Stay slim to stave off disease and save the planet

Chronic diseases and climate change are inextricably linked. For example, obesity causes chronic disease and affects climate change. Healthy body mass indexes (BMI) have environmental benefits in terms of lower greenhouse gas emissions.

A population with 40 per cent obesity uses a fifth more food, leading to more greenhouse gas emissions from food production. The UN Framework Convention on Climate Change wants everyone to pursue “sustainable lifestyles”, which means living a life that uses as few resources as possible and causes the least amount of environmental damage.

It means eating natural foods that are grown and produced in a sustainable way. It means reducing waste – the Environmental Protection Agency estimates that we throw away one-third of all the food we buy. It means walking, cycling and using public transport. Sustainable lifestyles are healthy but the emphasis shifts from the individual, to the collective, "do it for all of us and for the planet".

Chronic diseases

Ireland, like most EU countries, has a huge problem with chronic diseases, most of which can be prevented or delayed by not smoking, eating healthily and being physically active. Three-quarters of all ill health in Ireland is due to chronic diseases such as heart failure, asthma, chronic obstructive pulmonary disorder (COPD) and diabetes. Almost one-third of Irish adults are affected by one or more chronic diseases and this is expected to increase to 40 per cent by 2020.

The Cost of Heart Failure in Ireland

published recently by the

Irish Heart Foundation

(

[ Health+Family, December 15th ]

) shows that 90,000 people suffer from heart failure and a further 160,000 have heart failure with no symptoms.

The HSE’s Service Plan 2016 says chronic disease is the biggest risk to health service provision. The service plan prioritises “self-care and self-management” using a three-pronged approach. It includes: delivering “high impact, evidence-based communication and education campaigns to enable and support people to make healthy lifestyle choices”; a national framework for health behaviour change intervention and training to make “every contact count”; and a national framework for self-management support for chronic disease.

The HSE would be wise to spend its campaign budget on effective self-management programmes because information does not change behaviour. These self-management programmes are not cheap and, when delivered in accordance with best practice, can cost the same as conventional treatment programmes. Self-management is a complex science.

The Health Information and Quality Authority (Hiqa) has just published a new report about health technology and the assessment of chronic disease self-management support interventions. It examines the effectiveness of generic self-management support interventions for chronic diseases and disease-specific interventions for asthma, COPD, diabetes (Type 1 and Type 2) and cardiovascular disease such as stroke, hypertension, coronary artery disease and heart failure.

Systematic reviews were undertaken for each disease area and included evidence from more than 2,000 randomised controlled trials. This 500-page review found good evidence of effectiveness for some self-management interventions and limited or no evidence for others. One size does not fit all.

Education, training and action plans work for asthma. Patient education works for Type 2 diabetes but not for Type 1. Education and pulmonary rehabilitation work for COPD. Hiqa’s advice to the HSE is to prioritise investment in interventions for which there is good evidence of clinical effectiveness and concludes it must “have an agreed definition of self-management support interventions”.

This seems obvious but the service plan does not define what models of self-management interventions it intends to pursue. Instead it emphasises healthy lifestyles, which service users may interpret as a money-saving exercise. The HSE would be wise to start encouraging sustainable lifestyles which are easier to sell to citizens. Most people want to do something about climate change.

Huge advantages

The shift in emphasis from an individual healthy lifestyle approach to a collective sustainable lifestyle one has huge advantages. The HSE will get more support for its chronic disease self-management programmes and patients will not feel preached at. The Government will be able to introduce legislation and fiscal policies to encourage people to be healthy without being accused of nanny stateism.

Fat and sugar taxes can be levied to ensure the country meets its commitments under the Paris accords. Producers of nutrient-poor, energy-dense foods can be forced to make their products healthier for climate-change reasons. Taxpayers will be happy to invest in public transport, cycle-ways and safe places to walk. Sustainable lifestyles are a win-win for everyone.

drjackyjones@gmail.com Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council.