-planning-laws-72098">from proposed planning laws</a> and <a href="http://www.thefifthestate.com.au/urbanism/planning/nsw-government-axes-highly-valued-premiers-council-for-active-living/85285">abolished</a> its well-respected <a href="http://www.pcal.nsw.gov.au/">Premier’s Council for Active Living</a>. </p>
<p>Such disconnects flow down. Our recent study of four new residential communities in Sydney, <a href="https://cityfutures.be.unsw.edu.au/research/projects/planning-and-building-healthy-communities-a-multidisciplinary-study-of-the-relationship-between-the-built-environment-and-human-health/">Planning and Building Healthy Communities</a>, found a host of good intentions for a health-supportive environment were simply not carried through. For example:</p>
<ul>
<li><p>residents don’t use a link to a regional cycleway offering access to a greater range of facilities because it is on a busy highway and they consider it unsafe;</p></li>
<li><p>restrictive booking policies limit use of estate recreation facilities;</p></li>
<li><p>an extensive pedestrian and cycle path network is designed for recreation activity, but is too circuitous to encourage active transport use;</p></li>
<li><p>high-rise residents are frustrated about not knowing their neighbours, but regard foyers and lifts as too impersonal to be meeting places; and</p></li>
<li><p>garden maintenance is contracted out, so residents don’t garden and enjoy the benefits of improved fitness and contact with nature.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/174642/original/file-20170620-22151-13i28uu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/174642/original/file-20170620-22151-13i28uu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/174642/original/file-20170620-22151-13i28uu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=327&fit=crop&dpr=1 600w, https://images.theconversation.com/files/174642/original/file-20170620-22151-13i28uu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=327&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/174642/original/file-20170620-22151-13i28uu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=327&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/174642/original/file-20170620-22151-13i28uu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=411&fit=crop&dpr=1 754w, https://images.theconversation.com/files/174642/original/file-20170620-22151-13i28uu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=411&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/174642/original/file-20170620-22151-13i28uu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=411&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A
bike lane should promote healthy physical activity, but it won’t if potential users feel it’s unsafe.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/bike/5190071781/in/photolist-8UCtwe-893HVZ-owAP3U-ch8YRu-kebswH-cu71Vf-hojV6Q-8BjjAf-bGBeTg-cHLt85-auE48W-bGBerX-bEB4j6-btGr3d-brG9GS-HLcuFi-9YjCDm-6LUYnX-85kpQF-9XJ7yY-bQVjFe-77Q8eR-btGrTu-85kHcv-7i7YCv-5sw9f1-85oLNf-77U3V5-btGrPw-3eUnWv-bGBf78-aHWvyV-77U1Sh-bC1ES1-bQVm14-6Pdsks-85p2RU-48emTg-77Q6v6-85kqXP-85kB9p-tZL4aR-yoATpD-ueSZLW-9p6B2M-8XkhBk-e6dGGR-fzVoc-apafye-pm9WKT">Richard Masoner/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>One explanation points to a lack of engagement by designers, builders and managers. <a href="http://eprints.qut.edu.au/38966/">Research</a> suggests this derives from the long-held notion of a need for “professional detachment”. </p>
<p>This is curious when one considers the responsibility of professionals to be client-focused and responsive. No doubt professionals’ own heath aspirations and experiences would mirror those expressed by our study participants.</p>
<p>But it is not just practitioners who are implicated. Much research is still organised around the model of linear and quantifiable cause-and-effect, which is typical of communicable disease. This approach doesn’t work for people-place-health relationships, which are broad, qualitative and networked.</p>
<h2>A ‘deep immersion’ response to problems</h2>
<p>In response, our study took an integral, “deep immersion” method. This included:</p>
<ul>
<li><p>partnerships with key health and built environment “players”, state health and urban development authorities, and the Heart Foundation;</p></li>
<li><p>a comprehensive audit – not just reviewing census, medical and GIS data, but pounding the footpaths (or lack thereof), buying food in local shops, and observing how spaces were used day and night, on weekdays and weekends; and</p></li>
<li><p>detailed interviews with residents, asking about behaviours, aspirations and needs, followed by workshops to explore further what worked and what didn’t in terms of their health.</p></li>
</ul>
<p>The <a href="https://cityfutures.be.unsw.edu.au/research/city-wellbeing/city-wellbeing-resources/healthy-built-environments-audit-instrument-and-interview-questions/">audit, interview and workshop processes</a> are available for others interested in conducting similar comprehensive studies.</p>
<p>Instructively, the participating residents invariably “got it” in terms of what is actually needed – action by each of us as individuals, combined with action by us as a community to provide effective policy, design and management. One workshop participant summed it up:</p>
<blockquote>
<p>So … you’re asking, what do I do to keep healthy? That’s us. We need to do that. What should I do to keep healthy? That’s [also] us. What is helping me to keep healthy? This is about our community. What could actually help us? By having better gyms, all this sort of stuff … What I need to [do] … that’s where I see the linkage coming through … We’ve got to do that and make the choices…</p>
</blockquote>
<p>A sympathetic “putting oneself in the shoes” of residents via the deep-immersion techniques used in our research will better equip designers, builders, managers and researchers to plan and manage health-supportive environments for all.</p><img src="https://counter.theconversation.com/content/79115/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Thompson works for The University of New South Wales, Sydney. She is a member of the NTEU.
The research reported in this article was funded by an Australian Research Council Grant No. LP100100804. The research was conducted within the City Wellbeing Program (City Futures Research Centre UNSW) with partners UrbanGrowth NSW, the Heart Foundation (NSW) and the South Western Sydney Local Health District (NSW Health).
Senior Researcher on the project, Ms Emily Mitchell and Chief Investigators, Professors Bill Randolph and Bruce Judd (UNSW), are acknowledged.
</span></em></p><p class="fine-print"><em><span>Gregory Paine 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>New research shows many good intentions for creating urban environments that promote good health were not carried through. The solutions start with engaging more closely with residents themselves.Susan Thompson, Professor of Planning and Head, City Wellbeing Program, City Futures Research Centre, UNSW SydneyGregory Paine, Research Officer, City Futures Research Centre, City Wellbeing, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/764452017-06-11T20:30:21Z2017-06-11T20:30:21ZChoosing healthy food: your surroundings can help or hinder your dining choices<figure><img src="https://images.theconversation.com/files/166008/original/file-20170420-2392-im9b0r.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We can encourage people to make healthy adjustments to their diets with simple behaviour techniques.
</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/63783690@N08/13951998939/">Anas Maarawi/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Most of us know what sort of food we should eat to optimise our health and help avoid lifestyle diseases like obesity and heart disease. But we don’t stick to our ideal diets.</p>
<p>Part of the reason is that food producers and retailers spend a lot of money trying to influence our <a href="https://www.choice.com.au/shopping/everyday-shopping/supermarkets/articles/supermarket-sales-tricks">food choice</a> toward more expensive and processed food, the sort we’re overeating. But several things can be done to encourage healthier eating. </p>
<p><a href="http://www.behaviourworksaustralia.org/about/">We recently</a> reviewed research investigating <a href="http://www.behaviourworksaustralia.org/projects/fast-facts-fast-food/">how to promote healthy eating</a> when dining out. The review found manipulating the environment in dining and shopping areas, as well as some behavioural techniques, can make healthy choices more likely. </p>
<h2>Doing what’s considered normal</h2>
<p>Australians <a href="http://www.aihw.gov.au/risk-factors/nutrition/">don’t eat enough fruit or vegetables</a>, and too many of us are <a href="http://www.aihw.gov.au/overweight-and-obesity/">overweight</a>. Our diet choices are two out of the top three contributors to the burden of disease in Australia. </p>
<p>Humans get a large amount of information from watching the people around them, and it’s important to us to fit in.</p>
<p>We do this and understand how to act by watching the language, posture and activities of others. These are social models or norms, and we get information about what is a normal diet by seeing what other people eat. </p>
<p>This is so strong that when we see people eating healthy foods in small portion sizes, we’re more likely to <a href="http://www.behaviourworksaustralia.org/projects/fast-facts-fast-food/">choose lower calorie foods in smaller serves</a>. This means we can influence our families, including our children (and possibly even teenagers) and our colleagues, to eat better while reaping the benefits of eating better ourselves. </p>
<p>Organisations like hospitals, staff canteens and schools can also harness the power of social norms by displaying healthy meals of an appropriate size as normal and pleasurable choices made by people like us.</p>
<h2>Tangible labelling</h2>
<p>Fortunately, the responsibility of food producers to provide measurements of the energy contained in foods they produce is well established. </p>
<p>Unfortunately, there is evidence kilojoule counts don’t influence people to make <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/1479-5868-8-135">lower kilojoule choices when they appear on menus</a>. It seems the kilojoule and calorie count numbers are too abstract to influence most people.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/165991/original/file-20170420-2398-14tnjvw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/165991/original/file-20170420-2398-14tnjvw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/165991/original/file-20170420-2398-14tnjvw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/165991/original/file-20170420-2398-14tnjvw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/165991/original/file-20170420-2398-14tnjvw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=497&fit=crop&dpr=1 754w, https://images.theconversation.com/files/165991/original/file-20170420-2398-14tnjvw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=497&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/165991/original/file-20170420-2398-14tnjvw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=497&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Healthy eating is more likely to become a habit when most of those around us are engaging in the same behaviours.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/anthonyalbright/4713745704/in/photolist-m68aDF-boQCak-nVwuak-7Mi6XT-5Lihau-caXtZN-8oEgpz-bpq7rT-5AVdTK-4PESNZ-dJJCoG-boQzD4-gfWiYX-6bBCvX-kqyW-8u3XXv-75QcLj-m69Ct9-bV3Dco-65Q99B-kfxuUt-66PvpL-caXuhA-abxqd3-7ycuqG-dQsWAM-7oFeJq-6gN4PL-qSSVTT-6Qrm3p-mXporv-gqNUyW-bnnFDk-Jv2Ed2-gzoz2U-mXpj5p-5S5JB3-8ek3no-6gHT2P-969nbi-83qM8p-pgUCG-ABvXJ-7B4JC9-n5H9T-8bxbnE-dG92ko-7LK3yJ-edk4dN-kfzbkG">Anthony Albright/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>What does seem to work is translating those numbers into a meaningful rating system. Kilojoule counts are more effective if we <a href="http://www.andjrnl.org/article/S2212-2672%2814%2900599-1/pdf">relate it to something tangible</a>, such as the number of minutes of a specific exercise someone would need to do to work off the energy in a meal. </p>
<p>For example, making people aware it takes two hours of walking to burn off a can of cola could encourage them to make healthier choices.</p>
<p>Any organisation providing food can use this method, which could apply to meals, snacks and drinks sold for eating in, taking away, or even in vending machines. There are some easy to use sources of kilojoule-activity ratios, including one from the <a href="https://nccs.org.au/sites/default/files/_local_upload/others/Exercise%20to%20Counteract%20the%20Kilojoules%20Dec2015.pdf">Cancer Council NSW</a>.</p>
<h2>Plate size</h2>
<p>Although there is good evidence social norms and tangible labelling influence healthy eating behaviours while dining out, not every method to encourage healthy choices is effective.</p>
<p><a href="http://foodpsychology.cornell.edu/JACR/Small_Plates_Lose_Weight">Studies have</a> proposed choosing a smaller plate or fork encourages people to eat less. It seems logical that a meal would seem larger if it’s on a smaller plate. </p>
<p>But when tested experimentally, <a href="https://www.researchgate.net/profile/Sofia_Lourenco2/publication/233723061_Choice_architecture_as_a_means_to_change_eating_behaviour_in_self-service_settings_A_systematic_review/links/02e7e51920268e1cc4000000.pdf">this technique doesn’t work consistently</a>. When it does work, it may work only on those who <a href="http://dro.deakin.edu.au/eserv/DU:30072779/dubelaar-sizingup-2014.pdf">already have a healthy weight</a>.</p>
<p>On the bright side, this is a timely reminder of why efforts to change behaviour should be based on evidence and also tested in the field. When something sounds like it works, and has a logical pathway of influence so we understand how it would work, it still might not work in the field.</p>
<h2>Strategic positioning</h2>
<p>There has long been the assumption that increasing the availability or manipulating the placement of healthy food within places like supermarkets and cafeterias will lead to consumers making better choices. This technique is called “food architecture” and its logic makes sense, as marketers have been using <a href="https://theconversation.com/the-science-that-makes-us-spend-more-in-supermarkets-and-feel-good-while-we-do-it-23857">principles of product placement</a> to encourage us to buy certain products and spend more money for a long time. But can we assume the same principles for healthy food placement? </p>
