Tuesday 30 September 2014

The politics of wellbeing: how health checks can help us to know ourselves

Much of the debate surrounding the NHS Health Checks has focussed, quite rightly, on how the programme is most effectively delivered and the ways in which communities are best engaged. At times, opponents of the scheme have even raised questions as to whether the national programme should feature as part of public health policy. Whilst these issues are amongst the main topics to have been featured on this blog, this post looks more generally at the politics of wellbeing and how individuals are being empowered to take the reigns when it comes to their heart health. 
As Jules Evans – the author of Philosophy for Life – explores, as far back as the Ancient Greeks the promotion of physical and mental health has been an important concern of many governments. Indeed, Aristotle and Plato’s idea that the state should encourage the flourishing of its citizens has become the overwhelming consensus today. For Evans, the fact that the UK government recently agreed to spend half a billion pounds training 6,000 new CBT therapists shows the extent to which the nation’s wellbeing has become a prominent concern of policy makers.
As the ancient philosophers would be the first to acknowledge however, taking steps to improve mental wellbeing represents only part of the whole picture. Working to improve the nation’s physical health and lifestyle are equally fundamental to a progressive wellbeing agenda, particularly at a time when waistlines are steadily expanding and populations are ageing.
In the UK today, the NHS Health Check programme represents perhaps the most comprehensive and wide-ranging attempt to improve peoples’ general awareness of their health and cardiovascular risk. Indeed, the Socratic assertion that one should ‘know thyself’ is arguably, in the physical sense at least, exactly what an NHS Health Check aims to promote.
During a health check, individuals are presented with an opportunity to find out about how factors such as their cholesterol and blood pressure may be affecting their health. With this knowledge in hand, these individuals are then able to discuss with a trained health professional the ways in which they might go about making any lifestyle changes they regard as important. Information about local support services is also on offer, with providers able to make any appropriate referrals.
As Rashmi, a 55 year-old service user reports in this interview, ‘if it wasn’t for the health check', he would not have known that he had diabetes. After gaining the insights into his personal health, Rashmi decided it was time ‘to take control’ of the situation and began looking closely at his lifestyle in order to make the changes that would bring his diet and weight under control. In essence, that short appointment with his GP allowed Rashmi to address some fundamental questions about how he felt he should have been living. Rashmi has since been able to come off using insulin and tablets altogether and now manages his diabetes with a controlled diet.
Whilst a number in the medical profession continue to cite a lack of evidence for the national programme, feedback from service users repeatedly points in a different direction. For many like Rashmi, the NHS Health Checks bring the notion of making lifestyle changes to the very top of their personal agendas. It's case studies such as this that show how these brief consultations are helping many individuals take personal responsibility for their cardiovascular wellbeing.
Why however should 'knowing our numbers' be so important and conducive to improving our lifestyles? One suggestion may be that becoming aware of one's health status and prospects makes a crucial difference to the way in which health messages are received. Though it seems common that people choose to turn a blind eye to the well-known virtues of eating healthily for example, clearly and tangibly seeing how diet may be influencing the personal likelihood of developing heart disease gives these messages a potency and an immediacy that's difficult to ignore.
As the British Heart Foundation reaffirmed by including it as one of their 'top 10 tips to lead a heart healthier lifestyle', taking up an NHS Health Check can be the gateway to making the changes that make the difference. What's more, in terms of England's NHS Health Check model, harnessing peoples' ability to reconfigure their own lives is seen as essential to any profound and long-lasting improvement in our collective cardiovascular health. At a time when GPs are increasingly under pressure and with that trend looking to continue, promoting this preventative and patient-focussed agenda is as important as ever.
With yesterday having been World Heart Day, it's as good a time as any to acknowledge that ultimate responsibility lies with individuals themselves; whilst many of the most common lifestyle related diseases are preventable, taking steps to avoid them may mean making decisions to change. That said, the tools with which we can generate insight and implement this change have been put in place. For anyone between the ages of 40 and 74 who's not been previously diagnosed with a chronic condition and hasn't had a health check in the past 5 years, they're here to be taken advantage of.