The Sunday News
Dr Lovemore Moyo
An enduring truth is that health is the most precious form of wealth. Most people, however, are more alert at protecting inferior forms of wealth, such as money and material possessions which are replaceable if lost, compared to their health.
However, our tragic experience with Covid-19, has led to the realisation of how delicate and in need for protection our health is. Despite Covid -19 taking centre stage for the past year or so, other more deadly diseases have been and are still on the prowl and often cited as the drivers of Covid- 19.
These are the Non-Communicable Diseases (NCDs) also referred to as chronic diseases such as cancer, diabetes, cardiovascular conditions, hypertension which are estimated to account for 33 percent of total deaths in Zimbabwe.
For instance, each year in Zimbabwe, 5,000 new cancer cases are diagnosed resulting in more than 1,500 deaths. It is thought that cancer is set to overtake HIV and Aids as the leading cause of death.
The truth of the matter is that many cancer patients cannot afford the fees for services which include screening, biopsy, and chemotherapy.
The pain of losing loved ones to these deadly chronic diseases is compounded by the huge financial costs incurred in the treatment and care of patients before they die.
However, when it comes to chronic diseases, we do not have to be helpless victims. As will be shown below, given how these diseases develop, and new insights in the science of behaviour change, individuals, corporates and medical insurance entities have it in their power, if they so choose, to work for better health at lower costs.
The winning strategy against the misery and economic burdens of chronic diseases starts by looking at this simple sequence. Stress leads to unhealthy behaviours which lead to chronic diseases which then lead to health outcomes and costs.
At the centre of the development and prevalence of chronic diseases are the unhealthy behaviours in the population, namely the big five behaviours of smoking, drinking, diet, stress and physical inactivity. Stress is in a category of its own because, as pointed out below, it is the mother of unhealthy behaviours. This is how it happens. All the big five unhealthy behaviours cited above involve attempts by people to cope with stresses in their lives.
Hence one smokes so as to calm their nerves and relax, the abuse of alcohol comes from the need to ‘forget one’s problems’. Food which is cheap, sugary/salty and highly palatable is over- eaten not for nutrition, but as a source of comfort in a life characterised by a poor self-image and devoid of love and companionship.
Physical inactivity refers to the general sedentary behaviour of sitting too much at home and at work.
Stress and the resultant sleep deprivation, eating refined processed foods and physical inactivity are the behaviours behind the modern epidemics of overweight and obesity which are associated with chronic diseases.
To stop chronic diseases, the focus has to be on changing unhealthy behaviours.
There is just no way around this. Diabetes, for instance has increased by 328 percent from 1980 to 2019 worldwide despite all the medical advances.
The country with the most advanced medical technology and treatments and more highly trained medical professionals, namely the United States, has the worst cases of diabetes and obesity and second highest heart disease cases among the rich western nations.
The answer to the challenges of chronic diseases does not therefore lie solely in medical science.
The effective response to these diseases is in applying the innovations in human behaviour change sciences. There is a dilemma however.
Medical doctors are not trained in human behaviour change. Medical professionals advise their patients to exercise more, eat more vegetables and fruits.
However, compliance to these advises is very low. This is a frustrating experience for both the medical personnel and the patients who do not know how to change.
Due to the innovations in human behaviour science, behaviours can now be changed in favour of low cost wellness and health. Human behaviour change science came to the health industry through the practice of wellness and health coaching in the 1990s.
So successful has health coaching been in reversing some chronic diseases and reducing health care costs particularly in the U.S.A that hundreds of millions of dollars have been put in funding health coaching start-ups.
Although health coaching is still in its infancy in Zimbabwe, we can tap into some of its successful innovative behaviour change secrets, cited below, and apply them for better health at lower costs.
Stages of change. Firstly, is the knowledge that behaviour change takes place in predictable stages of pre- contemplation, contemplation, preparation, action, maintenance and termination. At each stage are certain change processes which are applicable.
These processes will be discussed further as we consider the specific unhealthy behaviours and how one can assess which stage they are at.
A focus on change processes not actions. The error with the advice to stop smoking/drinking too much/eating fast foods and to start exercising/eating more vegetables is that the focus is on the actions of stop and start. Success or failure is judged by the actions taken or not taken.
The problem is that many people who smoke (or any other unhealthy behaviour) already know they should stop smoking.
However, the people do not stop because they are not ready, willing or able. That is key and this is where health coaching is worth its weight in gold because it engages individuals where they are.
The insight from health coaching is that human behaviour change does not start at the action level but much earlier at the thinking and emotional levels.
Gymnasiums and corporate wellness programmes either flounder or operate well below capacity. Why? The reasons are that, these programmes, for all the good they intend to do, unconsciously target only a minority of people (about 20%) who are ready to take actions. The majority (about 80 %) either do not want, do not see the need or are at various stages of denial and delay.
In addition, a number of chronic diseases have no visible symptoms and their resolution is seen as not urgent. In some cases, the costs of unhealthy behaviours are seen as the medical insurance company’s responsibility.
Health coaching, using the stages of change model has a wider reach which include the reluctant, those in denial, the ignorant and the enthusiastic.
As an individual an early relapse in behaviour change is avoided by thoroughly running through one’s mind and emotions why they want to change, what they feel like about changing, what good picture they have of themselves after changes.
More importantly what they will do when obstacles to change are encountered. In Zimbabwe, there is a strategic advantage for companies and medical insurance entities to initiate their wellness programmes now to take advantage of how chronic diseases have now surpassed HIV and Aids as the leading causes of morbidity and mortality.
An important caveat however, is that such programmes need a health coaching backing for the low-cost health to be realised. Initiatives to train in-house health coaches are thus needed.Intrinsic motivation. People do not resist change, they just resist being changed. One has to look for their own internal reasons to change.
When we look at stress next week, we will learn more how this is done.
Dr Lovemore Moyo is a Wellness and Health coach and can be contacted at [email protected]