<p>While there is some evidence to suggest that manipulating how food is positioned in a store can <a href="https://www.researchgate.net/publication/230684130_Healthy_Bodegas_Increasing_and_Promoting_Healthy_Foods_at_Corner_Stores_in_New_York_City">increase the sales of healthier options</a>, the fact that we are
still constantly bombarded with alternative products and considerations such as cost make it unlikely that placement alone will sway our choices.</p>
<p>A <a href="https://www.researchgate.net/publication/301798224_Nudging_consumers_towards_healthier_choices_A_systematic_review_of_positional_influences_on_food_choice">recent review of studies into food architecture</a> concluded that while healthy food placement does show promise for increasing healthy food choice, we still need to learn more about how it actually influences diet and obesity levels.</p>
<h2>Manipulating people</h2>
<p>Even if these techniques are effective, is it ethical to influence peoples’ eating behaviour without their knowledge? Researchers and policymakers do think about the ethics of influencing people.</p>
<p>In our daily lives, we’re subjected to many efforts to influence us one way or another, from government policy to marketing and advertising. <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.708.8779&rep=rep1&type=pdf">Even the weather influences our decisions</a>. </p>
<p>Work to change people’s behaviour, also called “<a href="https://www.gov.uk/government/organisations/behavioural-insights-team">nudge</a>” and “<a href="https://www.chicagobooth.edu/news/2008mancon/01-thaler.aspx">choice architecture</a>” by researchers and governments, only changes elements of the space around us that may encourage us to make particular choices. It doesn’t take any decision out of our control. </p>
<p>And the opportunity to support people to be more healthy without costing them more, punishing them, or taking away any of their choices, is too good to pass up.</p><img src="https://counter.theconversation.com/content/76445/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>A lot of money is spent by food producers and retailers to try and influence the type of food we buy and eat. But what can be done to encourage healthier choices?Breanna Wright, Research fellow, Monash UniversityDenise Goodwin, Research Fellow, Monash UniversityNicholas Faulkner, Research Fellow, BehaviourWorks Australia, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/781862017-06-06T19:21:56Z2017-06-06T19:21:56ZOur ‘sporting nation’ is a myth, so how do we get youngsters back on the field?<figure><img src="https://images.theconversation.com/files/171965/original/file-20170602-25700-1e6r1fb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Neglected and sub-par facilities are one of many barriers to youth participation in sport.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/tupwanders/4090730864/">tup wanders</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Sport is seen as a key part of Australia’s identity. Yet woefully rundown facilities and outdated sport offerings are creating significant barriers to youth participation. </p>
<p>In partnership with the <a href="http://yourlocalclub.com.au/who-we-are/our-stories/">Cooks River Sporting Alliance</a>, Canterbury Hurlstone Park RSL Club, and 12 public and private schools from Sydney’s inner west, we’ll be working with youth to co-design an innovative program to reverse the decline in youth participation in sport. </p>
<p>Our program, Designing in Youth, will feature new sport offerings, advertising materials and redesigned facilities. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3315587/">Research</a> shows that environmental design works best when it considers multiple factors. Thus, the first phase of our project is a survey to identify psychological and social barriers alongside environmental drivers of youth sport participation. </p>
<h2>Barriers to participation</h2>
<p>Australia’s sporting landscape offers more barriers than motivations for youth, and the effects are obvious. The World Health Organisation recommends 60 minutes of physical activity every day. In Australia, only <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-active-evidence.htm">one in ten</a> young adults do this. </p>
<p>Despite many programs to increase youth physical activity and sport participation, <a href="https://www.ncbi.nlm.nih.gov/pubmed/18091006">results have been inconsistent</a>. Perhaps these programs’ failure to have a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871410/">lasting impact</a> on young people’s exercise habits is due to their <a href="http://pediatrics.aappublications.org/content/107/6/1459">highly structured</a> nature and <a href="http://docslide.net/documents/in-focuspositive-coaching-youth-sports-hold-a-lesson-for-leaders.html">lack of youth leadership</a>.</p>
<p><a href="http://docslide.net/documents/in-focuspositive-coaching-youth-sports-hold-a-lesson-for-leaders.html">Youth report</a> their reasons for playing sport include enjoyment, development of physical and motor skills, self-esteem and peer interaction, among other factors. We hypothesise that better interventions emphasise the fun factor and involve peer-led, unstructured play. This should produce long-lasting improvements in attitudes to physical activity. </p>
<p>Most organised sports promote practice and winning over play, are primarily coach-led and do not encourage the development of physical and motor skills. These <a href="http://journals.sagepub.com/doi/abs/10.1177/1356336X14555294">factors are barriers</a> to youth sport participation. </p>
<p>This is partly due to poorly designed facilities. Few facilities promote both social and competitive participation, focus on peer leadership, or offer a wide variety of sporting activities in one place. </p>
<h2>Neglect of grassroots sport</h2>
<p>In New South Wales, the divide between elite and grassroots sport is huge. Most youth participation is in grassroots sport, but the funding <a href="http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/BN/2012-2013/SportFunding#_Toc360096410">mostly goes into elite clubs</a>. </p>
<p>Sports fields for grassroots clubs are commonly placed as afterthoughts, typically on leftover land. In NSW, this can be seen along Cooks River in the suburbs of Hurlstone Park and Canterbury. Here, sporting events and practices are regularly cancelled due to flooding.</p>
<p>To make things worse, many fields are not designed for sport and poorly maintained. The uneven, pitted surfaces are bad for play.</p>
<p>At these fields, bathroom blocks are rare, dirty and often falling apart. There are usually no changing rooms or showers. Many fields have few, if any, benches to sit on, and no access to food and drink vendors. </p>
<p>In addition, facilities are usually designed for one sport only. This leaves parents or siblings with nothing else to do while they wait.</p>
<p>In other countries, such as the Netherlands, facilities for local sport clubs <a href="http://www.cladglobal.com/CLADnews/architecture-design/Feyenoord-football-stadium-design-architecture-OMA-David-Gianotten-Eredivise-Netherlands-regeneration/326277?source=news">function as community centres</a>. Their fields are designed for various sporting activities and have playgrounds and hospitality centres nearby. </p>
<h2>Why does participation matter?</h2>
<p>The decline in sport participation may be a factor in the rise of poor mental health. Despite decreases in substance abuse such as smoking and binge drinking, rates of self-harm, depression, anxiety and suicide are <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2015-ley096.htm">on the rise</a> among Australian youth. </p>
<p><a href="http://www.who.int/dietphysicalactivity/factsheet_young_people/en/">Many studies</a> have found habitual sport activities are an effective way to improve mental health. Other health benefits include reductions in obesity and blood pressure. The 2010 report, <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/aust_sport_path/%24file/aust_sport_path.pdf">Australian Sport: Pathway to Success</a>, recognised boosting youth participation in sport and supporting grassroots clubs as important for improving both population health and national sporting success. </p>
<p>Despite all this evidence of many benefits, studies have charted a <a href="http://www.who.int/whr/2002/en/">steady global decline in sport participation</a> between the ages of 11 and 16. Participation is particularly low among <a href="http://www.emeraldinsight.com/doi/pdfplus/10.1108/09654280010343555">older girls</a>. </p>
<p>Past studies have <a href="http://www.who.int/whr/2002/en/">identified some barriers</a> to participation. These include <a href="http://www.emeraldinsight.com/doi/pdfplus/10.1108/09654280010343555">reduced parental influence</a> on choice of activity, boredom with the available sports, and <a href="http://www.sportandrecreationspatial.com.au/resources/2014%20JSAMS%20Transition3..pdf">time challenges</a> created by increased academic workload.</p>
<p>Other possible barriers such as poorly designed and maintained public parks have not been well studied. It’s probable that the poor condition of facilities and the lack of variety in sports and other non-sporting amenities on offer also discourage participation.</p>
<h2>A new approach to involving youth</h2>
<p>If we’re to increase youth participation, we need to include their opinions in the redesign process to ensure being involved in sport appeals to them.</p>
<p>Most programs worldwide have focused only on promoting an overall increase in physical activity. But regular and vigorous sports participation has greater long-term benefits, including improvements in <a href="https://www.dsr.wa.gov.au/docs/default-source/file-support-and-advice/file-research-and-policies/brain-boost-how-sport-and-physical-activity-enhance-children%27s-learning.pdf?sfvrsn=4">children’s learning</a>. </p>
<p>We hope Designing in Youth will help create a whole new landscape for sport in Sydney’s inner west. If successful, our communities and our use of public outdoor space will change for the better. </p>
<p>We should see youth outside again. And maybe, just maybe, we will restore our status as a sporting nation.</p><img src="https://counter.theconversation.com/content/78186/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Ascher Barnstone receives funding from Canterbury Hurlstone Park RSL. </span></em></p><p class="fine-print"><em><span>Fiona Brooks receives funding from Hurlstone Park and Canterbury RSL
</span></em></p><p class="fine-print"><em><span>Job Fransen receives funding from Hurlstone Park/Canterbury RSL</span></em></p>The first step in reviving a lost sporting culture is to involve young Australians in working out why sport has lost its appeal and how to reverse the decline in youth participation.Deborah Ascher Barnstone, Professor, Associate Head of School, School of Architecture, University of Technology SydneyFiona Brooks, Professor of Public Health, Associate Dean Research, University of Technology SydneyJob Fransen, Lecturer in Skill Acquisition and Motor Control, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/770632017-05-17T09:27:03Z2017-05-17T09:27:03ZLearning from zoos – how our environment can influence our health<figure><img src="https://images.theconversation.com/files/169753/original/file-20170517-24330-1j3hzlq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/australia-sydney-city-taronga-zoo-giraffe-243256861?src=UrPIBQv-VQLiGP_8e-fchw-1-60">CoolR/Shutterstock</a></span></figcaption></figure><p>We are told that we are a nation of couch potatoes, lacking the will and the strength to turn around the obesity tanker. We all need a little help in our quest for a healthier life and design can play a crucial part. If we designed our towns, cities, homes and workplaces more like animal experts design zoos, we could be one step nearer to reaching our fitness goals – as long as we can have some fun along the way.</p>
<p>It is <a href="http://www.telegraph.co.uk/science/2016/03/31/british-people-will-be-fattest-in-europe-by-2025/">reported</a> that British people will be the fattest in Europe by 2025 and that if we want to reverse this we should have a healthier lifestyle by exercising more and eating less. But we are often made to feel guilty for not sticking to theses healthy lifestyle plans. I would suggest that before we start blaming people for adopting <a href="http://www.independent.co.uk/life-style/health-and-families/features/the-age-of-inactivity-how-laziness-is-killing-us-10347541.html">sedentary lifestyles</a>, we should be taking a step back to look at the design of the environments, towns and cities in which we live.</p>
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<p>The <a href="http://www.emeraldinsight.com/doi/abs/10.1108/02632770910933152?journalCode=f">link</a> between the design of the built and natural environment and its role in our health and well-being has been well explored. Now <a href="https://www.routledge.com/Design-for-Health/Tsekleves-Cooper/p/book/9781472457424">new research</a>, led by Lancaster University, on “design for health” suggests that the environment, including buildings, cities, urban spaces and transport infrastructure, is closely linked to the lifestyles we adopt. </p>
<p>What is abundantly clear is that, as we shape our environment, it is also shaping us. Our psychological, physiological and physical status as well as our interactions with other people and with the natural environment are all affected. A key challenge that governments and policy makers worldwide are facing is how our built environment and infrastructure should be shaped to support healthier behaviours to prevent disease. </p>
<p>First, we should stop focusing on methods that tell people what to (or not to) do and which attempt to change their behaviour simply through <a href="http://www.bbc.co.uk/news/health-35824071">media campaigns</a> and punitive measures, such as tax schemes. While seeking to minimise the barriers that prevent healthy behaviours, we should make sure that the design of new environments is taken into account.</p>
<h2>Looking to zoos</h2>
<p>A good model would be to look at how <a href="http://journals.sagepub.com/doi/abs/10.1177/216507999504300904">zoos are designed</a>. Before a zoo is built, it is common practice for zoologists, biologists, animal psychologists, nutritionists, architects, designers and landscape architects to work closely together to create an environment that optimises the living conditions for the animals. </p>
<p>Important environmental elements, such as vegetation, habitat, lighting, materials and each animal’s requirements are taken into account. The ultimate aim is to design an environment that fully supports the animals’ physical, psychological and social well-being. Ironically, we do not seem to make the same demands when a town, neighbourhood or workplace environment for humans is planned and designed.</p>
