Interview with Dr Charles Alessi, Chairman of The National Association of Primary Care
Q. On average people are living longer in the UK. Are they living longer in good health - or is modern medicine keeping people with chronic illness alive for longer?
A: At the moment they’re not living longer in good health. We’re managing longevity better – but haven’t yet managed to add life to years. That’s the challenge.
Living longer when you’re seriously chronically ill is not something any of us wants. What we all aspire to is more productive and independent years to life.
Q. How does the UK compare with other developed countries as regards health and longevity?
A: Average life expectancy here is now around 80, compared with 83 in the countries where people live longest.
One interesting development is that the gap between how long men and women live has started to close. On average women used to live six years longer than men. That’s now down to three years, probably in part because managing cardiovascular disease in men has improved and men have a greater risk for coronary artery disease and heart attacks earlier in life than women.
Quality of life is probably no worse in the UK than in most other developed countries.
Q. What are the three most significant things we should stop doing, or do less of, to reduce the risk of chronic illness?
A: Avoiding obesity is really important. This can’t be underestimated. A study in Cuba compared periods when fuel and other supplies were reasonably plentiful (so people drove more and ate more) and when they were less plentiful (so people walked more and ate less). In the period when people walked more and ate less they were healthier and lived longer.
Stop smoking. The health risks are well known and real. It is a pity the government haven’t approved plain packaging for cigarettes.
Avoid excessive alcohol consumption. In short, the usual suspects when it comes to chronic illness.
Q. What are the three most positive things we can start doing, or do more of, to help maintain good health throughout our lives?
A: Vigorous exercise, whatever your age. I’d like to see the rise of health clubs which aren’t just advertised with images of young people in leotards. Out of all the things we can do exercise is the most important. It doesn’t have to be going to the gym. Walking more can make a big difference and is something most of us can do. For instance I walked from the station to work this morning rather than catching the Tube.
Intellectual stimulation and interaction with other people. A large Danish study published this month has shown this has the biggest impact when it comes to slowing cognitive decline. As we get older our minds don’t have to get feeble. Also Social isolation kills people
Take the opportunity and have a health check. These are now available to all of us between the ages of 40 and 74, who have not already been diagnosed with a long term condition. Look after yourself.
Q. Is there anything we can do to help delay or reduce the risk of dementia?
A; Two big studies have just been published. As the New York Times reports, dementia rates among over 65’s in England and Wales are falling. This seems to be due to higher levels of education (exercising the brain) and to healthy behaviour, like controlling blood pressure and cholesterol (reducing the cardiovascular causes of dementia). This suggests two practical things we can do to delay or reduce the risk of dementia.
Q: What do you see as the main obstacles to people living healthy lives?
A: Unfortunately, people don’t always realise what a difference their actions can make. And there’s often a sense that if something goes wrong doctors and the NHS or health insurance will fix it, so they don’t need to bother doing things to stop getting ill in the first place. We have an equal responsibility to manage our health – and to do our bit to help.
Q: How can we overcome these obstacles?
A: Education. There’s lots of health information on the internet. It isn’t always true but it has changed the relationship between patients and doctors, particularly where people have long term conditions.
Health checks (like blood pressure and cholesterol) are now also becoming more readily available, for example through GPs and pharmacists.
Q. Sometimes we hear talk of treating the whole person not the disease. What does this mean – and can you give an example?
Clinicians need to start treating people rather than individual diseases. Sometimes different diseases have similar causes and care needs. For example high blood pressure, high cholesterol levels and high blood sugar/glucose can increase the risk of diabetes, heart attack, stroke, some cancers and dementia. And there can be a knock on effect. For instance diabetics are twice as likely to get dementia. So it makes sense to look at the big picture (the whole person) when it comes to our health.
The twentieth century was the century of evidence based medicine. The twenty first century will be the century of personalised medicine.
What does the patient actually want? For instance one patient needed a knee replacement and had an operation. At first it looked to be successful. She could walk up stairs easily for example. However, she was very upset. Following her operation she found it difficult to kneel to pray. She couldn’t do what for her was the most important way of using her knees. People need to determine what is important for them.
Q. Medicine has become increasingly evidence based. This is presumably a good thing. Are there any disadvantages to this approach?
A. Evidence based medicine is very good if you have one long term condition but not if you have quite a few – and many people have four or more.
Evidence based medicine needs to be applied to individuals and also to situations. One size may not fit all. If you’re elderly and infirm, for example, what might be appropriate to do on a pleasant summer’s day, like going for a test, might not be as appropriate on an icy winter’s day.
Q. Where can people find reliable, easy to understand information about what they can do to increase their chances of living long and healthy lives?
The major health charities and pressure groups, like the British Heart Foundation, the Alzheimer’s Society and Diabetes UK usually provide reliable, easy to understand information. However, this can all be a bit compartmentalised if you have a number of conditions. It might help to have a more joined up approach to make sure we’re not missing out on the whole person. Public Health England may be able to help achieve this.
Q: When it comes to preventing people getting ill, in the years to come what sort of things might this involve in practice?
Genome testing could change everything. If we know early in childhood what conditions we’re more susceptible to then we can choose a diet and lifestyle to reduce the risk, we can test for the risk during our lives and, if we do become ill, then there’s a better chance we can take drugs that really work for our population type ie people like us.
Interview published: 26/07/2013