improve your health essay

How to build a better health system: 8 expert essays

We need to focus on keeping people healthy, not just treating them when they're sick Image:  REUTERS/Rupak De Chowdhuri

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Introduction

By Francesca Colombo , Head, Health Division, Organisation for Economic Co-operation and Development (OECD) and Helen E. Clark , Prime Minister of New Zealand (1999-2008), The Helen Clark Foundation

Our healthy future cannot be achieved without putting the health and wellbeing of populations at the centre of public policy.

Ill health worsens an individual’s economic prospects throughout the lifecycle. For young infants and children, ill health affects their capacity to acumulate human capital; for adults, ill health lowers quality of life and labour market outcomes, and disadvantage compounds over the course of a lifetime.

And, yet, with all the robust evidence available that good health is beneficial to economies and societies, it is striking to see how health systems across the globe struggled to maximise the health of populations even before the COVID-19 pandemic – a crisis that has further exposed the stresses and weaknesses of our health systems. These must be addressed to make populations healthier and more resilient to future shocks.

Each one of us, at least once in our lives, is likely to have been frustrated with care that was inflexible, impersonal and bureaucratic. At the system level, these individual experiences add up to poor safety, poor care coordination and inefficiencies – costing millions of lives and enormous expense to societies.

This state of affairs contributes to slowing down the progress towards achieving the sustainable development goals to which all societies, regardless of their level of economic development, have committed.

Many of the conditions that can make change possible are in place. For example, ample evidence exists that investing in public health and primary prevention delivers significant health and economic dividends. Likewise, digital technology has made many services and products across different sectors safe, fast and seamless. There is no reason why, with the right policies, this should not happen in health systems as well. Think, for example, of the opportunities to bring high quality and specialised care to previously underserved populations. COVID-19 has accelerated the development and use of digital health technologies. There are opportunities to further nurture their use to improve public health and disease surveillance, clinical care, research and innovation.

To encourage reform towards health systems that are more resilient, better centred around what people need and sustainable over time, the Global Future Council on Health and Health Care has developed a series of stories illustrating why change must happen, and why this is eminently possible today. While the COVID-19 crisis is severally challenging health systems today, our healthy future is – with the right investments – within reach.

1. Five changes for sustainable health systems that put people first

The COVID-19 crisis has affected more than 188 countries and regions worldwide, causing large-scale loss of life and severe human suffering. The crisis poses a major threat to the global economy, with drops in activity, employment, and consumption worse than those seen during the 2008 financial crisis . COVID-19 has also exposed weaknesses in our health systems that must be addressed. How?

For a start, greater investment in population health would make people, particularly vulnerable population groups, more resilient to health risks. The health and socio-economic consequences of the virus are felt more acutely among disadvantaged populations, stretching a social fabric already challenged by high levels of inequalities. The crisis demonstrates the consequences of poor investment in addressing wider social determinants of health, including poverty, low education and unhealthy lifestyles. Despite much talk of the importance of health promotion, even across the richer OECD countries barely 3% of total health spending is devoted to prevention . Building resilience for populations also requires a greater focus on solidarity and redistribution in social protection systems to address underlying structural inequalities and poverty.

Beyond creating greater resilience in populations, health systems must be strengthened.

High-quality universal health coverage (UHC) is paramount. High levels of household out-of-pocket payments for health goods and services deter people from seeking early diagnosis and treatment at the very moment they need it most. Facing the COVID-19 crisis, many countries have strengthened access to health care, including coverage for diagnostic testing. Yet others do not have strong UHC arrangements. The pandemic reinforced the importance of commitments made in international fora, such as the 2019 High-Level Meeting on Universal Health Coverage , that well-functioning health systems require a deliberate focus on high-quality UHC. Such systems protect people from health threats, impoverishing health spending, and unexpected surges in demand for care.

Second, primary and elder care must be reinforced. COVID-19 presents a double threat for people with chronic conditions. Not only are they at greater risk of severe complications and death due to COVID-19; but also the crisis creates unintended health harm if they forgo usual care, whether because of disruption in services, fear of infections, or worries about burdening the health system. Strong primary health care maintains care continuity for these groups. With some 94% of deaths caused by COVID-19 among people aged over 60 in high-income countries, the elder care sector is also particularly vulnerable, calling for efforts to enhance control of infections, support and protect care workers and better coordinate medical and social care for frail elderly.

Third, the crisis demonstrates the importance of equipping health systems with both reserve capacity and agility. There is an historic underinvestment in the health workforce, with estimated global shortages of 18 million health professionals worldwide , mostly in low- and middle-income countries. Beyond sheer numbers, rigid health labour markets make it difficult to respond rapidly to demand and supply shocks. One way to address this is by creating a “reserve army” of health professionals that can be quickly mobilised. Some countries have allowed medical students in their last year of training to start working immediately, fast-tracked licenses and provided exceptional training. Others have mobilised pharmacists and care assistants. Storing a reserve capacity of supplies such as personal protection equipment, and maintaining care beds that can be quickly transformed into critical care beds, is similarly important.

Fourth, stronger health data systems are needed. The crisis has accelerated innovative digital solutions and uses of digital data, smartphone applications to monitor quarantine, robotic devices, and artificial intelligence to track the virus and predict where it may appear next. Access to telemedicine has been made easier. Yet more can be done to leverage standardised national electronic health records to extract routine data for real-time disease surveillance, clinical trials, and health system management. Barriers to full deployment of telemedicine, the lack of real-time data, of interoperable clinical record data, of data linkage capability and sharing within health and with other sectors remain to be addressed.