<p>Another opportunity that has recently emerged is the healthy new town <a href="https://www.england.nhs.uk/ourwork/innovation/healthy-new-towns/">NHS initiative</a>. The aim is to radically rethink how we live and take an ambitious look at improving health through the built environment. Ten demonstrator towns will be built across England with community health and well-being as their main focus. Clinicians, designers and technology experts will reimagine how healthcare can be delivered in these places. Although this is a step in the right direction, what it is currently missing is the more holistic approach we have seen in the design of the zoos. </p>
<p>A crucial element in designing these towns so they are places that people would want to live in, is to include community members in their creation. This strategy would help design-in health-promoting behaviours, such as access to healthy food outlets or green spaces in which people can walk and exercise. </p>
<h2>Embracing playfulness</h2>
<p>Playful design – the mapping of playful experiences from games and toys to other non-game contexts – can play an important role here in inviting and encouraging people towards healthier alternatives. For example, the <a href="http://www.thefuntheory.com/piano-staircase">piano stairs project</a> in Stockholm, which converts the metro stairs into a giant functioning piano keyboard – much like the piano made famous in the Tom Hanks movie Big (1988) – demonstrates great promise. It encourages commuters to opt for the intriguing new stairway instead of the escalators to enjoy making musical movements as they go up and down.</p>
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<p>A <a href="http://kwiekbeweegroute.nl/">project in The Netherlands</a>, meanwhile, illustrates how everyday street furniture, such as lampposts, benches and bollards, can be inexpensively converted into impromptu exercise devices, inviting people to engage in casual activity and socialise with their neighbours. We could therefore envisage several other contexts were playfulness can transform mundane everyday activities into fun ones that encourage people into a more active and social lifestyle. </p>
<p>We could convert building walls into <a href="https://www.youtube.com/watch?v=HSQZ3mIIgr8">activity walls</a> to encourage stretching of arms and legs through touch; redesign public squares and walkways into interactive dance floors that invite movement and guide you through a city; and transform workplace spaces and public places into “playgrounds” that boost movement and productivity and decrease lethargy.</p>
<p>So there you have it. If we want to be a nation of lean, mean and healthy citizens we need to learn from zoos and the animals that live in them. And we need to embrace playfulness and enjoy the place where we live. That way, we can tackle life with a hop, skip and a jump.</p><img src="https://counter.theconversation.com/content/77063/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emmanuel Tsekleves is the Co-editor of the Design for Health book part of the Design for social responsibilities series to be published on May 23rd 2017. </span></em></p>It’s not all about the gym and your diet. The places where we live and work shape our health, too.Emmanuel Tsekleves, Senior Lecturer in Design Interactions, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/717632017-01-30T15:18:03Z2017-01-30T15:18:03ZHow Africa can win the fight against childhood cancer<figure><img src="https://images.theconversation.com/files/154521/original/image-20170127-30419-13g2n8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Better technologies should be adopted in sub-Saharan Africa to deal with childhood cancer.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>World Cancer Day is celebrated globally on February 4 under the tag line “We Can. I Can”. Increased awareness and education about childhood cancers means that more lives are saved. The Conversation Africa’s Health and Medicine Editor Joy Wanja Muraya spoke to Jessie Githanga on the challenges of diagnosing and treating childhood cancer in Kenya.</em></p>
<p><strong>What are the top cancers in Kenya, regionally and in Africa? What are the most likely causes?</strong></p>
<p>In Kenya, accurate data about the most common forms of cancer is unavailable because the country doesn’t have an updated population based <a href="http://afcrn.org/membership/members/101-eldoret">cancer registry</a>. It therefore has to rely on regional registries that are largely <a href="http://afcrn.org/membership/membership-list/85-nairobi-kenya">hospital based</a>. Though not comprehensive, it’s nevertheless still useful as most patients with cancer will eventually go to a hospital where data will be collected. </p>
<p>The top <a href="http://www.ajhsjournal.or.ke/?p=1120">childhood cancers</a> are lymphoma (a form of cancer affecting the immune system), cancers of the blood (leukaemia), brain, eye, kidney and muscle cells.</p>
<p>Regional differences in the top cancers is seen in <a href="https://www.ncbi.nlm.nih.gov/pubmed/25724211">countries</a> like Mozambique, Uganda, Zambia and Malawi where childhood HIV/AIDS is more common. This leads to AIDS related cancers like Kaposi’s sarcoma (a cancer of the blood vessels) and certain types of lymphoma.</p>
<p>In countries with high rates of malaria infection, Burkitt’s lymphoma is the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207091/">most common childhood cancer</a>. It’s less common in the developed world where signs and symptoms differ.</p>
<p><strong>Are childhood cancers different from adult cancers?</strong></p>
<p>Adult cancers are strongly associated with lifestyle related <a href="https://www.cancer.org/cancer/cancer-in-children/risk-factors-and-causes.html">risk factors</a> like unhealthy eating, being overweight and obesity, lack of exercise as well as increased tobacco and alcohol use.</p>
<p><strong>Are children in Africa receiving appropriate treatment? What are the challenges on the continent?</strong></p>
<p>In developed countries a child diagnosed with cancer has an 80% <a href="http://www.gov.za/childhood-cancer-awareness-month-2015">chance</a> or more of surviving whereas the <a href="https://www.researchgate.net/publication/223957025_Challenge_of_pediatric_oncology_in_Africa">survival rate</a> of children in Africa is less than 20%. </p>
<p>The causes are many and interrelated. One is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849966/">late diagnosis</a> due to lack of awareness of cancer in children among guardians, health care workers and the general population coupled with poor access to treatment facilities.</p>
<p>There’s also inadequate diagnostic capability and a disturbing paucity of <a href="https://www.ncbi.nlm.nih.gov/pubmed/22475119">treatment facilities</a> especially those designed for childhood cancer in most sub Saharan African countries. </p>
<p>The prohibitive cost of chemotherapy drugs, few <a href="https://qz.com/692584/cancer-is-on-the-rise-in-africa-just-as-some-of-the-few-radiotherapy-centers-fall-apart/">radiotherapy facilities</a> as well as a lack of bone marrow transplantation technology, compounds the problem making treatment expensive. </p>
<p>The problem of insufficient health care workers trained in paediatric cancer, especially oncologists, pathologists, surgeons, nurses, pharmacists and palliative care experts needs urgent attention. </p>
<p><a href="https://www.karger.com/Article/Pdf/315586">Treatment protocols</a> are rarely standardised, evidence based or adapted for each developing country’s capacity. There’s little research into local childhood cancers and especially <a href="https://www.ncbi.nlm.nih.gov/pubmed/22844968">clinical trials </a>. This is a sorry state of affairs given that the best treatments in cancer are often in the context of a clinical trial. </p>
<p>Current evidence shows that even where the types of cancer may be similar to those in developed countries there are <a href="https://www.ncbi.nlm.nih.gov/pubmed/26274016">biological differences</a> that have a significant impact on the treatment choices and outcomes. </p>
<p>It’s therefore imperative that further research including clinical trials to identify suitable treatments are done to improve treatment outcomes.</p>
<p><strong>What is Kenya doing about the gaps?</strong></p>
<p>Kenya has now woken up to the fact that cancer is a serious problem. Even though most attention has been given to the common adult cancers, such as those of the male and female reproductive tracts (breast, cervical and prostatic cancers), more attention is now being paid to childhood cancers through efforts of the government, Non-Governmental Organisations, professional bodies and civil society. </p>
<p>Some of these initiatives include the collaborative efforts by the <a href="http://www.health.go.ke/">Ministry of Health</a> and the <a href="https://www.cancer.gov/">National Cancer Institute</a> in the US, Kenya Network of <a href="https://kenyacancernetwork.wordpress.com/kenya-cancer-facts">Cancer Organisations</a> , Kenya Hospices and <a href="http://kehpca.org">Palliative Care</a> Association, <a href="http://kesho-kenya.org/">Kenya Society for Haematology and Oncology</a> and various independent donors and well-wishers. </p>
<p>Groups specifically targeting children have been set up, like the <a href="http://wechope.org/kenya/contact-kecct/">Kenya Childhood Cancer Trust </a> and <a href="http://hope4cancerkids.org/">Hope for Cancer Kids</a>. Health care financing for all aspects of treatment of childhood cancers are now being considered by the <a href="http://www.nhif.or.ke/healthinsurance/">National Health Insurance Fund</a>. </p>
<p>Studies in public hospitals have shown that children with cancer who have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710438/">health insurance funding</a> have better chances of survival than those who don’t. While there’s still much to be done, these efforts will yield fruit with time. More coordination of the various stakeholders needs to be made to avoid duplication of efforts.</p>
<p><strong>What is the way forward for Africa in dealing with cancer?</strong></p>
<p>Advocacy and creating public awareness are key points if Africa is to move towards <a href="https://www.ncbi.nlm.nih.gov/pubmed/23434340">tackling childhood cancers</a>. </p>
<p>Holding international and national cancer awareness days should be coupled with continuous awareness efforts. </p>
<p><a href="http://www.cancercontrol.info/cc2016/world-child-cancer-supporting-partnership-models-in-paediatric-oncology/">Twinning programmes</a> linking centres in resource-rich countries with those in resource-limited ones have worked well in <a href="http://www.cancercontrol.info/cc2013/challinor/">Ethiopia</a> and <a href="https://www.worldchildcancer.org/blog/twinning-visit-ghana-%E2%80%93-may-2015">Ghana</a> to improve capacity and patient survival.</p>
<p><a href="http://www.nature.com/nrclinonc/journal/v10/n10/abs/nrclinonc.2013.137.html">Clinical trials</a> that can improve survival as well as enhance capacity need to be performed.</p>
<p>The International Society for Paediatric Oncology offers <a href="http://www.cancerpointe.com/">training information</a>. Training can be more cheaply offered in other African countries with established training programmes including <a href="http://www.choc.org.za/childhood-cancer/awareness-and-detection.html">South Africa</a>, <a href="http://egyptcancernetwork.org/achievements-5/fellowship-program/">Egypt</a> and <a href="http://aslanproject.org/what-we-do/our-programs/12-programs/28-pediatric-cancer-program-at-jimma-university.html">Ethiopia</a>. <a href="http://www.cancercontrol.info/cc2015/a-partnership-model-for-the-training-and-professional-development-of-health-care-staff-in-low-resource-settings/">Twinning</a> could also help <a href="https://www.worldchildcancer.org/blog/twinning-visit-ghana-%E2%80%93-may-2015">less well established programmes</a> in other African countries.</p><img src="https://counter.theconversation.com/content/71763/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessie N. Githanga 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>Better technology to diagnose, treat and manage the disease early enough is needed to improve the survival rates of childhood cancer in sub Saharan Africa.Jessie N. Githanga, Prof, Haematology and blood transfusion, University of NairobiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/693212017-01-04T03:36:49Z2017-01-04T03:36:49ZDoes a healthy diet have to come at a hefty price?<figure><img src="https://images.theconversation.com/files/148618/original/image-20161205-19401-gz9lg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Eating healthfully adds up quickly.</span> <span class="attribution"><span class="source">Fruits and veg via ww.shutterstock.com</span></span></figcaption></figure><p>Imagine you’re in the aisle of your favorite grocery store, bombarded with hundreds of the latest and greatest products on the market. After grabbing a box of your favorite pasta off the shelf, you notice a new organic version of the spaghetti sauce you usually buy. Strikingly, you notice that the price is <a href="https://mic.com/articles/144522/organic-food-expensive#.goBlOVkpk">at almost a 50 percent premium</a> compared to what your usual sauce costs. </p>
<p>Here we go again, you think: You have to empty your wallet to buy the “healthy” stuff. </p>
<p>If this describes how you think about the relationship between food health and price, you’re not alone. This belief is so pervasive that tips on how to eat <a href="http://www.foodnetwork.com/healthy/packages/healthy-eating-on-a-budget.html">healthy on a budget</a> are everywhere, implying that most consumers think this is a truly difficult task. Who hasn’t heard Whole Foods’ nickname, “<a href="http://www.bloomberg.com/news/articles/2016-05-18/whole-foods-seeks-to-shed-whole-paycheck-rap-with-new-format">Whole Paycheck</a>,” or seen incredibly cheap pricing on <a href="http://time.com/money/4208250/fast-food-deals-winners-losers/">unhealthy fast food</a>? </p>
<p>Measuring the relationship between health and price of food is in fact <a href="http://www.ers.usda.gov/webdocs/publications/eib96/19982_eib96_reportsummary_1_.pdf">difficult</a> as it can be evaluated in a variety of ways, from price per calorie to price per average portion. </p>
<p>So how pervasive is the view that “healthy = expensive” and why do consumers think this way? </p>
<p>In a <a href="http://dx.doi.org/10.1093/jcr/ucw078">series of studies</a> recently published in the <a href="http://www.ejcr.org/">Journal of Consumer Research</a>, we found that consumers do tend to believe that healthy foods are in fact more expensive. While this may actually hold true in only <a href="http://www.foxnews.com/leisure/2012/03/11/10-reasons-organic-food-is-so-expensive/">some product categories</a>, we discovered that many consumers tend to believe this relationship holds across all categories, regardless of the evidence.</p>
