For almost two years, McDonald’s was allowed to remain open almost all the time, while sports clubs had to close regularly. Liquor stores open, yoga centers closed. Coffee shops remained accessible, swimming pools were not.
Recently, this has been questioned a lot. Because the consequences for health are enormous, it is becoming increasingly clear.
For example, 34 percent of Dutch people started exercising less during the corona crisis, calculated sports dome NOC-NSF recently. And that during a pandemic in which body mass index (BMI) and general health are important determinants of the risk of serious illness when infected. Mental health is also under extreme pressure: never before have so many young people been lonely, anxious or depressed, according to the CBS.
Since the start of the pandemic, many doctors and health professionals have been frustrated with the lack of attention to the importance of a healthy lifestyle. Now that it is clear that this virus will remain for many years to come, is it time to talk less about illness and more about health?
How is it possible that lifestyle is still not central during this pandemic? “Getting and staying healthy is hard work,” says Sabine Pinedo, vascular internist, healthcare entrepreneur and a prominent pioneer of lifestyle medicine in the Netherlands. “While our society prefers quick solutions. We doctors have pills and injections, to get rid of their discomfort quickly, people ask for that too. But the root of the problem is rarely solved.”
Also according to radiologist and lifestyle doctor Femme Zijlstra, we are reducing illness and health to something that we can easily consume due to medicalization that has gone too far. “For health, we use the look that works well in acute medicine: there is someone who has had a car accident that has blood gushing from his thorax. If you cut that patient open, you can quickly sew up that bleeding vessel. Works great, that approach has brought a lot of good and new insights in recent decades.”
But most health problems are not acute but chronic. People are ill for a long time, they constantly feel sub-optimal, have multiple or constantly new complaints. Zijlstra: “If you apply the acute medicine model to this, you ignore the complexity of health and of life itself.” Pills and injections are often symptomatic, she says, and rarely solve the underlying problems.
Can it be otherwise? Many doctors have become convinced of this, even before the pandemic. This includes Thomas Plochg, director of the Federation for Health, a public-private network of about 80 organizations that is committed to a different approach to health problems. In the #MissieResiliency project that Plochg launched, a lot of attention is also paid to the role that patients have themselves, such as learning to deal with disorders, eating healthier and exercising more. In conditions such as diabetes, this can lead to a lot of improvement within a few weeks, according to research of the Leiden University Medical Center, among others.
“Let’s not look at a person as a single collection of cells, but at the whole picture, at the broader context in which a person lives,” says Plochg. According to him, we are too used to separating a person’s health from his cultural background, social environment and economic position, when those factors are all closely linked. According to him, health is not only about the care provided by doctors, but also about how people feel themselves mentally and physically.
As logical as this statement may sound, discussions about the relationship between lifestyle and health can quickly become fraught and sometimes even polarizing. Should Doctors Prescribe Bell Peppers Instead of Pills? Is a walk in the woods really better for your immune system than medicines? The boundary between holism and wishful thinking is not always clear.
It doesn’t help that lifestyle change is notoriously difficult.
Last year, gastrointestinal surgeon and researcher Maurits de Brauw published a summary of scientific research into the so-called combined lifestyle intervention in the Dutch Journal of Medicine. Evidence for the effectiveness of lifestyle change is rather poor, he concludes. For people who want to lose weight, weight loss is limited to about 5 percent in the short term and the vast majority do not manage to stay at that lower weight. Not only behavior plays a role, but also hormone balance and psychological health.
Various things add up to a healthier lifestyle. Sufficient relaxation, healthy food, regular exercise: almost all of us know that they matter, but yes: go for it.
And the psychological component of health often gets overlooked. When you are ill, how often do you think about things like meaning or nature as a medicine? Femme Zijlstra: “Even in lifestyle medicine, little attention is paid to the spiritual domain, for example for questions about meaning and spirituality.” While there is still no shortage of scientific research on the healing effect of rest, meditation, and meaning. It probably doesn’t help that these studies are rather eagerly published in self-help books where science and pseudoscience sometimes get mixed up.
But the evidence is pretty solid despite the hint of self-help. In so-called blue zonesthe places in the world where people live the oldest, such as on the Greek islands and in Japan, that meaning is shown time and again a significant factor. In addition to the healthy diets there, books have also been written about how central it is for people in those places to have a healthy diet ikigai to have: a reason to get out of bed, to experience a sense of meaning along with a close-knit community. But how often during the press conferences lately was it about meaning?
“We know from scientific studies how important a sense of autonomy over your life is for your health,” says Zijlstra. Not having control over one’s own health makes that same health measurably worse. None of these are groundbreaking ideas, but they are difficult to penetrate the medical world and social discussions about health, while they sound remarkably topical: how much say do people have over their (mental and physical) condition if they have nowhere to go and sports clubs are closed?
Or take nature: the list of proven health benefits of being outdoors is long. Being in nature more often encourages social contact, lowers blood pressure and stress, stimulates physical activity and according to researchers from Wageningen University it promotes, yes, a sense of purpose.
The opposite is also true: an unhealthy nature around you is unhealthy. Because the air in the Netherlands is so polluted with particulate matter, we are much unhealthier. The RIVM estimates the number of deaths due to particulate matter at 7,000 to 12,000 per year. By comparison, the official two-year corona death toll is about 21,000. According to pulmonologists, particulate matter shortens the lives of Dutch people on average by 13 months. “Unhealthy nature, dirty air, low soil quality: we know that these things lead to chronic inflammation in our body and vulnerability to viruses,” says Sabine Pinedo.
There are so many different things that interact for good health: from individual behavior to issues of meaning and from corona measures to environmental pollution. All that complexity can also be quite paralyzing. Where should you start?
In addition, in the polarized discussion between doctors and policymakers during the pandemic, it often seems as if people have to choose between lifestyle changes or acute medical solutions such as injections and pills. Couldn’t it be both-and? That a doctor if you have stomach problems, in addition to omeprazole, also prescribes a walk in the woods. But for the time being, ideas from one branch of medicine have difficulty penetrating the other. How often does a doctor prescribe a walk in the forest?
vague? Difficult to measure? Difficult to make concrete? Yes, that’s what health is, say these doctors. There is no easy list of ‘follow these three tips and you will be healthy’, no ‘five steps to a healthy lifestyle’.
Health is a complicated process that takes many years, not something you can buy in a hurry. And it is a challenge for the whole of society viewed in this systemic way. “Looking at health this way is complex, and it will be many years before it becomes the standard,” Pinedo says. “But we’ll have to, won’t we?”
A version of this article also appeared in NRC on the morning of January 25, 2022
#forest #walk #prescription