Fifth, an effective vaccine and successful vaccination of populations around the globe will provide the only real exit strategy. Success is not guaranteed and there are many policy issues yet to be resolved. International cooperation is vital. Multilateral commitments to pay for successful candidates would give manufacturers certainty so that they can scale production and have vaccine doses ready as quickly as possible following marketing authorisation, but could also help ensure that vaccines go first to where they are most effective in ending the pandemic. Whilst leaders face political pressure to put the health of their citizens first, it is more effective to allocate vaccines based on need. More support is needed for multilateral access mechanisms that contain licensing commitments and ensure that intellectual property is no barrier to access, commitments to technology transfer for local production, and allocation of scarce doses based on need.

The pandemic offers huge opportunities to learn lessons for health system preparedness and resilience. Greater focus on anticipating responses, solidarity within and across countries, agility in managing responses, and renewed efforts for collaborative actions will be a better normal for the future.

OECD Economic Outlook 2020 , Volume 2020 Issue 1, No. 107, OECD Publishing, Paris

OECD Employment Outlook 2020 : Worker Security and the COVID-19 Crisis, OECD Publishing, Paris

OECD Health at a Glance 2019, OECD Publishing, Paris

https://www.un.org/pga/73/wp-content/uploads/sites/53/2019/07/FINAL-draft-UHC-Political-Declaration.pdf

OECD (2020), Who Cares? Attracting and Retaining Care Workers for the Elderly, OECD Health Policy Studies, OECD Publishing, Paris

Working for Health and Growth: investing in the health workforce . Report of the High-Level Commission on Health Employment and Economic Growth, Geneva.

Colombo F., Oderkirk J., Slawomirski L. (2020) Health Information Systems, Electronic Medical Records, and Big Data in Global Healthcare: Progress and Challenges in OECD Countries . In: Haring R., Kickbusch I., Ganten D., Moeti M. (eds) Handbook of Global Health. Springer, Cham.

2. Improving population health and building healthy societies in times of COVID-19

By Helena Legido-Quigley , Associate Professor, London School of Hygiene and Tropical Medicine

The COVID-19 pandemic has been a stark reminder of the fragility of population health worldwide; at time of writing, more than 1 million people have died from the disease. The pandemic has already made evident that those suffering most from COVID-19 belong to disadvantaged populations and marginalised communities. Deep-rooted inequalities have contributed adversely to the health status of different populations within and between countries. Besides the direct and indirect health impacts of COVID-19 and the decimation of health systems, restrictions on population movement and lockdowns introduced to combat the pandemic are expected to have economic and social consequences on an unprecedented scale .

Population health – and addressing the consequences of COVID-19 – is about improving the physical and mental health outcomes and wellbeing of populations locally, regionally and nationally, while reducing health inequalities.¹ Moreover, there is an increasing recognition that societal and environmental factors, such as climate change and food insecurity, can also influence population health outcomes.

The experiences of Maria, David, and Ruben – as told by Spanish public broadcaster RTVE – exemplify the real challenges that people living in densely populated urban areas have faced when being exposed to COVID-19.¹

Maria is a Mexican migrant who has just returned from Connecticut to the Bronx. Her partner Jorge died in Connecticut from COVID-19. She now has no income and is looking for an apartment for herself and her three children. When Jorge became ill, she took him to the hospital, but they would not admit him and he was sent away to be cared for by Maria at home with their children. When an ambulance eventually took him to hospital, it was too late. He died that same night, alone in hospital. She thinks he had diabetes, but he was never diagnosed. They only had enough income to pay the basic bills. Maria is depressed, she is alone, but she knows she must carry on for her children. Her 10-year old child says that if he could help her, he would work. After three months, she finds an apartment.

David works as a hairdresser and takes an overcrowded train every day from Leganés to Chamberi in the centre of Madrid. He lives in a small flat in San Nicasio, one of the poorest working-class areas of Madrid with one of the largest ageing populations in Spain. The apartments are very small, making it difficult to be in confinement, and all of David’s neighbours know somebody who has been a victim of COVID-19. His father was also a hairdresser. David's father was not feeling well; he was taken to hospital by ambulance, and he died three days later. David was not able to say goodbye to his father. Unemployment has increased in that area; small local shops are losing their customers, and many more people are expecting to lose their jobs.

Ruben lives in Iztapalapa in Mexico City with three children, a daughter-in-law and five grandchildren. Their small apartment has few amenities, and no running water during the evening. At three o’clock every morning, he walks 45 minutes with his mobile stall to sell fruit juices near the hospital. His daily earnings keep the family. He goes to the central market to buy fruit, taking a packed dirty bus. He thinks the city's central market was contaminated at the beginning of the pandemic, but it could not be closed as it is the main source of food in the country. He has no health insurance, and he knows that as a diabetic he is at risk, but medication for his condition is too expensive. He has no alternative but to go to work every day: "We die of hunger or we die of COVID."

These real stories highlight the issues that must be addressed to reduce persistent health inequalities and achieve health outcomes focusing on population health. The examples of Maria, David and Ruben show the terrible outcomes COVID-19 has had for people living in poverty and social deprivation, older people, and those with co-morbidities and/or pre-existing health conditions. All three live in densely populated urban areas with poor housing, and have to travel long distances in overcrowded transport. Maria’s loss of income has had consequences for her housing security and access to healthcare and health insurance, which will most likely lead to worse health conditions for her and her children. Furthermore, all three experienced high levels of stress, which is magnified in the cases of Maria and David who were unable to be present when their loved ones died.