<h2>Consumers and lay theories</h2>
<p>Consumers appear to have a lay theory, or an intuition, that healthy foods are more expensive. </p>
<p>Discussions around <a href="http://americannutritionassociation.org/newsletter/usda-defines-food-deserts">food deserts</a> – low-income geographical areas with <a href="http://www.usnews.com/news/articles/2015/12/07/millions-of-food-desert-dwellers-struggle-to-get-fresh-groceries">limited access to affordable nutritious foods</a> – also suggest that healthy foods are indeed more expensive than unhealthy ones.</p>
<p>The marketplace and the media appear to have taught most U.S. consumers to expect foods with special health properties to command a premium price. While this is the case in some instances (for example, the USDA notes a price premium for many <a href="http://www.ers.usda.gov/topics/natural-resources-environment/organic-agriculture/organic-market-overview/">organic foods</a>), in other cases a general positive relationship between price and healthiness <a href="http://articles.latimes.com/2012/may/16/news/la-heb-healthy-cheap-food-usda-20120516">may not exist</a>.</p>
<p>A <a href="http://www.encyclopedia.com/social-sciences/applied-and-social-sciences-magazines/lay-theories">lay theory</a>, in psychology, is the term for a nonexpert’s belief about how the world works. We can have lay theories about how everything from <a href="https://www.jstor.org/stable/25674423?seq=1#page_scan_tab_contents">self-control</a> to <a href="http://nymag.com/news/features/27840/index1.html">intelligence</a> works. And these lay theories influence how we behave. </p>
<p>Consumers also have lay theories about food: for example, believing that <a href="https://www.psychologytoday.com/blog/sapient-nature/201104/the-unhealthy-tasty-intuition-are-you-under-its-subconscious-influence">unhealthy foods are tastier</a>, regardless of whether this is objectively true.</p>
<p>In our research, we document a new lay theory consumers have about food: that healthy foods are more expensive. In other words, unlike other research exploring whether there is a <a href="http://www.tandfonline.com/doi/pdf/10.1080/19320248.2015.1095144">true relationship between food health and price</a>, we were interested in understanding how this belief (regardless of whether it is objectively true) influences our food choices. Across five studies, we showed that even in food categories where there is no relation between price and health, the healthy = expensive intuition affects how consumers make decisions about food.</p>
<h2>How a food’s price equates to health</h2>
<p>Diving deeper into understanding what’s going on in the mind of the consumer, we wanted to know: Do higher price points drive consumers to think of something as healthier? Or do cues about healthiness lead consumers to believe that the price is higher? </p>
<p>In our studies, we found that the intuition seems to operate in both directions. That is, in our first study, we showed that when consumers were presented with price information only, perceptions of the healthiness of a breakfast bar varied with the price: higher price = healthier, lower price = less healthy. Similarly, when given a nutrition grade of an “A-,” the sort of summary analyses provided by various websites, including <a href="http://www.caloriecount.com">CalorieCount.com</a>, the breakfast bar was estimated as more expensive than when the same bar was graded as a “C.”</p>
<p>In another study, consumers were asked to choose the healthier of two similar chicken wraps. When the “Roasted Chicken Wrap” was priced at US$8.95 versus a “Chicken Balsamic Wrap” for $6.95, people chose roasted over balsamic. But when the prices were flipped, so were the choices. That is, people were actively choosing the more expensive option because they believed it was healthier.</p>
<p>Another study showed that food products running counter to the healthy = expensive intuition – that is, a product claiming to be healthy but offered at a less expensive than average price for the product category – led consumers to seek out more supporting evidence before they bought into a generic health claim. Specifically, study participants presented with a $0.99 protein bar (after being told that the average price for protein bars is $2 per bar) chose to view, on average, more than three online reviews before rating how likely they would be to buy the product themselves compared with two reviews when the protein bar had a $4 price tag. </p>
<p>It simply took more convincing when the price seems too good to be true for stated health claims.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/148632/original/image-20161205-19362-15yjala.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/148632/original/image-20161205-19362-15yjala.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=332&fit=crop&dpr=1 600w, https://images.theconversation.com/files/148632/original/image-20161205-19362-15yjala.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=332&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/148632/original/image-20161205-19362-15yjala.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=332&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/148632/original/image-20161205-19362-15yjala.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=417&fit=crop&dpr=1 754w, https://images.theconversation.com/files/148632/original/image-20161205-19362-15yjala.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=417&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/148632/original/image-20161205-19362-15yjala.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=417&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Would you pay more if this included DHA?</span>
<span class="attribution"><span class="source">Trail mix via www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>What is healthy?</h2>
<p>The impact of belief in the healthy = expensive intuition, however, goes beyond just general inferences about price and health. </p>
<p>In another study, we found that consumers used this intuition when valuing the importance of an unfamiliar specific ingredient in a food product. We asked participants to assess the importance of the inclusion of DHA (docosahexaenoic acid) – which we told them helps reverse <a href="http://umm.edu/health/medical/altmed/condition/macular-degeneration">macular degeneration</a>, an age-associated eye disease that can lead to vision loss – in a trail mix. When the DHA trail mix was sold at a premium price, participants put a higher value on both <a href="http://www.blindness.org/blog/index.php/can-dha-save-your-vision/">DHA</a> and the underlying health condition. When it was sold at an average price, participants weren’t as persuaded that their diet should include DHA or that preventing macular degeneration was as important.</p>
<p>Interestingly, it was the unfamiliarity of DHA that drove these inferences. When vitamin A was associated with the same health claim, a relative price premium didn’t alter perceptions of how important vitamin A is as an ingredient. This study suggests that people are more likely to rely on their lay theories when assessing health claims that are unfamiliar – a situation they likely face often at the grocery store as food manufacturers frequently introduce new products <a href="http://www.health.com/health/gallery/0,,20599288,00.html">claiming to include the latest health ingredient</a>.</p>
<h2>Ignore your gut</h2>
<p>Together, our studies reveal that consumers have a pervasive tendency to associate healthier food products and higher prices. </p>
<p>If one is operating with an unlimited budget while trying to cook and serve healthy meals, then perhaps this isn’t a problem. However, those trying to manage a food budget and feel good about the healthiness of their family meals may pay too much for their nutrition. This can occur despite ready availability of both pricing and <a href="http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm248732.htm">nutritional information</a>.</p>
<p>What is the takeaway for consumers? We all know that price and quality aren’t perfectly correlated, but it doesn’t stop us from <a href="http://journals.ama.org/doi/abs/10.1509/jmr.12.0407">using price to judge quality</a> when we don’t have other information.</p>
<p>So if you’re truly concerned about choosing healthy foods without overpaying, stop and think next time you see a health claim paired with a high price rather than relying on your gut feelings. A simple solution to overcoming the influence of the intuition is to seek out more information before you buy. </p>
<p>Getting more information, which mobile devices let consumers do easily, even while shopping in a store, will enable you to rely on more careful, systematic thinking about the health claim being presented – rather than just your gut’s take that a healthy idea requires emptying your wallet.</p><img src="https://counter.theconversation.com/content/69321/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 organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Consumers tend to think that healthy foods have to cost more than their less nutritional counterparts. New psychological research looks at how pervasive this is.Kelly L. Haws, Associate Professor of Marketing, Vanderbilt UniversityKevin L. Sample, Ph.D. Candidate in Marketing, University of GeorgiaRebecca Walker Reczek, Associate Professor of Marketing, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/677242016-11-14T19:08:53Z2016-11-14T19:08:53ZHow strong social networks can help migrants manage health risks better<figure><img src="https://images.theconversation.com/files/145015/original/image-20161108-16697-1c66pxq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Jamestown in Accra, Ghana, is home to many migrants from other parts of the country.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/davidstanleytravel/21799429649/in/photolist-gFepq2-gFg9Jo-drJ9sB-4E7DDu-gFhPkD-4E3oTP-gFi5nn-AreVC-gFb5mY-zdkLXk-zH3efK-zF14br-zbGKEv-znApUW-gFufAD-B9XvG-4E3ki8-4E7BmS-gFDG4A-fBdhQ5-4E7DMU-4E7AM9-4E3nG6-4E7Evf-4E7DXS-4E3pQa-BaEZe-4E3pCB-zD5ki1-4E3pov-4E3pbn-yyP9ft-yPU4SR-zua9Do-yPU59c-zJt6R5-yPKiaG-zKEtDG-yPU75B-8BZu9Y-zKEv7b-zJt7Lm-yPKjM9-yPU6Zr-zubEJ9-zLMc6z-CxGYWC-zvnbAF-BCviFb-HmXsSk">David Stanley/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Migration is a global phenomenon. In West Africa, about 33% of people have moved from their village of birth. In Ghana, inter-regional movement is a major contributor to <a href="http://migratingoutofpoverty.dfid.gov.uk/files/file.php?name=wp-13---awumbila-owusu-teye-2014-can-rural-urban-migration-into-slums-reduce-poverty-final.pdf&site=354">where people live</a>, with over 50% of the population living outside the villages they were born in.</p>
<p><a href="http://migratingoutofpoverty.dfid.gov.uk/files/file.php?name=wp7-internal-migration-remittances-and-poverty.pdf&site=354">Previous research</a> shows that the greater Accra region attracts the largest number of migrants by far. The general trend is that people <a href="http://www.migrationdrc.org/research/regions/ghana_africa.html">move from</a> the less economically endowed locations in the northern regions to find work in the relatively richer south. </p>
<p>Many of these migrants end up in poor neighbourhoods in the city’s urban centres because they cannot afford rents in better residential areas. On the margins of society, the poor conditions they live in make them susceptible to environmentally induced diseases such as malaria, cholera and typhoid. </p>
<p>To evaluate the health of migrants, research has traditionally mainly focused on geography, sexual ill health, the double burden of infectious and chronic diseases, the environment, wealth, income and health factors. </p>
<p>The <a href="http://ugspace.ug.edu.gh/handle/123456789/1071">research</a> shows that rural migrants and residents in poor communities have a higher burden of sexual ill health and suffer from both infectious and non-communicable diseases. These are also the major causes of death and disability. </p>
<p>In our <a href="http://link.springer.com/article/10.1007%2Fs10708-016-9723-1">study</a> we expanded the lens to understand patterns of disease by looking at lifestyle factors as well as social factors. These included how long migrants stayed in a place, what job they had, how religious they were and how often they ate “street meals”. </p>
<p>What our research points to is that a systematic policy framework to promote the active creation of social networks – at formal and informal work places and at places where people congregate for recreation or for worship – would make a dramatic difference in helping migrants better manage their health.</p>
<h2>The factors that affect migrants’ health</h2>
<p>Researchers have traditionally used a set of <a href="http://link.springer.com/article/10.1007%2Fs10708-016-9723-1">social factors</a> that look at migrants’ disease patterns to determine their health status. These have included living and working conditions, family wealth, health literacy, education, employment and the degree of autonomy in jobs, the quality of housing, ethnicity, and gender. </p>
<p>Environment factors also come into play. These include the quality of food and water, air and soil. For example, diseases thrive in areas where migrants live in degraded, overcrowded environments with poor sanitation. Overcrowding increases the risk and spread of respiratory diseases. This becomes worse when too many people use charcoal and firewood as cooking fuels.</p>
<p>In addition, social relationships have been shown to matter.</p>
<p>Urbanisation dramatically affects social relationships. For example, traditional lifestyles of family cooking and the sharing of home cooked food are replaced by out-of-home “street meals”. This has led to an increase in lifestyle diseases such as cardiovascular diseases and associated risk factors like obesity, high blood pressure, cholera and other diarrhoeal disease epidemics. </p>
<p>Social relationships also affect the social support networks migrants can rely on to access health care services.</p>
<p><a href="http://link.springer.com/article/10.1007%2Fs10708-016-9723-1">Our study</a> looked at the health status of migrants in Jamestown, a poorer neighbourhood in Accra. </p>
<p>We found that socio-demographic factors, individual lifestyles and the type of resources migrants could access through their social networks all played a part in how healthy, or not, they were.</p>
<p>Migrants face multiple health challenges. Hazardous working and poor living conditions as well as the fact that they have moved to new and unfamiliar terrain also play a part. For example, we found that migrants who had lived in the neighbourhood longer were more likely to have a better health status than those who had migrated recently. </p>
