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What I Have Learned about Advocating for Health Promotion

Yach, Derek, MBChB, MPH

Progress in Preventive Medicine: February 2017 - Volume 2 - Issue 2 - p e0003
doi: 10.1097/pp9.0000000000000003
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From the Vitality Group, New York, N.Y.

Received for publication 7 December 2016; accepted 15 December 2016.

Published online 3 March 2017

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

Correspondence to Derek Yach, MBChB, MPH, Vitality Group, 3 Columbus Circle, Suite 1656, New York, NY 10019; E-mail: dyach@thevitalitygroup.com

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Presenting at a TEDx event provided the perfect stage for advocating for better health.[1] The TEDx organizers and coaches work with the presenters to sharpen the arguments to focus on a core idea and to improve its delivery to a general audience. It is a performance, not a lecture series. The complexity of the topic has to be reduced to the essentials. Graphics and figures have to focus on the imperative ones that can be immediately understood. Jargon is cut. Timing is taken seriously. When they say 12 or 14 minutes, they mean it. I thought this task would be easy. It was not!

The live performance includes diverse presentations by outstanding people. Each presenter brings his/her idea, passion, and life’s work to the stage. Among the diverse people I shared my Monte Carlo session with, there was a solo, multiple trans-Atlantic sailor–turned marine scientist (Alexia Barrier); a survivor of gender violence–turned human rights lawyer (Sara Elizabeth Dill); a pianist who travels the world with his piano to “bring joy and happiness to all” (Marc Vella); a fashion designer leading the empowerment of black women (Jenke Ahmed Tailly); and a shipping company lawyer focused on the power of meditation (Micha Withoft).

In that setting, so much of health promotion could sound tedious, mundane, and unexciting. For some, maybe it did! The TEDx speech development process helped to frame the messages to attract interest that I could palpably feel on the day. Simple and powerful stories that engage the audience, visuals with an emotional underpinning as opposed to cold graphics, and a few surprising lines and action points are required to successfully communicate the messages.

I hope that you will watch my TEDx video and agree that the lines that resonated most included the following:

“Tough choices are made on a daily basis between treating a lesser number of sick versus preventing future ill-health in far greater numbers. The urgent crowds out the important.”

  • Governments and businesses spend more than 95% of their healthcare costs on treatment and care. They undervalue chronic disease prevention and health promotion.
  • Kahneman[2] showed that we often act irrationally. This prevents us from acting in our best long-term interests.
  • An emotive health scenario such as a child needing a transplanted organ captivates public attention and galvanizes funding. In contrast, there is no applause for an epidemic averted or for lives extended through healthy lifelong behaviors.
  • Thirty years ago this week on November 21, 1986, countries gathered in Ottawa, Canada, to develop guiding principles to make healthy choices the easy choice. Strategies initially focused on government actions.[3]

People no longer expect government alone to fix their health. They are being agents of their own health, being led by millennials who are impatient in creating a healthier world.

“Healthcare delivery must radically transform to be person-centric and preventive, rather than focused on curative care.”

  • A shift in focus is needed toward personalized precision health, where the focus is truly on maintaining optimal health upstream rather than treating the later and more costly onset of disease.
  • Person-centric care can be greatly facilitated by the healthcare sector optimizing its technology-enabled health infrastructure. This may include combining wearables or other health promoting behavior information recorded during the patient’s daily life with conventional health records. Another example is the utility of machine learning to inform tailored prevention.
  • Healthcare should be made accessible from various sources that are outside of the conventional healthcare delivery system to keep up with immediate accessibility.
  • Person-centric care will require a greater involvement of patients in their own health decisions, including prevention, by increasing their understanding of risk and how to reduce risk.

“We must recognize the broader role and influence of clinicians.”