The COVID-19 pandemic has made it evident that to improve the health of the population and build healthy societies, there is a need to shift the focus from illness to health and wellness in order to address the social, political and commercial determinants of health; to promote healthy behaviours and lifestyles; and to foster universal health coverage.² Citizens all over the world are demanding that health systems be strengthened and for governments to protect the most vulnerable. A better future could be possible with leadership that is able to carefully consider the long-term health, economic and social policies that are needed.

In order to design and implement population health-friendly policies, there are three prerequisites. First, there is a need to improve understanding of the factors that influence health inequalities and the interconnections between the economic, social and health impacts. Second, broader policies should be considered not only within the health sector, but also in other sectors such as education, employment, transport and infrastructure, agriculture, water and sanitation. Third, the proposed policies need to be designed through involving the community, addressing the health of vulnerable groups, and fostering inter-sectoral action and partnerships.

Finally, within the UN's Agenda 2030 , Sustainable Development Goal (SDG) 3 sets out a forward-looking strategy for health whose main goal is to attain healthier lives and wellbeing. The 17 interdependent SDGs offer an opportunity to contribute to healthier, fairer and more equitable societies from which both communities and the environment can benefit.

The stories of Maria, David and Ruben are real stories featured in the Documentary: The impact of COVID19 in urban outskirts, Directed by Jose A Guardiola. Available here. Permission has been granted to narrate these stories.

Buck, D., Baylis, A., Dougall, D. and Robertson, R. (2018). A vision for population health: Towards a healthier future . [online] London: The King's Fund. [Accessed 20 Sept. 2020]

Wilton Park. (2020). Healthy societies, healthy populations (WP1734). Wiston House, Steyning. Retrieved from https://www.wiltonpark.org.uk/event/wp1734/ Cohen B. E. (2006). Population health as a framework for public health practice: a Canadian perspective. American journal of public health , 96 (9), 1574–1576.

3. Imagine a 'well-care' system that invests in keeping people healthy

By Maliha Hashmi , Executive Director, Health and Well-Being and Biotech, NEOM, and Jan Kimpen , Global Chief Medical Officer, Philips

Imagine a patient named Emily. Emily is aged 32 and I’m her doctor.

Emily was 65lb (29kg) above her ideal body weight, pre-diabetic and had high cholesterol. My initial visit with Emily was taken up with counselling on lifestyle changes, mainly diet and exercise; typical advice from one’s doctor in a time-pressured 15-minute visit. I had no other additional resources, incentives or systems to support me or Emily to help her turn her lifestyle around.

I saw Emily eight months later, not in my office, but in the hospital emergency room. Her husband accompanied her – she was vomiting, very weak and confused. She was admitted to the intensive care unit, connected to an insulin drip to lower her blood sugar, and diagnosed with type 2 diabetes. I talked to Emily then, emphasizing that the new medications for diabetes would only control the sugars, but she still had time to reverse things if she changed her lifestyle. She received further counselling from a nutritionist.

Over the years, Emily continued to gain weight, necessitating higher doses of her diabetes medication. More emergency room visits for high blood sugars ensued, she developed infections of her skin and feet, and ultimately, she developed kidney disease because of the uncontrolled diabetes. Ten years after I met Emily, she is 78lb (35kg) above her ideal body weight; she is blind and cannot feel her feet due to nerve damage from the high blood sugars; and she will soon need dialysis for her failing kidneys. Emily’s deteriorating health has carried a high financial cost both for herself and the healthcare system. We have prevented her from dying and extended her life with our interventions, but each interaction with the medical system has come at significant cost – and those costs will only rise. But we have also failed Emily by allowing her diabetes to progress. We know how to prevent this, but neither the right investments nor incentives are in place.

Emily could have been a real patient of mine. Her sad story will be familiar to all doctors caring for chronically ill patients. Unfortunately, patients like Emily are neglected by health systems across the world today. The burden of chronic disease is increasing at alarming rates. Across the OECD nearly 33% of those over 15 years live with one or more chronic condition, rising to 60% for over-65s. Approximately 50% of chronic disease deaths are attributed to cardiovascular disease (CVD). In the coming decades, obesity, will claim 92 million lives in the OECD while obesity-related diseases will cut life expectancy by three years by 2050.

These diseases can be largely prevented by primary prevention, an approach that emphasizes vaccinations, lifestyle behaviour modification and the regulation of unhealthy substances. Preventative interventions have been efficacious. For obesity, countries have effectively employed public awareness campaigns, health professionals training, and encouragement of dietary change (for example, limits on unhealthy foods, taxes and nutrition labelling).⁴,⁵ Other interventions, such as workplace health-promotion programmes, while showing some promise, still need to demonstrate their efficacy.

The COVID-19 crisis provides the ultimate incentive to double down on the prevention of chronic disease. Most people dying from COVID-19 have one or more chronic disease, including obesity, CVD, diabetes or respiratory problems – diseases that are preventable with a healthy lifestyle. COVID-19 has highlighted structural weaknesses in our health systems such as the neglect of prevention and primary care.

