The Continuum of Health
Transcriber: Rhonda Jacobs
Reviewer: Eunice Tan
We’re in the middle of the North Atlantic;
it’s late spring and pretty cold out.
My grandmother used to tell me
to bundle up or I was going to get sick.
But what does it mean to be sick?
Is it your kid that’s home
from school with a sniffle?
What about their grandparent
that has osteoporosis?
Well, if someone has cancer,
they have to be sick, right?
But there’s people that suffer
with mental health conditions
for their entire lives.
Well, the reality is there’s lots of ways
we define being sick.
According to the Global
Burden of Disease study,
96 percent of people in the world
have at least one medical condition
requiring medical attention.
Meanwhile, one-third
of the world’s population
has at least five medical
ailments concurrently.
I’m a professor now,
but in my former life,
I used to work with companies
to improve the health of their workers.
And I once met a guy we’ll call Joe,
who worked in the shipyard.
Now, Joe was like a lot of us
and thought he was healthy
because he was told he wasn’t sick.
Let me explain.
To get a job with these companies,
you have to pass a medical to be deemed
healthy enough to go to work,
and you have to do these every few years.
Well, Joe worked for one
of these companies as a crane operator.
His job was to lift several-ton containers
hundreds of feet in the air
over his friends working below
and load them onto container ships.
It’s a really dangerous job.
Now, one day, Joe’s eyes
started getting bad.
His glasses didn’t seem strong enough,
and his vision was getting
worse really quickly.
At no point did he think
he was getting sick;
he just thought there was something
wrong with his vision.
So he made an appointment
with an optometrist
to get a new prescription.
But what they told him wasn’t good.
He was told he had developed
a condition called macular edema,
which was strongly
associated with diabetes,
and he should go check
with his doctor right away.
Now, let’s just remember
that less than a year prior,
Joe was deemed healthy by a medical.
When Joe went back to the doctor,
the doctor confirmed these suspicions.
They told him that in the last year,
he’d become severely diabetic,
to the point it was causing
this vision loss.
His cholesterol had skyrocketed,
his blood pressure had gone up
and he’d developed hypertension.
When all these conditions
were put together,
it was determined he’d developed
a condition called metabolic disease,
which is strongly associated
with diabetic complications,
fatal heart attack and stroke.
Now, for a bit of background,
Joe was middle-aged, he was obese,
he had a self-admitted poor diet
and he never exercised.
So he had all the risk factors
for these conditions.
But what had happened
was his previous medical had given him
a false sense of security,
and that clearance had made him
think he was healthy,
when in reality, he just wasn’t sick yet.
The reason I used the case of Joe
is that he’s like so many of us,
and that’s because we’re taught
that health is binary:
we’re either sick or we’re healthy.
But even if we’re in that small
proportion of the population
that’s free from disease,
that only means at this moment.
Our health status
can change from day to day,
month to month and year to year.
Health is a continuum.
It’s a lot like a thermometer.
And if there’s one thing we know
here in Newfoundland and Labrador,
it’s how to read the temperature
and judge the weather.
We all know that at 15 degrees Celsius,
we’re wearing shorts,
and at zero degrees Celsius,
we should probably drive slow
because it could be icy.
Each degree in that thermometer
gives us a piece of information
that we can use to make decisions.
So like a thermometer,
our health can change.
But unlike a thermometer
that only goes up and down,
our health can go
in many different directions.
The problems start when we go
to the doctor to check our health status,
or to find out what the “temperature” is.
That’s because only two in five Canadians
have the ability to obtain, understand
and then act on the information
they’re provided by their doctor.
Meanwhile, one-fifth of Canadians don’t
have access to a family doctor at all.
That means that 60 percent of us
have no idea what our health status is,
and even if we’re provided
the right information,
we don’t know what to do with it.
For most people,
trying to understand our health
is like trying to understand the smell
of the color nine.
So how do we fix this problem?
Well, the good news is that even a bit
of information can be really powerful,
and that is called health literacy.
Health literacy is defined
as the degree to which
an individual has the capacity to act on
and understand basic health information
in order to make
appropriate health decisions.
And it’s amazing what we can do
with a bit of the right information.
Here’s an example we all know.
For many of us,
buying a house is a huge goal
and an even bigger investment,
so we value it.
If we’re buying a house,
we get it inspected.
If it’s losing heat, we’ll insulate
the walls or replace the windows.
If the roof is leaking,
we’ll fix the shingles
before the rain ruins the ceiling.
After a big snowstorm
like Snowmageddon,
we’ll spend hours or days digging it out.
It’s because we feel like we can’t
let it deteriorate; we have to value it.
