For a start, greater investment in population health would make people, particularly vulnerable population groups, more resilient to health risks. The health and socio-economic consequences of the virus are felt more acutely among disadvantaged populations, stretching a social fabric already challenged by high levels of inequalities. The crisis demonstrates the consequences of poor investment in addressing wider social determinants of health, including poverty, low education and unhealthy lifestyles. Despite much talk of the importance of health promotion, even across the richer OECD countries barely 3% of total health spending is devoted to prevention. Building resilience for populations also requires a greater focus on solidarity and redistribution in social protection systems to address underlying structural inequalities and poverty.
The COVID-19 pandemic has made it evident that to improve the health of the population and build healthy societies, there is a need to shift the focus from illness to health and wellness in order to address the social, political and commercial determinants of health; to promote healthy behaviours and lifestyles; and to foster universal health coverage.² Citizens all over the world are demanding that health systems be strengthened and for governments to protect the most vulnerable. A better future could be possible with leadership that is able to carefully consider the long-term health, economic and social policies that are needed.
Fee-for-service models that remunerate physicians based on the number of sick patients they see, regardless the quality and outcome, dominate healthcare systems worldwide. Primary prevention mandates a payment system that reimburses healthcare professionals and patients for preventive actions. Ministries of health and governmental leaders need to challenge skepticism around preventive interventions, realign incentives towards preventive actions and those that promote healthy choices by people. Primary prevention will eventually reduce the burden of chronic diseases on the healthcare system.
As I reflect back on Emily and her life, I wonder what our healthcare system could have done differently. What if our healthcare system was a well-care system instead of a sick-care system? Imagine a different scenario: Emily, a 32 year old pre-diabetic, had access to a nutritionist, an exercise coach or health coach and nurse who followed her closely at the time of her first visit with me. Imagine if Emily joined group exercise classes, learned where to find healthy foods and how to cook them, and had access to spaces in which to exercise and be active. Imagine Emily being better educated about her diabetes and empowered in her healthcare and staying healthy. In reality, it is much more complicated than this, but if our healthcare systems began to incentivize and invest in prevention and even rewarded Emily for weight loss and healthy behavioural changes, the outcome might have been different. Imagine Emily losing weight and continuing to be an active and contributing member of society. Imagine if we invested in keeping people healthy rather than waiting for people to get sick, and then treating them. Imagine a well-care system.
Lang, J., Cluff, L., Payne, J., Matson-Koffman, D., & Hampton, J. (2017). The centers for disease control and prevention: findings from the national healthy worksite program. Journal of occupational and environmental medicine, 59(7), 631.
Governments are challenged by how best to provide care to their populations and make their systems sustainable. Neither universal health, single payer systems, hybrid systems, nor the variety of systems used throughout the US have yet provided a solution. However, systems that are ranked higher in numerous studies, such as a 2017 report by the Commonwealth Fund, typically include strong prevention care and early-detection programmes. This alone does not guarantee a good outcome as measured by either high or healthy life expectancy. But there should be no doubt that prevention and early detection can contribute to a more sustainable system by reducing the risk of serious diseases or disorders, and that investing in and operationalizing earlier detection and diagnosis of key conditions can lead to better patient outcomes and lower long-term costs.
Successful investment exits in LMICs and other private sector success stories will attract more private capital. Governments that enable and support private investment in their healthcare systems would, with appropriate governance and guidance, generate benefits to their populations and economies. The economic value of healthy populations has been proven repeatedly, and in the face of COVID-19, private sector investment can promote innovation and the development of responsible, sustainable solutions.
Joyce lies next to 10 other women in bare single beds in the post-partum recovery room at a rural hospital in Uganda. Just an hour ago, Joyce gave birth to a healthy baby boy. She is now struggling with abdominal pain. A nurse walks by, and Joyce tries to call out, but the nurse was too busy to attend to her; she was the only nurse looking after 20 patients.
Adopted by United Nations (UN) in 2015, the Sustainable Development Goals (SDG) are a universal call to action to end poverty, protect the planet and ensure that all enjoy peace and prosperity by 2030. SDG 3 aims to ensure healthy lives and promote wellbeing for all. The 2019 UN General Assembly High Level Meeting on Universal Health Coverage (UHC) reaffirmed the need for the highest level of political commitment to health care for all.