While the utility of primary prevention is understood and supported by a growing evidence base, its implementation has been thwarted by chronic underinvestment, indicating a lack of societal and governmental prioritization. On average, OECD countries only invest 2.8% of health spending on public health and prevention. The underlying drivers include decreased allocation to prevention research, lack of awareness in populations, the belief that long-run prevention may be more costly than treatment, and a lack of commitment by and incentives for healthcare professionals. Furthermore, public health is often viewed in a silo separate from the overall health system rather than a foundational component.

Health benefits aside, increasing investment in primary prevention presents a strong economic imperative. For example, obesity contributes to the treatment costs of many other diseases: 70% of diabetes costs, 23% for CVD and 9% for cancers. Economic losses further extend to absenteeism and decreased productivity.

Fee-for-service models that remunerate physicians based on the number of sick patients they see, regardless the quality and outcome, dominate healthcare systems worldwide. Primary prevention mandates a payment system that reimburses healthcare professionals and patients for preventive actions. Ministries of health and governmental leaders need to challenge skepticism around preventive interventions, realign incentives towards preventive actions and those that promote healthy choices by people. Primary prevention will eventually reduce the burden of chronic diseases on the healthcare system.

As I reflect back on Emily and her life, I wonder what our healthcare system could have done differently. What if our healthcare system was a well-care system instead of a sick-care system? Imagine a different scenario: Emily, a 32 year old pre-diabetic, had access to a nutritionist, an exercise coach or health coach and nurse who followed her closely at the time of her first visit with me. Imagine if Emily joined group exercise classes, learned where to find healthy foods and how to cook them, and had access to spaces in which to exercise and be active. Imagine Emily being better educated about her diabetes and empowered in her healthcare and staying healthy. In reality, it is much more complicated than this, but if our healthcare systems began to incentivize and invest in prevention and even rewarded Emily for weight loss and healthy behavioural changes, the outcome might have been different. Imagine Emily losing weight and continuing to be an active and contributing member of society. Imagine if we invested in keeping people healthy rather than waiting for people to get sick, and then treating them. Imagine a well-care system.

Anderson, G. (2011). Responding to the growing cost and prevalence of people with multiple chronic conditions . Retrieved from OECD.

Institute for Health Metrics and Evaluation. GBD Data Visualizations. Retrieved here.

OECD (2019), The Heavy Burden of Obesity: The Economics of Prevention, OECD Health Policy Studies, OECD Publishing, Paris.

OECD. (2017). Obesity Update . Retrieved here.

Malik, V. S., Willett, W. C., & Hu, F. B. (2013). Global obesity: trends, risk factors and policy implications. Nature Reviews Endocrinology , 9 (1), 13-27.

Lang, J., Cluff, L., Payne, J., Matson-Koffman, D., & Hampton, J. (2017). The centers for disease control and prevention: findings from the national healthy worksite program. Journal of occupational and environmental medicine , 59 (7), 631.

Gmeinder, M., Morgan, D., & Mueller, M. (2017). How much do OECD countries spend on prevention? Retrieved from OECD.

Jordan RE, Adab P, Cheng KK. Covid-19: risk factors for severe disease and death. BMJ. 2020;368:m1198.

Richardson, A. K. (2012). Investing in public health: barriers and possible solutions. Journal of Public Health , 34 (3), 322-327.

Yong, P. L., Saunders, R. S., & Olsen, L. (2010). Missed Prevention Opportunities The healthcare imperative: lowering costs and improving outcomes: workshop series summary (Vol. 852): National Academies Press Washington, DC.

OECD. (2019). The Heavy Burden of Obesity: The Economics of Prevention. Retrieved here .

McDaid, D., F. Sassi and S. Merkur (Eds.) (2015a), “Promoting Health, Preventing Disease: The Economic Case ”, Open University Press, New York.

OECD. (2019). The Heavy Burden of Obesity: The Economics of Prevention. Retrieved from OECD.

4. Why e arly detection and diagnosis is critical

By Paul Murray , Head of Life and Health Products, Swiss Re, and André Goy , Chairman and Executive Director & Chief of Lymphoma, John Theurer Cancer Center, Hackensack University Medical Center

Although healthcare systems around the world follow a common and simple principle and goal – that is, access to affordable high-quality healthcare – they vary significantly, and it is becoming increasingly costly to provide this access, due to ageing populations, the increasing burden of chronic diseases and the price of new innovations.

Governments are challenged by how best to provide care to their populations and make their systems sustainable. Neither universal health, single payer systems, hybrid systems, nor the variety of systems used throughout the US have yet provided a solution. However, systems that are ranked higher in numerous studies, such as a 2017 report by the Commonwealth Fund , typically include strong prevention care and early-detection programmes. This alone does not guarantee a good outcome as measured by either high or healthy life expectancy. But there should be no doubt that prevention and early detection can contribute to a more sustainable system by reducing the risk of serious diseases or disorders, and that investing in and operationalizing earlier detection and diagnosis of key conditions can lead to better patient outcomes and lower long-term costs.

To discuss early detection in a constructive manner it makes sense to describe its activities and scope. Early detection includes pre-symptomatic screening and treatment immediately or shortly after first symptoms are diagnosed. Programmes may include searching for a specific disease (for example, HIV/AIDS or breast cancer), or be more ubiquitous. Prevention, which is not the focus of this blog, can be interpreted as any activities undertaken to avoid diseases, such as information programmes, education, immunization or health monitoring.