<p>The jobs they did also affected their health. Those employed in jobs involving physical activity such as masonry, welding and carpentry were more likely to say they were healthy compared to those who provided services, such as seamstresses, nurses and drivers. Migrants involved in sales such as trading, food vending and fish mongering also did not rate their health highly. </p>
<p>Migrants who bought food from food vendors were more likely to have a lower self-rated health status than those who didn’t. </p>
<h2>Social capital</h2>
<p>The association between poor migrants’ lifestyles and their health in poor urban neighbourhoods as well as how social capital mediates that association has been a largely neglected area of research.</p>
<p>Previous <a href="http://www.springer.com/us/book/9789400767317">research in Accra</a> on poverty and health has largely focused on the spatial distribution of inequalities in health. It has shown that there is uneven distribution of diseases with some places having higher prevalence of certain diseases than others. </p>
<p>But we found that those who felt that they had enough information on how to live successfully – including how to access health care from the host population in Jamestown – had a more positive outlook on their health. This confirms <a href="http://happierhuman.wpengine.netdna-cdn.com/wp-content/uploads/2014/06/P13.-Social-Isolation-in-America-Changes-in-Core-Discussion-Networks-over-Two-Decades.pdf">earlier research</a> that <a href="https://my.vanderbilt.edu/lijunsong/files/2015/09/Social-Capital-and-Health-2013.pdf">social capital</a> at the individual and interpersonal level is a major source for passing on information as well as a predictor of health. </p>
<p>This study is important because it provides some of the answers about existing health differentials for people living in disadvantaged neighbourhoods and points out some of the contributions that lifestyles can make. The findings have implications for policy. They can also help design improvements in areas of community health insurance schemes, strengthening community health care systems, and promoting communal and family support systems that are falling apart. </p>
<h2>Information and education are key</h2>
<p>As things stand, people who don’t get adequate information about health issues often resort to cheaper herbal medicines and unauthorised conventional medicines that are less effective in controlling diseases such as malaria, TB, cholera and even obesity. This not only endangers migrants’ health: it can also contribute to drug resistance. </p>
<p>Of course, health facilities should be improved so that migrants have access to affordable health services. Currently many have little or no access. </p>
<p>But the research highlights the need for intervention at a much more granular level. It shows that there is an urgent need for strong policies to support informal health education, health literacy and counselling to migrants as well as host populations about healthy living. </p>
<p>New policies should be developed to promote proactive social, familial and community support networks that facilitate better information about health. This would include information about healthy living, good hygiene and responsible sexual behaviour. </p>
<p>Strong networks would help facilitate discussions among community members about ways to avoid health risks associated with lifestyles, poor sanitary conditions and unprotected sex. They would provide the channels through which people could be armed with the necessary information to improve their lives, particularly their health. This, then, would encourage them to take the necessary steps to avoid risks.</p><img src="https://counter.theconversation.com/content/67724/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Boateng 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>Vast numbers of people who migrate in search of a better life end up living in marginal conditions that put their health at risk. But individual lifestyle is also an important factor.John Boateng, Lecturer in Continuing and Distance Education, University of GhanaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/576632016-05-16T00:44:57Z2016-05-16T00:44:57ZHow ‘gamification’ can make transport systems and choices work better for us<figure><img src="https://images.theconversation.com/files/120933/original/image-20160503-19538-1ve7dwd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Using incentives drawn from game play, the peak-hour crush can be reduced, or avoided altogether.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/stilgherrian/4820063055/in/photolist-8kW5Pr-mVmgND-dpp4GX-e1A5u7-5BYsA-fyf8S-dpp4PB-dppeVo-83zxqq-qGDAjH-c7d3Km-9NGcbW-p4Uk49-e1uoKP-q7wLgf-5TPgH8-d47m7-8XgbJm-PmdjF-r1RcgE-bCyNPJ-dpp67R-5J4X4n-dppe1b-e3ofZL-e3hvt8-dxWxBf-dxWzZQ-9p2JvP-e3ofZ7-e3hvqH-e3hvsB-e3ofYE-aaoVEp-e1A57N-dxWybm-e1uou8-e1A4TQ-e3og13-e3hvrx-dxWCQb-e1unZi-e3hvsa-dxWxuC-e3ofZj-awexJ7-dxWA7N-dxWAGy-bZBAuL-bZByej">Stilgherrian/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Individual users and their behaviours are critical to how transport systems work. How can we better incentivise their behaviour to achieve policy goals such as shifting transport modes and reducing road trauma and traffic congestion? </p>
<p>Peak-hour congestion and peak loading, for example, are the twin most pressing issues for public transport agencies around the world. The search for low-cost “solutions” to such problems is a continuing challenge. By 2031, public transport patronage in many cities is expected have <a href="http://www.cabinet.qld.gov.au/documents/2010/jul/connecting%20seq%202031/Attachments/Draft%20Connecting%20SEQ%202031.pdf">doubled or even tripled in 25 years</a>. </p>
<p>Australian governments at all levels recognise this increasing demand, but infrastructure investments are facing long delays due to funding shortfalls. Instead of building costly new infrastructure – for example, the <a href="http://www.choosebrisbane.com.au/invest/why-brisbane/brisbanes-changing-landscape/bus-and-train-tunnel?sc_lang=en-au">A$5 billion Brisbane bus and train tunnel</a> – can we use transport capacity more efficiently to defer this investment? That is, how can we shift demand from peak to off-peak times? </p>
<h2>How about playing a game?</h2>
<p>A game is viewed as “an activity that is voluntary and enjoyable, and governed by rules”. Gamification incorporates elements of game play into an interactive system without having a fully fledged game as the end product. </p>
<p>Gamification can be defined as the “<a href="http://gamification-research.org/wp-content/uploads/2011/04/02-Deterding-Khaled-Nacke-Dixon.pdf">use of game design elements in non-game contexts</a>”. It introduces competition and social activity into behavioural interventions. The participants, such as public transport passengers, become “players” who can win individual or group rewards if they adjust their behaviour.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/120922/original/image-20160503-19535-wg3teo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/120922/original/image-20160503-19535-wg3teo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/120922/original/image-20160503-19535-wg3teo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=158&fit=crop&dpr=1 600w, https://images.theconversation.com/files/120922/original/image-20160503-19535-wg3teo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=158&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/120922/original/image-20160503-19535-wg3teo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=158&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/120922/original/image-20160503-19535-wg3teo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=198&fit=crop&dpr=1 754w, https://images.theconversation.com/files/120922/original/image-20160503-19535-wg3teo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=198&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/120922/original/image-20160503-19535-wg3teo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=198&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Conceptual gamification procedure applied to transport use.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Recent evidence underlines the significance of a gamified approach to behaviour change. Currently, there are few case studies in the transport field. These may not be branded directly as gamification, but the concepts of these cases are borrowed from it. </p>
<h2>Active travel</h2>
<p>Gamified design has been used in the health field and can dramatically transform people’s health and physical activity levels. One example from the UK is the <a href="http://www.beatthestreet.me/">Beat the Street</a> initiative. In Reading, it has <a href="http://www.intelligenthealth.co.uk/best-foot-forward-for-reading-as-beat-the-street-returns/">encouraged thousands of residents to walk and cycle</a> for health benefits. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"726795827226677248"}"></div></p>
<p>Another example of such <a href="http://www.activehealthykidsaustralia.com.au/siteassets/documents/ahka_reportcard_2015_web.pdf">programs in Australia</a> is Healthy Active School Travel. This is a free, tailored program proven to help primary school students, parents and teachers to leave the car at home and use sustainable travel modes to get to school. Examples include walking, cycling, riding a scooter, or taking public transport. </p>
<p>In participating schools in Brisbane, the program has helped to convert 35% of single-family car trips to school to an <a href="http://www.brisbane.qld.gov.au/traffic-transport/public-transport/school-transport/active-school-travel-program">active and healthy transport mode</a>.</p>
<p>For these games, leaderboards are compiled and reported at all competition levels. Peer encouragement is strong. Low-cost rewards like stickers encourage students to make positive changes in their travel behaviour or participate in events such as scooter safety skills sessions. </p>
<p>Engagement remains strong throughout the year as each month has a new focus and a new prize. Examples include prizes for the “most children walking to school” in March, the “most children bike riding” in April, and the “most children scootering” in May.</p>
<h2>Public transport</h2>
<p>Gamification schemes have just been introduced in a public transport context for the first time via <a href="https://www.travelsmartrewards.sg/">Singapore’s INSINC program</a>. This aims to shift demand from peak to off-peak shoulder times in Singapore’s public transport system.</p>
<p>The scheme manages peak-hour congestion by offering incentives for commuters to travel in off-peak periods. These incentives include random (raffle-like) rewards, social influence and personalised offers. </p>
<p>A six-month research pilot, launched in January 2012, achieved a <a href="http://web.stanford.edu/%7Ebalaji/papers/13INSINC.pdf">7.49% shift from peak to off-peak hours</a> for all commuter trips. </p>
<h2>Road safety</h2>
<p>There are many gamified schemes and interventions to improve road safety, especially when it comes to young drivers. It is well established that they are over-represented in numbers of road accidents in any driver demographics.</p>
<p>In Australia, people in the 17-25 age group made up 12.4% of the population, but <a href="https://bitre.gov.au/publications/ongoing/files/Road_trauma_Australia_2014_statistical_summary_N_ISSN.pdf">20.5% of driver deaths and 20.2% of all deaths</a> in 2014.</p>
<p>To motivate young people to drive more safely, many interventions have been developed. Car insurance companies have designed some interventions. Examples include: </p>
<ul>
<li><p><a href="http://gametuned.com/about/">GAMETUNED</a> in the UK; </p></li>
<li><p><a href="https://www.youtube.com/watch?v=U9TlxdyYNUY">S-Drive</a> in Australia; </p></li>
<li><p><a href="http://www.actuarios.org/espa/web-nueva/publicaciones/anales/2013/135-154.pdf">paying accident insurance by the kilometres driven</a> in the Netherlands; </p></li>
<li><p><a href="https://www.tower.co.nz/car-insurance/smartdriver">SmartDrive</a> in New Zealand; </p></li>
<li><p>a <a href="http://sciencenordic.com/rewarding-safe-drivers-could-make-roads-safer">return insurance premium scheme</a> in Norway; and </p></li>
<li><p><a href="http://www.citylab.com/commute/2014/11/the-swedish-approach-to-road-safety-the-accident-is-not-the-major-problem/382995/">starting bonuses</a> in Sweden. </p></li>
</ul>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/A8dAUA4wKBU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">S-Drive offers rewards for safe driving in Australia.</span></figcaption>
</figure>
<p>These gamified programs are designed to promote safe driving. Such programs fall into two categories: monetary rewards and a reward point scheme. </p>
<h2>What’s next?</h2>
<p>Gamification is based on sound psychological and social theory and has had success in the transport field. </p>
<p>The important questions confronting transport agencies are not if and how gamification works, but where it may be useful and how to design a successful intervention. We know most about the approach’s efficacy in schools, but less about its efficacy with adults and in the transport context.</p>
<p>There is ample scope to harness a gamification approach in Australia to achieve transport-system-oriented goals. <a href="http://www.technovelgy.com/ct/technology-article.asp">Radio Frequency Identification card</a> or app technology could be used to encourage better use of new bicycle/pedestrian path infrastructure, or local area walking and cycling. </p>
<p>The potential to combine games and rewards with public transport travel is significant. It could provide additional behaviour change rewards for off-peak travel, encourage walking instead of vehicle access to public transport, or reward use of alternative public transport stops to avoid congested stations. </p>
