PREVENTING AND COPING WITH DISEASE

Key messages 

The increase in the prevalence of disease as people live longer is mainly due to their environment rather than the ageing process and can be reduced

the effects of disease are often complicated by accelerated loss of fitness

healthcare is what individuals do for themselves and everyone should know their NHS number and hold their own record
  
What is disease?
This may seem a question with an obvious answer namely a disease is a condition that the medical profession and the WHO the World Health Organisation, classifies as a disease and includes in the International Classification of Diseases , It is however important to distinguish between two types of disease.

• The first type of disease is the disease in which it is clear whether the individual has the disease or does not have the disease. Tuberculosis would be an example of this but so would many non-infectious diseases such as rheumatoid arthritis or Parkinson’s disease.  
• The second type are conditions in which everyone in society has  some biological variable  but in which the medical profession has decided that when that variable reaches a certain level  then action has to be taken.  For example everyone has a blood pressure.  If you don’t have a blood pressure you are dead but with some people the blood pressure is so high that the risk of the person having a stroke or heart disease has reached a level at which  the risks of taking a drug to lower the heart disease is judged to be worthwhile. The doctor says, “you have got high blood pressure” but what the doctor is meaning is that “well your blood pressure is at a level at which we think you should consider taking this medication to reduce your risk even though there are side effects because the risks of high blood pressure are serious and could be fatal whereas the risks of taking the medication are relatively minor and do not affect everyone." 

Some other modern epidemics are conditions like this.  Type II diabetes for example is quite unlike type I diabetes.  Furthermore an increasing proportion of people have more than one long term condition and this is sometimes called multi-morbidity. It has now been recognised by the medical profession that simply having more than one disease is only part of the difficulties faced by the affected person. Their problems are often aggravated by the disorganisation of the health service. 
HEALTHCARE IS WHAT YOU DO FOR YOURSELF –
 Look after your own information 
 
We believe that everyone should have access to and be the owner of all the information about you and there are moves to do this but at present in too many parts of the country you could finish up with 

• a record on your GP's system
• a record on the hospital you have been treated at, hopefully just one record although you have been sat three different specialist services over the last few years
• a record at the big teaching hospital to which you were referred for super 

Different General Practices use different online services but the principle is the same- the person called the patient should be in charge of their record and their healthcare.

Reduce the risk of disease
 
The first step is to think about ways in which you can reduce your risk of disease and you can get help with risk reduction either from NHS Health Check Programme which invites people aged between forty and sixty-five for a Health Check or from the One You Programme in which you can download a programme that will allow you to assess your risk particularly your risk of heart disease and then plan actions that will reduce your risk.
The One You programme is also suitable for people over 65 and will help them reduce their risk not only of diseases like heart disease. It will also reduce the risk of dementia and frailty

Ensure that any treatment will do more good than harm 
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It is important to appreciate that all health care can do harm as well as good, even in the best of hands and when delivered at the highest quality.  Before taking any new treatment, it is important to ask sixquestions which were developed by the NHS in Scotland in their Realistic Medicine programme. The aim is not to save money but to help people get care that was right for them as an individual.  Here are the six questions

• What would happen if I did nothing?
• Is this test, treatment or procedure really needed?
• What are the potential benefits and risk?
• What are the possible side effects?
• Are there simpler, safer treatment options?
• What would happen if I did nothing

The Health Service now appreciates that people can often get medication from different doctors and different departments working in isolation who are unaware of the impact that the treatment that one department has introduced will have on a treatment introduced by another department.

Reduce the complication that can occur because of inactivity 

Obviously the effects of disease may have a direct impact on ability levels.  The person who has a heart attack for example loses heart muscle and therefore the maximum possible power of the heart is reduced.  However, what we also see is that for many people the onset of disease is marked by an acceleration of the actual rate of decline
 
The scientific evidence is that people with a long term condition or more than one long term condition are even more in need of activity than people without long term conditions and the good news from research is that at any age or with any number of long term conditions people who become more active close the fitness gap  What is of particular importance however is not only the strategy  to reduce the risk of disability, dementia and frailty after disease has developed but also there is now a major drive to help people who have one or more than one long term conditions, whatever their age, to take action to reduce the risk of these complications of disease by becoming more active. The medical profession is leading with Moving Medicine

LISTEN TO OUR PODCAST 

REDUCING THE IMPACT OF DISEASE
The probability of developing and living with long term health problems increases with age as does the probability of what is called multi morbidity namely having more than one condition.
However, as this podcast emphasises this is not because the common diseases that occur in old age like heart disease, stroke and diabetes are due to the ageing process.  What they are fostered by is the environment in which we live and have lived since birth, both the social and the physical environment. 
As the podcast emphasises our genetic inheritance is relatively unimportant and what top scientists are now discussing is the relatively greater importance of what is called the exposome.  This is analogous to the chromosome which is a collection of genes but the exposome is the collection of the influences of the physical and social environment in which we have lived and have lived.  It is the environmental influence and the way in which we have adapted to it that is the major cause of the common diseases of later life which we have hitherto assumed is called ageing and it is clear too, that as well as the physical diseases dementia is the result of environmental factors, and this will be discussed as part of a separate podcast on common health problems and what individuals and communities can do to tackle this.
In the podcast after this we will focus in particular on the social environment. 
Points for Reflection after listening and reading; if you are working through these podcasts with a group ask people to turn to their neighbour and discuss thesepoints or allocate them to a Zoom room if you are online

• Which disease would you most like to avoid?
• What would you say were the most significant aspects of your Exposome, for example parents who smoked or a job that required you to sit all day for forty years

Individual Action
Explain to a friend  why the prevalence of disease increases as we live longer?
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