Expenditures for prevention and early detection vary by country and typically range between 1-5% of total health expenditures.¹ During the 2008 global financial crisis, many countries reduced preventive spending. In the past few years, however, a number of countries have introduced reforms to strengthen and promote prevention and early detection. Possibly the most prominent example in recent years was the introduction of the Affordable Care Act in the US, which placed a special focus on providing a wide range of preventive and screening services. It lists 63 distinct services that must be covered without any copayment, co-insurance or having to pay a deductible.

Whilst logic dictates that investment in early detection should be encouraged, there are a few hurdles and challenges that need to be overcome and considered. We set out a few key criteria and requirements for an efficient early detection program:

1. Accessibility The healthcare system needs to provide access to a balanced distribution of physicians, both geographically (such as accessibility in rural areas), and by specialty. Patients should be able to access the system promptly without excessive waiting times for diagnoses or elective treatments. This helps mitigate conditions or diseases that are already quite advanced or have been incubating for months or even years before a clinical diagnosis. Access to physicians varies significantly across the globe from below one to more than 60 physicians per 10,000 people.² One important innovation for mitigating access deficiencies is telehealth. This should give individuals easier access to health-related services, not only in cases of sickness but also to supplement primary care.

2. Early symptoms and initial diagnosis Inaccurate or delayed initial diagnoses present a risk to the health of patients, can lead to inappropriate or unnecessary testing and treatment, and represents a significant share of total health expenditures. A medical second opinion service, especially for serious medical diagnoses, which can occur remotely, can help improve healthcare outcomes. Moreover, studies show that early and correct diagnosis opens up a greater range of curative treatment options and can reduce costs (e.g. for colon cancer, stage-four treatment costs are a multiple of stage-one treatment costs).³

3. New technology New early detection technologies can improve the ability to identify symptoms and diseases early: i. Advances in medical monitoring devices and wearable health technology, such as ECG and blood pressure monitors and biosensors, enable patients to take control of their own health and physical condition. This is an important trend that is expected to positively contribute to early detection, for example in atrial fibrillation and Alzheimers’ disease. ii. Diagnostic tools, using new biomarkers such as liquid biopsies or volatile organic compounds, together with the implementation of machine learning, can play an increasing role in areas such as oncology or infectious diseases.⁴

4. Regulation and Intervention Government regulation and intervention will be necessary to set ranges of normality, to prohibit or discourage overdiagnosis and to reduce incentives for providers to overtreat patients or to follow patients' inappropriate requests. In some countries, such as the US, there has been some success through capitation models and value-based care. Governments might also need to intervene to de-risk the innovation paradigm, such that private providers of capital feel able to invest more in the development of new detection technologies, in addition to proven business models in novel therapeutics.

OECD Health Working Papers No. 101 "How much do OECD countries spend on prevention" , 2017

World Health Organization; Global Health Observatory (GHO) data; https://www.who.int/gho/health_workforce/physicians_density/en/

Saving lives, averting costs; A report for Cancer Research UK, by Incisive Health, September 2014

Liquid Biopsy: Market Drivers And Obstacles; by Divyaa Ravishankar, Frost & Sullivan, January 21, 2019

Liquid Biopsies Become Cheap and Easy with New Microfluidic Device; February 26, 2019

How America’s 5 Top Hospitals are Using Machine Learning Today; by Kumba Sennaar, February 19, 2019

5. The business case for private investment in healthcare for all

Pascal Fröhlicher, Primary Care Innovation Scholar, Harvard Medical School, and Ian Wijaya, Managing Director in Lazard’s Global Healthcare Group

Faith, a mother of two, has just lost another customer. Some households where she is employed to clean, in a small town in South Africa, have little understanding of her medical needs. As a type 2 diabetes patient, this Zimbabwean woman visits the public clinic regularly, sometimes on short notice. At her last visit, after spending hours in a queue, she was finally told that the doctor could not see her. To avoid losing another day of work, she went to the local general practitioner to get her script, paying more than three daily wages for consultation and medication. Sadly, this fictional person reflects a reality for many people in middle-income countries.

Achieving universal health coverage by 2030, a key UN Sustainable Development Goal (SDG), is at risk. The World Bank has identified a $176 billion funding gap , increasing every year due to the growing needs of an ageing population, with the health burden shifting towards non-communicable diseases (NCDs), now the major cause of death in emerging markets . Traditional sources of healthcare funding struggle to increase budgets sufficiently to cover this gap and only about 4% of private health care investments focus on diseases that primarily affect low- and middle-income countries.

In middle-income countries, private investors often focus on extending established businesses, including developing private hospital capacity, targeting consumers already benefiting from quality healthcare. As a result, an insufficient amount of private capital is invested in strengthening healthcare systems for everyone.

Why is this the case? We discussed with senior health executives investing in Lower and Middle Income Countries (LMIC) and the following reasons emerged:

• Small market size . Scaling innovations in healthcare requires dealing with country-specific regulatory frameworks and competing interest groups, resulting in high market entry cost.
• Talent . Several LMICs are losing nurses and doctors but also business and finance professionals to European and North American markets due to the lack of local opportunities and a significant difference in salaries.
• Untested business models with relatively low gross margins. Providing healthcare requires innovative business models where consumers’ willingness to pay often needs to be demonstrated over a significant period of time. Additionally, relatively low gross margins drive the need for scale to leverage administrative costs, which increases risk.
• Government Relations. The main buyer of health-related products and services is government; yet the relationship between public and private sectors often lacks trust, creating barriers to successful collaboration. Add to that significant political risk, as contracts can be cancelled by incoming administrations after elections. Many countries also lack comprehensive technology strategies to successfully manage technological innovation.
• Complexity of donor funding. A significant portion of healthcare is funded by private donors, whose priorities might not always be congruent with the health priorities of the government.