So why is it that we value our homes
so much and not our health?
Well, it’s because quite often
our health isn’t valued until it’s lost.
Now, if you ask me
how we’d start to fix this,
I’d start here because
I work with people’s physical health.
Our physical health changes
throughout our life,
so it makes sense we should
continually learn about health
as it relates to our life circumstances.
Now, if you haven’t noticed,
this health is basically absent from
our community and public health education.
The last time most of us learned
about health was in middle school,
and it was about getting pregnant
and our voices changing.
Take our buddy Joe, for example.
He now knows that he has to eat better,
so he goes online to do some research.
Well, here’s what Joe’s going to find out.
He’s going to find out, I can’t eat fruit
because it’s got fructose,
which is bad for my diabetes.
I can’t eat fats because
it’ll increase my cholesterol.
Too much protein will damage my kidneys,
but it’s better than sugar,
which increases my blood glucose.
So I guess I just won’t eat.
When you don’t eat,
your body goes into starvation mode,
which causes your metabolism to drop,
gain weight and amplifies
all your conditions.
It’s confusing, right?
Well, you’re not alone.
This is a common predicament for people
looking at improving their health,
because the majority
of wellness information
that’s readily available
is typically unregulated
and often provided by somebody who has
an agenda and trying to sell us something.
Meanwhile, our qualified
personnel are overburdened
by the barrage of patients
already in the health care system.
Now, just as important
as improving our wellness knowledge
is identifying the invisible barriers
that keep us from achieving good health.
That’s because there’s both physiological
and social determinants of health.
Our health is determined
by a variety of factors,
including our life circumstances,
our workplace, our environment
and the social and economic factors
that influence our lives.
Research shows that these social
determinants of health
can be just as, if not more, important
at predicting our long-term health
than our wellness choices
and even our medical choices.
That’s why we all know we should exercise
more and eat better and get more sleep,
but we can’t.
It’s because there’s very real barriers
that keep us from doing this,
some of which are more
challenging than others.
Maybe it’s cultural, like the case of Joe,
whose poor health is very in line
with the poor health of his community.
Or maybe it’s a single parent
with a tight food budget
and very little time to exercise.
Or maybe it’s somebody who’s addicted
to the foods that make them feel good
but ultimately make them sick.
These are all valid reasons
and in many cases, extremely limiting.
But this is why health literacy
becomes so important.
It provides us with a toolbox
that allows us to be adaptable.
So why do I feel this way?
Well, I spent 25 years of my life
working in the world of wellness
and 16 years in university,
and guess what I found out.
I found that people that make
small changes in their health
typically get the exact same results
as people that strive
for wellness perfection,
with the added benefit, they’re able
to sustain these changes over time.
The resounding takeaway from my research
was that with basic wellness education,
people could make informed decisions
around their health.
This could be changes to their diet
and exercise and lifestyle
based on their personal, physical,
social and economic challenges.
The results seen by these people
were typically the motivation they needed
to continue to improve on their own.
The saying “Don’t let perfect be the enemy
of good” couldn’t be any truer for health.
So this isn’t about us solving
all the health problems
facing our communities.
It’s about us -
finding out where we fall
in the continuum of health,
evaluating what we can do better
and improving our health.
And you may not know
how to improve your health literacy.
You don’t know where to start.
That’s okay. That’s why I’m here.
So here’s what I challenge you to do.
Next time you go to the doctor,
ask questions until you understand
what they’re telling you.
If you’ve had an injury for a long time
and it’s not getting better on its own,
then find someone to help you heal it.
If you have risk factors,
find out what they are
and how you can reduce them.
Do simple things to monitor your health,
like count your steps,
how much water you’re drinking,
how much you sleep
and what foods you’re eating.
If you think you’re healthy
and this doesn’t apply to you,
revisit your definition of health
and see if it needs to be updated
based on your current life circumstances.
And while you’re at it,
get a checkup and see where you fall
in the continuum of health.
Know where you stand
and what direction you’re moving.
Don’t wait until you’re sick
to make changes,
because it’s easier when you’re healthy.
Now, if you’re struggling
with your health,
then here’s a bit of hope.
Remember my buddy Joe?
Well, he found out what was wrong.
He found out what he had to do.
He made small changes,
and he got support for areas
that were barriers for him.
And ultimately, he was able to control
his health and get back to work.
Our health changes by degrees
just like a thermometer,
not only throughout
each season of our life,
but sometimes unexpectedly,
like stormy weather.
This doesn’t mean we’re not going
to get sick, just less likely to be.
Health is a continuum;
it’s always changing.
But the one thing we can control
is knowing where we fall on that continuum
and what actions we need to take
to move in the right direction.