Key to protecting the health of your child is to get regular prenatal care. If you think you're pregnant, call your health care provider to schedule your first prenatal appointment. Many health care providers, though, won't schedule the first visit before 8 weeks of pregnancy, unless there is a problem.
At this first visit, your health care provider will probably do a pregnancy test, and will figure out how many weeks pregnant you are based on a physical examination and the date of your last period. He or she will also use this information to predict your delivery date (an ultrasound done sometime later in your pregnancy will help to verify that date).
Any of these is a good choice if you're healthy and there's no reason to anticipate complications with your pregnancy and delivery. However, nurse-midwives do need to have a doctor available for the delivery in case an unexpected problem arises or a cesarean section (C-section) is required.
By eating a healthy, balanced diet you're more likely to get the nutrients you need. But you will need more of the essential nutrients (especially calcium, iron, and folic acid) than you did before you became pregnant. Your health care provider will prescribe prenatal vitamins to be sure both you and your growing baby are getting enough.
Although you need to eat plenty of healthy foods during pregnancy, you also need to avoid food-borne illnesses, such as listeriosis and toxoplasmosis, which can be life-threatening to an unborn baby and may cause birth defects or miscarriage.
Also, although fish and shellfish can be an extremely healthy part of your pregnancy diet (they contain beneficial omega-3 fatty acids and are high in protein and low in saturated fat), you should avoid eating:
According to a Gallup study, people who "always make time for regular trips" had a 68.4 score on the Gallup-Heathway's Well-Being Index, in comparison to a 51.4 Well-Being score for less frequent travelers. One study found that three days after vacation, subjects' physical complaints, quality of sleep, and mood had improved compared to before vacation. These gains were still present five weeks later, especially in those who had more personal time and overall satisfaction during their vacation.
Studies orientated toward the physiological mechanism of breathing intervention effects have indicated a shared physiological basis underlying breathing, emotion, and cognition, involving the autonomic nervous system. Physiological evidence has indicated that even a single breathing practice significantly reduces blood pressure, increases heart rate variability (HRV) (Wang et al., 2010; Lehrer and Gevirtz, 2014; Wei et al., 2016) and oxygenation (Bernardi et al., 1998), enhances pulmonary function (Shaw et al., 2010), and improves cardiorespiratory fitness and respiratory muscle strength (Shaw et al., 2010). A daily 15-min breathing training for 2 weeks significantly promoted mean forced expiratory volume in 1 s and peak expiratory flow rate (Bernardi et al., 1998). Breathing with a certain frequency and amplitude was found to relieve clinical symptoms in patients of all ages with sleep-disordered breathing (Chervin et al., 2006). Evidence from yoga practice also confirms a reduction of sympathetic and an increase of parasympathetic nervous system activity (Vempati and Telles, 2002; Raghuraj and Telles, 2003). Cardiac vagal tone is assumed to form part of the shared physiological basis of breathing and emotion. It is influenced by breathing and is also integral to vagal nerve stimulation that is closely associated with the physiological basis of emotion, including emotional regulation, psychological adaptation (Sargunaraj et al., 1996; Beauchaine, 2001), emotional reactivity and expression, empathic responses, and attachment (Porges, 2001). Moreover, dysfunction of the autonomic nervous system is observed in adults with anxiety (Kawachi et al., 1995; Thayer et al., 1996; Friedman and Thayer, 1998), depression (Carney et al., 1995; Lehofer et al., 1997), PTSD (Sahar et al., 2001), panic disorder (Friedman and Thayer, 1998), and other stress-related mental and physical disorders (Benson, 1996; Becker, 2000; Bazhenova et al., 2001; Jacobs, 2001).
Although breathing practice offers an integrated benefit for mental and physical health, the results of studies on this topic are inconsistent, because of methodological limitations in the experimental design, a lack of measurable breathing feedback, and limited sample sizes. Most cross-sectional and longitudinal studies have focused on how breathing treatment benefits individuals with particular conditions, such as women during pregnancy (Schmidt et al., 2000; Booth et al., 2014) and clerks experiencing job burnout (Salyers et al., 2011), rather than on its health promotion function in a healthy population. Most importantly, most studies have investigated physiological effects, emotional benefits, and cognitive benefits separately, which prevents an understanding of the possible mental and physiological mechanisms of breathing in terms of its potential benefit for both mental and physical health. 2b1af7f3a8