Notwithstanding these barriers, healthcare, specifically in middle-income settings, could present an attractive value proposition for private investors:

• Economic growth rates . A growing middle class is expanding the potential market for healthcare products and services.
• Alignment of incentives . A high ratio of out-of-pocket payments for healthcare services is often associated with low quality. However, innovative business models can turn out of pocket payments into the basis for a customer-centric value proposition, as the provider is required to compete for a share of disposable income.
• Emergence of National Health Insurance Schemes . South Africa, Ghana, Nigeria and others are building national health insurance schemes, increasing a population’s ability to fund healthcare services and products .
• Increased prevalence of NCDs. Given the increasing incidence of chronic diseases and the potential of using technology to address these diseases, new business opportunities for private investment exist.

Based on the context above, several areas in healthcare delivery can present compelling opportunities for private companies.

• Aggregation of existing players.
• Leveraging primary care infrastructure. Retail companies can leverage their real estate, infrastructure and supply chains to deploy primary care services at greater scale than is currently the case.
• Telemedicine . Telecommunications providers can leverage their existing infrastructure and customer base to provide payment mechanisms and telehealth services at scale. As seen during the COVID-19 pandemic, investment in telemedicine can ensure that patients receive timely and continuous care in spite of restrictions and lockdowns.
• Cost effective diagnostics . Diagnostic tools operated by frontline workers and combined with the expertise of specialists can provide timely and efficient care.

To fully realize these opportunities, government must incentivise innovation, provide clear regulatory frameworks and, most importantly, ensure that health priorities are adequately addressed.

Venture capital and private equity firms as well as large international corporations can identify the most commercially viable solutions and scale them into new markets. The ubiquity of NCDs and the requirement to reduce costs globally provides innovators with the opportunity to scale their tested solutions from LMICs to higher income environments.

Successful investment exits in LMICs and other private sector success stories will attract more private capital. Governments that enable and support private investment in their healthcare systems would, with appropriate governance and guidance, generate benefits to their populations and economies. The economic value of healthy populations has been proven repeatedly , and in the face of COVID-19, private sector investment can promote innovation and the development of responsible, sustainable solutions.

Faith – the diabetic mother we introduced at the beginning of this article - could keep her client. As a stable patient, she could measure her glucose level at home and enter the results in an app on her phone, part of her monthly diabetes programme with the company that runs the health centre. She visits the nurse-led facility at the local taxi stand on her way to work when her app suggests it. The nurse in charge of the centre treats Faith efficiently, and, if necessary, communicates with a primary care physician or even a specialist through the telemedicine functionality of her electronic health system.

Improving LMIC health systems is not only a business opportunity, but a moral imperative for public and private leaders. With the appropriate technology and political will, this can become a reality.

6. How could COVID-19 change the way we pay for health services?

John E. Ataguba, Associate Professor and Director, University of Cape Town and Matthew Guilford, Co-Founder and Chief Executive Officer, Common Health

The emergence of the new severe acute respiratory syndrome coronavirus (SARS-Cov-2), causing the coronavirus disease 2019 (COVID-19), has challenged both developing and developed countries.

Countries have approached the management of infections differently. Many people are curious to understand their health system’s performance on COVID-19, both at the national level and compared to international peers. Alongside limited resources for health, many developing countries may have weak health systems that can make it challenging to respond adequately to the pandemic.

Even before COVID-19, high rates of out-of-pocket spending on health meant that every year, 800 million people faced catastrophic healthcare costs ,100 million families were pushed into poverty, and millions more simply avoided care for critical conditions because they could not afford to pay for it.

The pandemic and its economic fallout have caused household incomes to decline at the same time as healthcare risks are rising. In some countries with insurance schemes, and especially for private health insurance, the following questions have arisen: How large is the co-payment for a COVID-19 test? If my doctor’s office is closed, will the telemedicine consultation be covered by my insurance? Will my coronavirus care be paid for regardless of how I contracted the virus? These and other doubts can prevent people from seeking medical care in some countries.

In Nigeria, like many other countries in Africa, the government bears the costs associated with testing and treating COVID-19 irrespective of the individual’s insurance status. In the public health sector, where COVID-19 cases are treated, health workers are paid monthly salaries while budgets are allocated to health facilities for other services. Hospitals continue to receive budget allocations to finance all health services including the management and treatment of COVID-19. That implies that funds allocated to address other health needs are reduced and that in turn could affect the availability and quality of health services.

Although health workers providing care for COVID-19 patients in isolation and treatment centres in Nigeria are paid salaries that are augmented with a special incentive package, the degree of impact on the quality improvement of services remains unclear. The traditional and historical allocation of budgets does not always address the needs of the whole population and could result in poor health services and under-provision of health services for COVID-19 patients.

In some countries, the reliance on out-of-pocket funding is hardly better for private providers, who encounter brand risks, operational difficulties, and – in extreme cases – the risk of creating “debtor prisons” as they seek to collect payment from patients. Ironically, despite the huge demand for medical services to diagnose and treat COVID-19, large healthcare institutions and individual healthcare practitioners alike are facing financial distress.

Dependence on a steady stream of fee-for-service payments for outpatient consultations and elective procedures is leading to pay cuts for doctors in India , forfeited Eid bonuses for nurses in Indonesia , and hospital bankruptcies in the United States . In a recent McKinsey & Company survey, 77% of physicians reported that their business would suffer in 2020 , and 46% were concerned about their practice surviving the coronavirus pandemic.

