Health Promotion

Health Promotion
On MedHeads show this week
This week I chatted with Aileen Thoms about health promotion and lifestyle medicine.
Aileen has a master's degree in health promotion and is the director of primary health and innovation at a regional health service. She has a passion and a wealth of experience and expertise in this sometimes-neglected area of health care. As she says, an ounce of prevention is better than a pound of cure.

We discussed the following issues.

The definition of health

Aillen feels that one's definition of health needs to be contextualised, for instance health can mean body beautiful to a young person but could mean being able to do gardening pain free to an elderly person.

The determinants of health

Poor health has been shown to be associated with low social economic status, ethnicity, cultural background.

The difference between a proximal and distal determinant of health

It is important to understand the difference between a proximal versus a distal determinant of health. For instance, a plane crashes because it loses lift and gravity pulls it out of the sky. That is the proximal determinant of the plane crash. However why did the plane lose lift? Well, it could be the case that there was an engine malfunction because the engineer made a mistake during the last scheduled maintenance, because he did not sleep well the night before, because he had a fight with his wife the evening before. These factors are all more distal determinants of the plane crash. Similarly, in the context of disease, it is important to ask the question why.

For instance, people from lower socio-economic classes smoke more. But why? Is it because they have lower levels of health literacy? But why? Is it because they do not speak English well? But why? Is it because they come from a culturally and linguistically diverse background? But why? Is it because people from these backgrounds are not adequately supported by health policy? Asking why helps us all to consider the distal determinants of health.

The six pillars of lifestyle medicine

We discuss the six pillars of lifestyle medicine which are: the feet (exercise); the fork (diet); the fingers (smoking cessation, alcohol in moderation and abstinence from illicit drugs); sleep (we all need seven to nine hours sleep per night); stress management (stress is known to cause a wide range of diseases); and socialisation (we all need positive rewarding and nurturing relationships).

The changes that can be made to improve one's lifestyle

Within the above construct we all can make small changes which, if applied consistently, will provide benefits to our health in the long term. These could include walking more, eating less processed food and eating more vegetables, cutting down on alcohol, and going to bed earlier.

The barriers to change and how to overcome those barriers

It is not enough to know what to do, but rather we need to do it. Sometimes people may feel overwhelmed by what they perceive as an insurmountable challenge such as "lose ten Kgs". The trick is to break the task down into a series of smart goals. These goals should be specific measurable achievable relevant and time bound. The longest journey starts with the smallest step. All we need to do on a daily basis is take the next step towards a healthier lifestyle.

Author: Ferghal Armstrong
FRACGP, FAChAM, FASLM
Ferghal is a general practitioner, Adiction Medicine specialist and fellow of the Australasian Society of Lifestyle Medicine