<p>The outcomes could be tied to business-based travel plans where businesses can show improvements in their bottom lines from encouraging mode shift from car to public transport or active travel. Some of the incentives may then be underwritten through their savings.</p><img src="https://counter.theconversation.com/content/57663/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Barbara T.H. Yen 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>Using elements of game play, we can create incentives for people to change how and when they make various transport choices in ways that enable the whole system to work better.Barbara T.H. Yen, Research Fellow at Urban Research Program, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/555992016-03-04T04:24:38Z2016-03-04T04:24:38ZDoctors must be taught how to be better counsellors on lifestyle choices<figure><img src="https://images.theconversation.com/files/113718/original/image-20160303-9499-sgum6m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Smoking, excessive drinking, not exercising or eating unhealthy foods leads to lifestyle diseases. </span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>People who smoke and drink too much, don’t exercise and eat unhealthily are likely to suffer from non-communicable diseases such as heart disease and diabetes. They are also likely to die early. More than most, they need counselling on how to change their behaviour. This is important because it can ensure that scarce resources in the public health sector are used more cost-effectively.</p>
<p>But, in South Africa, <a href="http://dx.doi.org/10.4102/PHCFM.V7I1.819">counselling</a> about non-communicable diseases and the underlying risk factors has, until recently, been particularly inadequate. Primary care providers are ill equipped to provide more than ad hoc advise on how to adopt a healthy lifestyle.</p>
<p>More than 38 million people die across the world from non-communicable diseases <a href="http://www.who.int/nmh/publications/ncd_report_chapter1.pdf">every year</a>. Four groups of diseases are responsible for 82% of these deaths: cardiovascular diseases, cancers, respiratory diseases and diabetes. </p>
<p>According to the World Health Organisation 40% of deaths in the developed and developing world occur in people who are younger than 70. Of these, 82% are in lower- and middle-income <a href="http://www.who.int/gho/countries/zaf.pdf?ua=1">countries</a>. </p>
<p>In South Africa, non-communicable diseases are among the top ten <a href="http://www.who.int/gho/countries/zaf.pdf?ua=1">leading causes of death</a>. These have been on the increase, driven by risky lifestyle choices. Smoking, drinking excessively, a lack of physical inactivity and an unhealthy diet all contribute to high levels of morbidity and death from these diseases. </p>
<p>Although these can be changed, progress towards prevention has not kept pace with the rising burden of disease. </p>
<p>The effect of non-communicable diseases is felt by the individual as well as their families, communities and the over-burdened health system. </p>
<p><a href="http://www.ichangeforhealth.co.za/healthcare-professionals/">Research</a> has shown that interventions that target people as part of a family unit and a community is more effective. For example, two 40-year-old men – one married and the other single – but both suffering from diabetes need a counselling approach that takes into account their lifestyles. </p>
<h2>Doctors and nurses lack the know-how</h2>
<p>In South Africa, patients are most likely to be counselled by public sector nurses or primary care doctors. Recent <a href="http://dx.doi.org/10.4102/PHCFM.V7I1.819">studies</a> that assessed healthcare providers’ capacity to deliver behaviour change counselling show this service is inadequate in both the public and private sectors. </p>
<p>None of the nurses included in the study and only one-fifth of the doctors had excellent knowledge of the key issues around non-communicable disease risk factors. </p>
<p>Public sector nurses accept the role of providing counselling and about one-fifth believe they are knowledgeable. But they may have an <a href="http://dx.doi.org/10.4102/phcfm.v7i1.731">inflated perception</a> of their knowledge on how to modify a patient’s lifestyle for non-communicable diseases. </p>
<p>Primary care doctors also accept that they must deliver brief counselling and feel it is important. But they doubt their ability to effectively assist patients to change risky behaviours. </p>
<p>Aside from insufficient training, several other factors contribute to their <a href="http://dx.doi.org/10.4102/phcfm.v7i1.731">lack of confidence</a> to deliver counselling.</p>
<p>Many have faced several barriers which have discouraged them. These include: </p>
<ul>
<li><p>a lack of patient education materials;</p></li>
<li><p>time and language constraints;</p></li>
<li><p>poor continuity of care and record-keeping;</p></li>
<li><p>conflicting lifestyle messages; and </p></li>
<li><p>an unsupportive organisational culture. </p></li>
</ul>
<p>There is a need to revise the approach to training doctors to ensure skills can be learnt and transferred to the clinical setting.</p>
<h2>Putting the patient at the centre</h2>
<p>Current training for primary care providers in the Western Cape is not sufficient to achieve competence in clinical practice. Training is limited by time constraints and is not integrated into the curriculum. There is a focus on theory rather than modelling and practice as well as a lack of assessment.</p>
<p>To improve the current training programs, I designed, developed and implemented a best practice training program along with training materials and resources. The program, piloted in the Western Cape, targeted primary care doctors and nurses. </p>
<p>The training programme is based on a conceptual model that combines the 5 A’s: ask, alert, assess, assist and arrange. The training is based on a guiding style derived from motivational interviewing, which differs from the traditional directing style of counselling. This guiding style has been <a href="http://www.files.ithuta.net/eCPD_Healthcare/General/HELPING%20PEOPLE%20CHANGE%20Manual72.pdf">widely used internationally</a>.</p>
<p>The program is designed to target all four risk factors associated with non-communicable diseases.</p>
<p>Traditionally, primary care doctors have been the expert advice giver. They try to convince the patient why, what and how they should change. But in the guiding style, the argument for change is evoked from the patient. Primary care providers are trained to expertly guide the shared decision making process. </p>
<p>This moves the counselling approach from provider-centred to patient-centered. </p>
<p>The program changed primary care doctors’ approach and skills to deliver patient centred counselling, at least in the short term. And it helped them develop the approach of the guiding style, which they were able to retain in <a href="http://bmcfampract.biomedcentral.com/articles/10.1186/s12875-015-0318-6">clinical practice</a>.</p>
<h2>Training is not enough</h2>
<p>Although training enabled primary care doctors to deliver better behaviour change counselling effectively, and increased their confidence, delivering it in a clinical environment remains challenging. Training alone is not enough to ensure that better behaviour change counselling is implemented. </p>
<p>There are still several barriers. These include: </p>
<ul>
<li><p>under-staffing;</p></li>
<li><p>lack of managerial support; and </p></li>
<li><p>poor continuity of care. </p></li>
</ul>
<p>To incorporate better behaviour change counselling into everyday care, a whole systems approach is needed. This requires training primary care doctors to change their counselling behaviour, but also requires change at other levels. </p>
<p>For example, the current organisational culture is not congruent with the patient-centred guiding style of better behaviour change counselling. Asking primary care doctors to embody values of trust, respect and openness in an environment where they are experiencing manipulation, blame and control, is unrealistic. </p>
<p>Incorporating better behaviour change counselling into everyday care does not only require training, but also a change in the underlying supportive culture in primary care settings.</p><img src="https://counter.theconversation.com/content/55599/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zelra Malan receives funding from CDIA (Chronic Diseases Initiative in Africa), and Stellenbosch University.</span></em></p>Doctors in South Africa have not been doing enough counselling of people who drink, smoke, don’t exercise and eat badly on ways to change their lifestyles.Zelra Malan, Senior Lecturer, Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/532272016-01-31T19:04:10Z2016-01-31T19:04:10ZWhy a walk in the woods really does help your body and your soul<figure><img src="https://images.theconversation.com/files/109309/original/image-20160127-19660-1ljnjw4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's something in the tree air and it's good for you.</span> <span class="attribution"><span class="source">Shutterstock/Stokkete</span></span></figcaption></figure><p>Have you ever wondered why you feel healthier and happier when you stroll through the trees or frolic by the sea? Is it just that you’re spending time away from work, de-stressing and taking in the view? Or is there more to it?</p>
<p>For more than 20 years, scientists have been trying to determine the mechanisms by which exposure to biodiversity improves health. Japanese scientists pioneered the search when they travelled to the island of Yakushima, famous for its biodiversity.</p>
<p>The Japanese already had a name for the experience of well-being in nature: shinrin-yoku or “forest bathing”.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/109311/original/image-20160127-19633-1q7gjr5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/109311/original/image-20160127-19633-1q7gjr5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/109311/original/image-20160127-19633-1q7gjr5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=361&fit=crop&dpr=1 600w, https://images.theconversation.com/files/109311/original/image-20160127-19633-1q7gjr5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=361&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/109311/original/image-20160127-19633-1q7gjr5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=361&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/109311/original/image-20160127-19633-1q7gjr5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=454&fit=crop&dpr=1 754w, https://images.theconversation.com/files/109311/original/image-20160127-19633-1q7gjr5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=454&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/109311/original/image-20160127-19633-1q7gjr5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=454&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Bathe yourself in the forests of Japan’s Yakushima island.</span>
<span class="attribution"><span class="source">Alan Logan</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>We do <a href="https://theconversation.com/explainer-what-is-biodiversity-and-why-does-it-matter-9798">know</a> that a diverse ecosystem supports a varied and beneficial microbial community living around and inside us. </p>
<p>We also <a href="https://theconversation.com/biodiversity-can-flourish-on-an-urban-planet-18723">know</a> that exposure to green space, even within urban environments, increases our physical and mental well-being. But what are the mechanisms?</p>
<h2>The forest air</h2>
<p>The Japanese researchers <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793347/">suggested</a> that we are taking in beneficial substances when we breathe forest air.</p>
<p>Research has identified three major inhaled factors that can make us feel healthier. These factors are beneficial bacteria, plant-derived essential oils and negatively-charged ions.</p>
<p>From birth to the grave, beneficial bacteria surround us; they live in the environment and, importantly, in <a href="http://www.scientificamerican.com/article/microbe-census-reveals-ai/">the air we breathe</a>. We also share almost our entire body with them. The more interaction we have with them, the happier and healthier we are.</p>
<p>This is in part due to our gut-dwelling bacteria, which break down the food we cannot digest and produce substances that benefit us both <a href="https://theconversation.com/are-people-born-by-caesarean-section-more-likely-to-be-obese-7200">physically</a> and <a href="https://theconversation.com/gut-feeling-how-bacteria-can-mess-with-your-mood-17080">mentally</a>.</p>
<p>Plants and the bacteria living on them can produce essential oils to fight off harmful microorganisms. These are referred to collectively as <a href="http://www.encyclopedia.com/doc/1O7-phytoncide.html">phytoncides</a>, literally, “plant-derived exterminators”.</p>
<p>Research on the health benefits of plant essential oils is in its <a href="http://www.americanscientist.org/issues/pub/a-walk-in-the-woods">infancy</a>. But one recent <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4092941/">study</a> found that a phytoncide from Korean pine trees improved the health and bacterial make-up of pigs.</p>
<p>Notwithstanding some of the pseudoscience that gets wrapped around negative ion generating machines, there is evidence that negative air ions may influence mental outlook in beneficial ways. There are relatively higher levels of negative air ions in forested areas and close to bodies of <a href="http://www.atmos-chem-phys.net/12/3687/2012/acp-12-3687-2012.pdf">water</a>. This may factor into the benefits of walking in a forest or near the ocean.</p>
<p>But as the German writer Goethe once said:</p>
<blockquote>
<p>Nature has neither kernel nor shell; she is everything at once.</p>
</blockquote>
<p>Bacteria, essential oils and negative ions interact and influence each other. For example, negative ions and phytoncides may dictate the microbial make-up within a natural environment. There is <a href="http://yalepress.yale.edu/book.asp?isbn=9780300025811">evidence</a> that this could also be taking place in the human gut.</p>
<h2>More to be done</h2>
<p>Nature-relatedness, or <a href="https://en.wikipedia.org/wiki/Biophilia_hypothesis">biophilia</a> in which an individual feels connected to nature, has been <a href="http://www.naturerelatedness.ca/Nature_Relatedness.html">linked</a> with better health.</p>
<p>But we have a long way to go before we can more fully understand the mechanisms by which an innate love of nature can benefit our health. An important part of this discussion – an overlooked one in our opinion – is further understanding of an individual’s connection to nature.</p>
<p>Psychologists have convincingly demonstrated <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157607/">connections</a> between nature relatedness and mental well-being. But how does a greater personal affinity to nature interact with dietary habits, personal microbiome, physical activity levels and many other lifestyle variables that might be intertwined with having such an affinity?</p>