COVID-19 is exposing how fee-for-service, historical budget allocation and out-of-pocket financing methods can hinder the performance of the health system. Some providers and health systems that deployed “value-based” models prior to the pandemic have reported that these approaches have improved financial resilience during COVID-19 and may support better results for patients. Nevertheless, these types of innovations do not represent the dominant payment model in any country.

How health service providers are paid has implications for whether service users can get needed health services in a timely fashion, and at an appropriate quality and an affordable cost. By shifting from fee-for-service reimbursements to fixed "capitation" and performance-based payments, these models incentivize providers to improve quality and coordination while also guaranteeing a baseline income level, even during times of disruption.

Health service providers could be paid either in the form of salaries, a fee for services they provide, by capitation (whether adjusted or straightforward), through global budgets, or by using a case-based payment system (for example, the diagnostics-related groups), among others. Because there are different incentives to consider when adopting any of the methods, they could be combined to achieve a specific goal. For example, in some countries, health workers are paid salaries , and some specific services are paid on a fee-for-service basis.

Ideally, health services could be purchased strategically , incorporating aspects of provider performance in transferring funds to providers and accounting for the health needs of the population they serve.

In this regard, strategic purchasing for health has been advocated and should be highlighted as crucial with the emergence of the COVID-19 pandemic. There is a need to ensure value in the way health providers are paid, inter alia to increase efficiency, ensure equity, and improve access to needed health services. Value-based payment methods, although not new in many countries, provide an avenue to encourage long-term value for money, better quality, and strategic purchasing for health, helping to build a healthier, more resilient world.

7. L essons in integrated care from the COVID-19 pandemic

Sarah Ziegler, Postdoctoral Researcher, Department of Epidemiology and Biostatistics, University of Zurich, and Ninie Wang, Founder & CEO, Pinetree Care Group.

Since the start of the COVID-19 pandemic, people suffering non-communicable diseases (NCDs) have been at higher risk of becoming severely ill or dying. In Italy, 96.2% of people who died of COVID-19 lived with two or more chronic conditions.

Beyond the pandemic, cardiovascular disease, cancer, respiratory disease and diabetes are the leading burden of disease, with 41 million annual deaths. People with multimorbidity - a number of different conditions - often experience difficulties in accessing timely and coordinated healthcare, made worse when health systems are busy fighting against the pandemic.

Here is what happened in China with Lee, aged 62, who has been living with Chronic Obstructive Pulmonary Disease (COPD) for the past five years.

Before the pandemic, Lee’s care manager coordinated a multi-disciplinary team of physicians, nurses, pulmonary rehabilitation therapists, psychologists and social workers to put together a personalized care plan for her. Following the care plan, Lee stopped smoking and paid special attention to her diet, sleep and physical exercises, as well as sticking to her medication and follow-up visits. She participated in a weekly community-based physical activity program to meet other COPD patients, including short walks and exchange experiences. A mobile care team supported her with weekly cleaning and grocery shopping.

Together with her family, Lee had follow-up visits to ensure her care plan reflected her recovery and to modify the plan if needed. These integrated care services brought pieces of care together, centered around Lee’s needs, and provided a continuum of care that helped keep Lee in the community with a good quality of life for as long as possible.

Since the COVID-19 outbreak, such NCD services have been disrupted by lockdowns, the cancellation of elective care and the fear of visiting care service . These factors particularly affected people living with NCDs like Lee. As such, Lee was not able to follow her care plan anymore. The mobile care team was unable to visit her weekly as they were deployed to provide COVID-19 relief. Lee couldn’t participate in her community-based program, follow up on her daily activities, or see her family or psychologists. This negatively affected Lee’s COPD management and led to poor management of her physical activity and healthy diet.

The pandemic highlights the need for a flexible and reliable integrated care system to enable healthcare delivery to all people no matter where they live, uzilizing approaches such as telemedicine and effective triaging to overcome care disruptions.

Lee’s care manager created short videos to assist her family through each step of her care and called daily to check in on the implementation of the plan and answer questions. Lee received tele-consultations, and was invited to the weekly webcast series that supported COPD patient communities. When her uncle passed away because of pneumonia complications from COVID-19 in early April, Lee’s care manager arranged a palliative care provider to support the family through the difficult time of bereavement and provided food and supplies during quarantine. Lee could even continue with her physical activity program with an online training coach. There were a total of 38 exercise videos for strengthening and stretching arms, legs and trunk, which she could complete at different levels of difficulty and with different numbers of repetitions.

Lee’s case demonstrates that early detection, prevention, and management of NCDs play a crucial role in a global pandemic response. It shows how we need to shift away from health systems designed around single diseases towards health systems designed for the multidimensional needs of individuals. As part of the pandemic responses, addressing and managing risks related to NCDs and prevention of their complications are critical to improve outcomes for vulnerable people like Lee.