  • The importance of the doctor–patient interaction is not merely the medication prescribed but a 2-way dialogue and contract. The impact on patient health outcomes by a doctor’s communication and empathy skills are increasingly recognized.
  • One of the strongest predictors of health promotion counseling by primary care physicians is practicing a healthful behavior oneself.[4] Data from Vitality’s members confirm that a doctors’ own lifestyle choices including smoking, weight, and health status can significantly influence their patients’ lifestyle choices.[5]
  • Training of clinicians in communication has been shown to influence their patients’ lifestyle choices, and simulated consultations may help to identify doctors who would benefit from such training.
  • Doctors can be strong advocates for health in their roles outside of the clinic setting.

“We must make markets work for disease prevention and health promotion.”

  • Personalized technologies that nudge, prompt, and support us are being used by innovative insurers, retailers, and technology companies to transform ways of engaging people in their health.
  • Software, computing, artificial intelligence, wearables, sports and leisure, insurers, and healthy food companies are forming a new ecology that place health—not healthcare—as central to business goals to benefit business and society.
  • It will soon be unacceptable for life insurers not to extend life by stimulating healthy behaviors or for health insurers to not promote health. It will soon be unacceptable to not improve access to reduced risk tobacco products as a means of cutting future tobacco deaths. And it will soon be unacceptable for food companies and retailers not to cut portion sizes and make healthy foods the more available, attractive, and affordable option.

“Reporting on health must become more transparent for us, for companies and for governments.”

  • Reporting on the health of employees, who are critical to companies’ productivity, morale, and long-term success, is virtually ignored. Reporting on the impact—positive or negative—of companies’ products and services on the health of billions of people is yet to start.[6]
  • In an increasingly transparent world, the more we can verify, the more we can eventually trust. That applies to all companies and governments who claim to advance health.

Imagine a world where governments, private sector companies, and personal incentives were aligned toward chronic disease prevention, health promotion, and the enhancement of life as we age. It would be a world in which tomorrow’s health gains and people’s increased vitality are the accepted way forward. It would be a world in which anything less would be deemed unacceptable.

Audience’s response favors individual struggles that are overcome and lead to benefits beyond the individual. They favor stories that start with a person they can identify with, or empathize with, or admire for courage or impact. As we consider how to increase the priority given to chronic disease prevention and health promotion, we need to do more to allow policymakers and the public see, feel, and experience the benefits in tangible ways and expressed by real people.

Preparing for my TEDx presentation reminded me of how easy it is to assume that data can speak for itself. It does not. The joy the audience experienced when the pianist played showed me that we have to better integrate smiles and tears with data if we are to succeed in putting in place the means for people to live in a world in which the “healthy choice is the easy choice.”

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Acknowledgments

Thank you to Gillian Christie, Cother Hajat, and Kymberlee Weil for their support in preparing my TEDx Monte Carlo presentation and this article.

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References

[1]. TEDxMonteCarlo. TEDxMonteCarlo: home to the world’s top innovators and forward thinking leaders. TEDxMonteCarlo. 2016. Available at http://www.tedxmontecarlo.com. Accessed November 28, 2016.
[2]. Kahneman D.. Thinking, Fast and Slow. 2013.New York, N.Y.: Farrar, Straus and Girous.
[3]. Christie G. Canadian leadership: the Ottawa charter for health promotion after 30 years. Vitality Institute. 2016. Available at http://thevitalityinstitute.org/site/wp-content/uploads/2016/11/Canadian-Leadership_Ottawa-Charter-2016.pdf. Accessed November 28, 2016.
[4]. Oberg EB, Frank E. Physicians’ health practices strongly influence patient health practices. J R Coll Physicians Edinb. 2009;39:290–291.
[5]. Yach D, Hajat C. Physician, heal thyself. Mail & Guardian. 2015. Available at http://mg.co.za/article/201508-06-physician-exercise-thyself. Accessed November 28, 2016.
[6]. Malan D, Radjy S, Pronk N, et al. Reporting on health: a roadmap for investors, companies, and reporting platforms. Vitality Institute. 2016. Available at http://thevitalityinstitute.org/site/wp-content/uploads/2016/01/Vitality-HealthMetricsReportingRoadmap22Ja.pdf. Accessed November 28, 2016.
Copyright © 2017 The Authors. Published by Wolters Kluwer Health Inc., on behalf of the European Society of Preventive Medicine.