<p>In the meantime, while scientists turn over stones and search for important mechanistic clues – including those related to biodiversity – there are many simple ways to capitalise on our biophilia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/109323/original/image-20160127-20387-1q60tpq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/109323/original/image-20160127-20387-1q60tpq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/109323/original/image-20160127-20387-1q60tpq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=422&fit=crop&dpr=1 600w, https://images.theconversation.com/files/109323/original/image-20160127-20387-1q60tpq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=422&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/109323/original/image-20160127-20387-1q60tpq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=422&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/109323/original/image-20160127-20387-1q60tpq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=531&fit=crop&dpr=1 754w, https://images.theconversation.com/files/109323/original/image-20160127-20387-1q60tpq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=531&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/109323/original/image-20160127-20387-1q60tpq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=531&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Live in a city? The take time to walk in the city’s parks and gardens such as Melbourne’s Botanical Gardens.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/stephenb/2194835580/">Flickr/Stephen Barber</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>Why not run in the park or by a river instead of on a treadmill, or take a walk <a href="http://www.huffingtonpost.com/wray-herbert/effects-of-nature-on-happiness-well-being_b_927562.html">through a park</a> on the way to work or at lunchtime?</p>
<p>Critically, there is increasing evidence that we can help shape our children’s mental and physical health by exposing them to more green environments as they work, rest and play. The US-based <a href="http://www.childrenandnature.org/">Children and Nature Network</a> is a great resource of research news and activities bringing children and nature together.</p>
<p>In the World Health Organization report <a href="http://www.who.int/globalchange/publications/biodiversity-human-health/en/">Connecting Global Priorities – Biodiversity and Human Health</a>, released in December last year, it was concluded that:</p>
<blockquote>
<p>Considering ‘microbial diversity’ as an ecosystem service provider may contribute to bridging the chasm between ecology and medicine/immunology [… ] the relationships our individual bodies have with our microbiomes are a microcosm for the vital relationships our species shares with countless other organisms with which we share the planet.</p>
</blockquote>
<p>It is easy to see that discussions of natural environments and human health are no mere matter of intellectual fancy.</p>
<p>In a <a href="http://jphysiolanthropol.biomedcentral.com/articles/10.1186/s40101-016-0083-9">paper published</a> last month in Journal of Physiological Anthropology, we’ve called for more research into the links between biodiversity and human physical and mental well-being, particular in relation to childhood, that most formative of times.</p>
<p>Wouldn’t it be good if by nurturing our environment we were also nurturing our children’s future health?</p><img src="https://counter.theconversation.com/content/53227/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeffrey Craig receives funding from the National Health and Medical Research Council and the Financial Markets Foundation For Children </span></em></p><p class="fine-print"><em><span>Susan Prescott receives funding from the National Health and Medical Research Council of Australia, she is on the Scientific Advisory Board of the Nestle Nutrition Institute and Danone Nutricia Early Life Nutrition. She is the President of the DOHaD Society of Australia and New Zealand, and the Chair of the International Inflammation Network.</span></em></p>There’s something in the air that actually has health benefits when you take time to walk among the plants and trees. What that is exactly is still being studied by scientists.Jeffrey Craig, Principal Research Fellow, Murdoch Children's Research InstituteSusan L. Prescott, Professor of Paediatrics, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/476162015-09-21T10:00:05Z2015-09-21T10:00:05ZLiving longer, sicker lives? Make lifestyle changes to remain healthier in old age<figure><img src="https://images.theconversation.com/files/95374/original/image-20150918-17676-1hyi65o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fighting fit.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-181671983/stock-photo-elderly-person-practicing-a-sport.html?src=hQii59zazhAJcrlSpf4HSQ-2-72">Exercise by Shutterstock</a></span></figcaption></figure><p>Life expectancy across the world is growing, but the number of those extra years in which we’re healthy is not rising at the same rate. This adds to the demographic time-bomb of a greater number of older people suffering from ill-health. Yet, according to the Global Burden of Disease study <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2961340-X/abstract">published in the Lancet</a>, of the top ten health risks most are lifestyle-related and within our power to change.</p>
<p>Between 1990 and 2013, life expectancy in the UK increased by 6.2 years for men to 79.1 years, and by 4.4 years for women to 82.8 years. However, the amount of this gain expected to be lived in good health increased by only 4.7 years for men and 3.3 years for women. </p>
<p>While a similar improving trend was observed in most countries across the globe, in dozens of countries including Belarus, Belize, Gabon, Guyana, Paraguay, Syria and all of southern Sub-Saharan Africa, healthy life expectancy was lower in 2013 than in 1990. Interestingly, this is also the first time that improvements to healthy life expectancy in the developing world (5.4 years for men and 6.4 years for women) are greater than those in the developed world (3.9 years for men and 2.8 years for women).</p>
<h2>Chronic disease and disability</h2>
<p>A surprising fact is that, nowadays, <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960692-4/abstract">fewer than 4% of people are completely free of any health problem</a>, with more people living with chronic and under-reported illnesses. The number of years lived with disability have increased in almost every country, attributable to the growth of chronic diseases such as cardiovascular and respiratory diseases, cancer, back pain, mental health disorders, dementia, road injuries, HIV/AIDS and malaria. This has also increased the demand for care.</p>
<p>A comparison of years of life lost between regions of the UK, <a href="https://stats.oecd.org/glossary/detail.asp?ID=6805">the EU15 group of countries</a>, plus Australia, Canada, Norway and the US, shows that England’s worst affected region – the north-west (with north-east England close behind) – is similar to Scotland, Northern Ireland and the US. The East Midlands is the UK average, equivalent to France, Canada and Germany, while better-off regions such as the south-west, south-east and London are closer to Spain, Australia and Norway.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rates of years of life lost (YLLs) for both sexes combined in the nine English regions, Scotland, Northern Ireland, Wales, the EU15 countries, Australia, Canada, Norway and the US (2013).</span>
<span class="attribution"><a class="source" href="http://dx.doi.org/10.1016/S0140-6736(15)00195-6">Newton et al\The Lancet</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Factors within our control</h2>
<p>We could live longer and healthier if we tackled the main health risks that affect us. Globally, the leading ten risks are smoking, obesity, high blood pressure, diabetes, alcohol use, high cholesterol, kidney disease, low physical activity, diets <a href="https://theconversation.com/top-five-things-you-can-do-to-keep-your-heart-healthy-34950">low in fruits and vegetables</a> and drug use. These are drawn from 79 biological, behavioural, environmental and occupational factors.</p>
<p>The list is similar in the UK, with smoking, high blood pressure, obesity at the top and <a href="https://theconversation.com/top-five-things-you-can-do-to-keep-your-heart-healthy-34950">low physical activity also ranking highly</a>, comparable to <a href="http://www.lancet.com/journals/lancet/article/PIIS0140-6736%2815%2900128-2/abstract">Australasia, Ireland and the US</a>. Among developed countries there is some variation: alcohol use is a bigger problem in Belgium, Denmark, Finland and South Korea, while smoking is less of a problem in Finland, Israel and Singapore, for example.</p>
<p>The same is true <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2900195-6/abstract">within the UK</a>, where Wales scored worse in physical activity but better in blood pressure, or where drug use was a greater problem in the south-west, south-east and the east of England than elsewhere. As the chart below shows, of metabolic (biological), environmental, or behavioural (lifestyle) factors affecting health, it is lifestyle factors that carry the most weight.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=372&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=372&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=372&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=468&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=468&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=468&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Proportion of disability-adjusted life years lost in 2013 attributable to behavioural, environmental and metabolic risks and where they overlap (marked by ∩).</span>
<span class="attribution"><a class="source" href="http://dx.doi.org/10.1016/S0140-6736(15)00128-2">GBD 2013 Risk Factors Collaborators/The Lancet</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>The future</h2>
<p>We are now entering an era when fighting for funding to tackle a single disease in isolation is no longer effective. Health problems <a href="http://pediatrics.aappublications.org/content/88/3/519.abstract">tend to cluster from childhood to adulthood</a> and then <a href="http://spcare.bmj.com/content/5/Suppl_1/A6.1.abstract">around the end of life</a>. They also share both biological and environmental risks. </p>
<p>The main risk factors leading to chronic diseases such as high blood pressure, obesity, smoking and heavy alcohol consumption might result from <a href="http://www.jsad.com/doi/abs/10.15288/jsa.2001.62.773">family problems</a>, <a href="http://bmjopen.bmj.com/content/5/5/e006588.long">social inequality</a> or poverty, beliefs or <a href="http://psycnet.apa.org/journals/hea/21/3/279/">customs</a> of particular subcultures, <a href="http://www.bmj.com/content/350/bmj.h1565.long">selfish business models</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861792/">bullying</a> or violence, <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.82.6.816">poor education (awareness)</a>, depressive mood and even <a href="https://theconversation.com/being-too-hot-or-too-cold-can-worsen-health-conditions-27086">the changeable weather</a>.</p>
<p>Current prevention and interventions programmes and social and health policies aimed at reducing the leading risks might have limited effects. Instead, we should focus on the context and mechanism of actions of these risks. We, therefore, need to restructure human society in each country, with systematic examination and improvements in every aspect of human life including <a href="http://www.healthpolicyjrnl.com/article/S0168-8510%2815%2900221-3/abstract">politics</a>, the occupational (for example, more healthcare and less business; <a href="http://www.theguardian.com/commentisfree/2013/sep/18/shorter-working-week-fairer-economy">shorter working hours</a> with lower unemployment rates), the built environment (including <a href="http://www.ingentaconnect.com/content/hsp/jbsav/2015/00000004/00000001/art00012">housing and neighbourhoods renewal</a>, <a href="http://onlinelibrary.wiley.com/doi/10.1002/wps.20191/epdf">the transport system</a>, etc), <a href="http://link.springer.com/article/10.1007%2Fs10964-010-9584-8">consistent culture, education and parenting</a>, <a href="http://www.tandfonline.com/doi/full/10.3109/11038128.2015.1085596">hobbies</a> and so on. This is the grand challenge that faces us in the next decade.</p><img src="https://counter.theconversation.com/content/47616/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ivy Shiue (Scthiue) 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 global health and disease study shows we’re living longer, but spending more years in poor health. But there are some things within our power to change.Ivy Shiue (Scthiue), Senior research associate, Northumbria University, NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/434502015-06-19T12:18:33Z2015-06-19T12:18:33ZWhen it comes to Fitbit’s 10,000 steps, one size doesn’t fit all<figure><img src="https://images.theconversation.com/files/85714/original/image-20150619-3386-rpp1ad.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Long walk to fitness</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The rise of wearable fitness technology is something of a paradox. The <a href="http://www.cnet.com/news/fitness-trackers-rise-and-fall/">surge in popularity</a> of devices that monitor the amount of exercise you do suggest more people than ever are interested in maintaining regular fitness regimes. Just witness the success of the company behind fitness tracking bracelet Fitbit, which investors have just deemed <a href="http://www.ft.com/cms/s/0/f4c51d3e-1543-11e5-9509-00144feabdc0.html">worth US$4.1bn</a> (£2.6bn) after it floated on the stock market. Yet this comes at a time when physical inactivity has reached levels of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645500/pdf/nihms385288.pdf">global pandemic proportion</a>.</p>
<p>This shows how important it is that the public understand and follow science-based health and behaviour advice. The advantage of wearable fitness technology is that it can provide a way for personalised data to shape how much extra physical activity (including exercise) a person needs to do and when.</p>
<p>The <a href="http://www.nhs.uk/Livewell/loseweight/Pages/10000stepschallenge.aspx">well-publicised</a> recommendation to take “10,000 steps a day” is a perfect example. The <a href="https://books.google.co.uk/books?id=EQ3OxfuICAMC&pg=PP5&dq=Manpo-Kei:+The+Art+and+Science+of+Step+Counting+hatano&hl=en&sa=X&ei=YeKDVZr1KMP0UMr-lvgO&ved=0CCAQ6AEwAA#v=onepage&q=Manpo-Kei%3A%20The%20Art%20and%20Science%20of%20Step%20Counting%20hatano&f=false">figure actually originates</a> from Japanese walking clubs and a marketing slogan for pedometers more than 40 years ago. But step counts <a href="http://rubytec.eu/downloads/yamax/f-2004-m.pdf">have been shown</a> to provide a reliable measure of daily activity in healthy adults. They also provide a meaningful everyday metric that allows individuals to self-monitor their physical activity and walking.</p>
<p>The self-monitoring (observing and evaluating one’s behaviour) and goal setting that come with devices like Fitbit are two of the most complementary and potent ways of changing people’s physical activity behaviour. Combining activity trackers, which allow the wearer to observe their steps in real-time and review at their leisure, with goals such as <a href="http://her.oxfordjournals.org/content/26/2/372.full.pdf+html">walking 10,000 steps</a> can make people more motivated and more able to increase or maintain their physical activity levels.</p>
<h2>More is better</h2>
<p>But it is important to realise that 10,000 steps is not a magic threshold. Increasing our time spent walking, regardless of our starting point, is beneficial. At a population level, the biggest changes to health come from improvements at the lower end of the scale. For example, going from 2,000 steps to 4,000 steps will produce greater overall health benefits than going from 4,000 steps to 6,000 steps. At the same time, the <a href="http://www.cmaj.ca/content/174/6/801.full.pdf+html">more active we are</a> (or more steps we take) each day <a href="http://circ.ahajournals.org/content/124/7/789.full.pdf+html">the better</a>. So taking 6,000 steps a day is still better for your health than 4,000 steps.</p>
<p>With the emergence of a large number of activity trackers, a new challenge has emerged for the promotion of 10,000 steps. The <a href="http://www.health.utah.edu/peak/docs/Tudor%20Locke%20Paper.pdf">data behind the recommendation</a> was derived from pedometers which are conventionally worn on the hip. Today, manufacturers tend to produce devices for the wrist because they are more comfortable and convenient for self-monitoring. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.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">Step-by-step improvement.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>But devices worn on the extremities will pick up extra movement <a href="http://iopscience.iop.org/0967-3334/35/11/2191/pdf/0967-3334_35_11_2191.pdf">compared with hip-worn monitors</a>. That means they may miscount other large movements from daily life, such as sweeping the floor or doing the dishes, as steps. As a result, it is important for people to be aware that wrist-worn devices may inflate their daily step count.</p>
<p>In general, we should remember that, when it comes to physical activity, “some is good but more is better”. But we can also use step counters to tackle the problems of long periods of sedentary behaviour (sitting). For example, many of us will have particular times of the day (perhaps during work or during the evening) where we spend most of our time sitting. By continuing to accumulate steps during these periods we can simultaneously target reductions in our sitting time.</p>
<p>By monitoring our sitting behaviours alongside the aim of achieving 10,000 steps, we can start to break up these extensive sedentary periods with bouts of activity. Not only would we take more steps but also we would spend less time sitting for long periods. <a href="http://sites.garmin.com/en-US/vivo/vivofit/">Some fitness trackers</a> have started implementing this idea by prompting the wearer when they have been inactive for “too long”.</p>
<h2>Lifestyle medicine</h2>
<p>The difficulty with physical activity promotion is that one size doesn’t necessarily fit all. For individuals with health conditions that impact their ability to accumulate higher levels of physical activity, such as rheumatoid arthritis or severe respiratory impairment, it is likely to be more feasible to prescribe lower step-count targets to begin with.</p>
<p>People who spend a lot of time sitting during work, such as taxi drivers, will likely need to accumulate <a href="http://bit.ly/1Rfe1S5">higher step counts</a> to help compensate for the negative effects of prolonged sitting. This has contributed to the concept of “<a href="https://www.mja.com.au/system/files/issues/190_03_020209/egg10622_fm.pdf">lifestyle medicine</a>” (preventing and managing health conditions through lifestyle choices).</p>
<p>If we can get the message out that physical activity trackers need to be combined with this kind of individual goal setting, then we might see both increases in physical activity and reductions in sitting across populations.</p><img src="https://counter.theconversation.com/content/43450/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Orme 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>Fitness devices like Fitbit set an automatic goal of 10,000 steps a day. But this isn’t the magic threshold some make it out to be.Mark Orme, PhD Candidate, Loughborough UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/280072014-06-13T15:00:16Z2014-06-13T15:00:16ZScotland might slowly be turning the corner on diabetes<figure><img src="https://images.theconversation.com/files/51072/original/836rjznt-1402669857.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Scottish diabetes rates have rocketed, but there are promising signs</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-196472765/stock-photo-fat-man-drinking-beer-and-sitting-on-sofa-to-watch-tv.html?src=RWEQLOPfy0E35VttKiChtQ-3-47">Tom Wang</a></span></figcaption></figure><p>The number of people with diabetes in the UK has more than doubled over the past two decades, with more than 3.8 million people <a href="http://www.diabetes.org.uk/About_us/What-we-do/">currently affected</a>. Around 10% of them have <a href="http://www.nhs.uk/Conditions/Diabetes-type1/Pages/Introduction.aspx">Type 1 diabetes</a>, which is caused by loss of insulin production, while the remaining 90% have <a href="http://www.nhs.uk/Conditions/Diabetes-type1/Pages/Introduction.aspx">Type 2 diabetes</a>, associated with loss of responsiveness to insulin. A further seven million people are at high risk of developing Type 2 diabetes, reflecting an ageing and increasingly inactive, overweight and obese population.</p>
<p>Individuals living with diabetes face an increased risk of heart disease, stroke, lower limb amputation, kidney disease and blindness. This has a negative impact on social and economic independence and reduces life expectancy by up to 14 years. </p>
<p>In Scotland, more than a quarter of a million people have diabetes. This is just below 5% of the population, which is slightly better than the 6% in the UK as a whole, but it appears to be getting worse more quickly, with incidences having doubled in the past ten years alone. It is worth stressing the need to be careful with these numbers: to some extent they may reflect advances in being able to diagnose the disease. But saying that, there seems little doubt that the problem is getting worse. </p>
<p>Diabetes <a href="http://www.diabetes.org.uk/upload/Scotland/State%20of%20the%20Nation%2311a_ScreenRes_SinglePages.pdf">costs the NHS</a> in Scotland more than £1 billion a year, 80% of which is spent on managing avoidable complications associated with the disease. People with diabetes account for around one-fifth of hospital in-patients at any point in time and spend nearly three days longer in hospital than patients without diabetes.</p>
<h2>Direction of travel</h2>
<p>Cases of both Type 1 and Type 2 diabetes are increasing in number. Scotland has the third-highest incidence of childhood Type 1 diabetes in the world (after <a href="http://www.ncbi.nlm.nih.gov/pubmed/17727380">Finland and Sardinia</a>), and levels of Type 2 diabetes are also increasing in young individuals. </p>
<p>Type 1 diabetes is an auto-immune disease and has nothing to do with lifestyle choices. The high and growing prevalence is not well understood. On the other hand, with Type 2 diabetes, the evidence shows that about three-quarters of sufferers are either overweight or obese (with most of the remainder either explained by tendencies within families or ethnicity, with south Asians and Afro-Caribbeans most at risk). So this increase goes hand in hand with the fact that Scottish people are <a href="http://www.strathclydetelegraph.com/2014/04/spotlight-scotlands-obesity-epidemic-really-blame/">increasingly likely</a> to be overweight. </p>
<p>Significantly, 13.8% of very young Scottish children <a href="http://www.heraldscotland.com/news/health/young-scottish-children-getting-fatter.18980840">were reported to be</a> obese in 2010, and only 65% of school children were of a healthy weight. <a href="http://www.diabetes.org.uk/upload/Scotland/State%20of%20the%20Nation%2311a_ScreenRes_SinglePages.pdf">Overall</a>, one in five people either has or is at high risk of diabetes.</p>
<p>So – an uphill battle indeed. In a bid to turn it around, eight years ago the Scottish government set up the <a href="http://www.sdrn.org.uk/">Scottish Diabetes Research Network (SDRN)</a>, which was developed a National Research Register for patients wishing to take part in research with the aim of improving the quality and quantity of diabetes research in Scotland. It is an impressive initiative, which doesn’t exist elsewhere in the UK for example. </p>
<p>New treatments are now emerging or being tested in large-scale clinical trials. Research is ongoing into <a href="https://www.scotblood.co.uk/about-us/tissues-and-cells/islet-cell-programme.aspx">islet cell transplantation</a> with a view to developing a vaccine for Type 1 diabetes.</p>
<h2>Route map</h2>
<p>In 2010 the government published <a href="http://www.scotland.gov.uk/Publications/2010/02/17140721/0">a route map towards healthy weight</a>.
It outlined plans for reducing Scotland’s energy consumption, encouraging more exercise, and instilling good habits during early years with a view to improving the proportion of children within the healthy weight range. </p>
<p>The government <a href="http://www.scotland.gov.uk/Resource/0043/00438827.pdf">published a report</a> in 2013 that looked at how this strategy had been progressing. It showed early signs that obesity had reduced slightly, while acknowledging there was still a long way to go. This is an encouraging sign, though it has not yet produced any decline in the diabetes numbers. </p>
<p>Since the early 2000s, the authorities have also monitored the quality of diabetes care across Scotland by the <a href="http://www.diabetesinscotland.org.uk/Publications.aspx?catId=3">Scottish Diabetes Survey</a>. The survey provides key information to help NHS boards identify what is needed to improve care or outcomes for diabetic individuals. </p>
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<a href="https://images.theconversation.com/files/51071/original/td996h7g-1402668930.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/51071/original/td996h7g-1402668930.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/51071/original/td996h7g-1402668930.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/51071/original/td996h7g-1402668930.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/51071/original/td996h7g-1402668930.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/51071/original/td996h7g-1402668930.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/51071/original/td996h7g-1402668930.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/51071/original/td996h7g-1402668930.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>
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<span class="caption">Insulin injections: Daily life for diabetes sufferers.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/youngun/4932175472/in/photolist-8vQFW9-zvQpz-zvQnS-65hUvj-5kyLzu-JVzo4-cTvvCb-45sPBT-41RAZ1-9RALpZ-3EW2MH-zvQsG-zvQvQ-zvQui-4u9SNL-jKFvjp-hLuPbP-49EZ8C-JQiu-JVzrc-jKGX2A-cc3FPE-6TdHu-h7Pwf7-h7MmsK-h7Ng4h-5Rcz4H-4oLJ3p-4aX8RT-dEgcWb-47GZvL-bbntCM-vNYqH-55DH1J-8Uu562-4iSAQX-55DFMo-55DNUN-55DHMd-55DN8L-55zL62-55zXrM-55DGhs-55zy9n-55zAnP-55DKi5-55zB9H-55DL2y-4z8pHW-9CCipc">Mike Young</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>For example, one priority is to ensure that individuals with Type 1 diabetes achieve optimal control of their blood glucose: four out of five individuals, particularly 15-25 year olds do not achieve target levels, increasing their risk of life-threatening <a href="http://www.nhs.uk/conditions/diabetic-ketoacidosis/Pages/Introduction.aspx">ketoacidosis</a> and other serious complications in the future. </p>
<p>Does this add up to a good package? The truth is that it will be years before we know for sure. It will be vital that we keep monitoring our progress against the route map and make changes if we seem to be heading in the wrong direction.</p>
<h2>Self-management</h2>
<p>The other side of the coin is that individuals need to take responsibility for their own health, whether or not they already have diabetes. There tends to be a lot of emphasis on confronting people with their failures to make the right choices, which in my view is more likely to lead them to give up rather than change their behaviour. </p>
<p>Instead it is worth emphasising the positive steps that people can take on their own. Those living with diabetes can register to access their own clinical information on an <a href="http://www.mydiabetesmyway.scot.nhs.uk">interactive diabetes website</a>. It helps people who have diabetes, with their carers, to self-manage their disease. </p>
<p>Good self-management involves carrying out nine key healthcare checks each year. These include measuring blood glucose, blood pressure and cholesterol; retinal screening, a foot and leg check, assessing kidney function (urine and blood), and checking their weight and smoking status. Diabetes UK also recommends care planning, emotional and psychological support, inpatient diabetes support, advice during pregnancy, access to insulin pumps, education and self-management. </p>
<p>For individuals who do not have diabetes, it is vital that they understand their future risk of diabetes, for example by using the online <a href="http://www.diabetes.org.uk/Professionals/Diabetes-Risk-Score-assessment-tool/">Diabetes UK risk assessment tool</a>. Those considered more at risk can then take preventive measures such as reducing their weight and doing more physical activity. With education and encouragement, the hope is that we can start to turn the corner. </p><img src="https://counter.theconversation.com/content/28007/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ann Graham receives funding from from BSF, BHF, Heart Research UK, Alzheimer’s Research UK, The Leverhulme Trust, BBSRC/CASE, Diabetes UK, Rosetrees Trust.</span></em></p>The number of people with diabetes in the UK has more than doubled over the past two decades, with more than 3.8 million people currently affected. Around 10% of them have Type 1 diabetes, which is caused…Ann Graham, Professor of Vascular Cell Biology, Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.