How to design and deliver successful integrated care

The challenge for the successful transformation of healthcare is to tailor care system-wide to population needs. A 2016 WHO Framework on integrated people-centered health services developed a set of five general strategies for countries to progress towards people-centered and sustainable health systems, calling for a fundamental transformation not only in the way health services are delivered, but also in the way they are financed and managed . These strategies call for countries to:

• Engage and empower people / communities: an integrated care system must mobilize everyone to work together using all available resources, especially when continuity of essential health and community services for NCDs are at risk of being undermined.
• Strengthen governance and accountability, so that integration emphasizes rather than weakens leadership in every part of the system, and ensure that NCDs are included in national COVID-19 plans and future essential health services.
• Reorient the model of care to put the needs and perspectives of each person / family at the center of care planning and outcome measurement, rather than institutions.
• Coordinate services within and across sectors, for example, integrate inter-disciplinary medical care with social care, addressing wider socio-economic, environmental and behavioral determinants of health.
• Create an enabling environment, with clear objectives, supportive financing, regulations and insurance coverage for integrated care, including the development and use of systemic digital health care solutions.

Whether due to an unexpected pandemic or a gradual increase in the burden of NCDs, each person could face many health threats across the life-course.

Only systems that dynamically assess each person’s complex health needs and address them through a timely, well-coordinated and tailored mix of health and social care services will be able to deliver desired health outcomes over the longer term, ensuring an uninterrupted good quality of life for Lee and many others like her.

• Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY) 2020;12: 6049–57.
• WHO. Noncommunicable diseases in emergencies. Geneva: World Health Organization, 2016.
• WHO. COVID-19 significantly impacts health services for noncommunicable diseases. June 2020.
• Kluge HHP, Wickramasinghe K, Rippin HL, et al. Prevention and control of non-communicalbe diseases in the COVID-19 response. The Lancet. 2020. 395:1678-1680
• WHO. Framework on integrated people-centred health services. Geneva: World Health Organization, 2016.

8 . Why access to healthcare alone will not save lives

Donald Berwick, President Emeritus and Senior Fellow, Institute for Healthcare Improvement; Nicola Bedlington, Special Adviser, European Patient Forum; and David Duong, Director, Program in Global Primary Care and Social Change, Harvard Medical School.

Joyce lies next to 10 other women in bare single beds in the post-partum recovery room at a rural hospital in Uganda. Just an hour ago, Joyce gave birth to a healthy baby boy. She is now struggling with abdominal pain. A nurse walks by, and Joyce tries to call out, but the nurse was too busy to attend to her; she was the only nurse looking after 20 patients.

Another hour passes, and Joyce is shaking and sweating profusely. Joyce’s husband runs into the corridor to find a nurse to come and evaluate her. The nurse notices Joyce’s critical condition - a high fever and a low blood pressure - and she quickly calls the doctor. The medical team rushes Joyce to the intensive care unit. Joyce has a very severe blood stream infection. It takes another hour before antibiotics are started - too late. Joyce dies, leaving behind a newborn son and a husband. Joyce, like many before her, falls victim to a pervasive global threat: poor quality of care.

Adopted by United Nations (UN) in 2015, the Sustainable Development Goals (SDG) are a universal call to action to end poverty, protect the planet and ensure that all enjoy peace and prosperity by 2030. SDG 3 aims to ensure healthy lives and promote wellbeing for all. The 2019 UN General Assembly High Level Meeting on Universal Health Coverage (UHC) reaffirmed the need for the highest level of political commitment to health care for all.

However, progress towards UHC, often measured in terms of access, not outcomes, does not guarantee better health, as we can see from Joyce’s tragedy. This is also evident with the COVID-19 response. The rapidly evolving nature of the COVID-19 pandemic has highlighted long-term structural inefficiencies and inequities in health systems and societies trying to mitigate the contagion and loss of life.

Systems are straining under significant pressure to ensure standards of care for both COVID-19 patients and other patients that run the risk of not receiving timely and appropriate care. Although poor quality of care has been a long-standing issue, it is imperative now more than ever that systems implement high-quality services as part of their efforts toward UHC.

Poor quality healthcare remains a challenge for countries at all levels of economic development: 10% of hospitalized patients acquire an infection during their hospitalization in low-and-middle income countries (LMIC), whereas 7% do in high-income countries. Poor quality healthcare disproportionally affects the poor and those in LMICs. Of the approximately 8.6 million deaths per year in 137 LMICs, 3.6 million are people who did not access the health system, whereas 5 million are people who sought and had access to services but received poor-quality care.

Joyce’s story is all too familiar; poor quality of care results in deaths from treatable diseases and conditions. Although the causes of death are often multifactorial, deaths and increased morbidity from treatable conditions are often a reflection of defects in the quality of care.

The large number of deaths and avoidable complications are also accompanied by substantial economic costs. In 2015 alone, 130 LMICs faced US $6 trillion in economic losses. Although there is concern that implementing quality measures may be a costly endeavor, it is clear that the economic toll associated with a lack of quality of care is far more troublesome and further stunts the socio-economic development of LMICs, made apparent with the COVID-19 pandemic.

Poor-quality care not only leads to adverse outcomes in terms of high morbidity and mortality, but it also impacts patient experience and patient confidence in health systems. Less than one-quarter of people in LMICs and approximately half of people in high-income countries believe that their health systems work well.

A lack of application and availability of evidenced-based guidelines is one key driver of poor-quality care. The rapidly changing landscape of medical knowledge and guidelines requires healthcare workers to have immediate access to current clinical resources. Despite our "information age", health providers are not accessing clinical guidelines or do not have access to the latest practical, lifesaving information.

Getting information to health workers in the places where it is most needed is a delivery challenge. Indeed, adherence to clinical practice guidelines in eight LMICs was below 50%, and in OECD countries, despite being a part of national guidelines, 19-53% of women aged 50-69 years did not receive mammography screening.4 The evidence in LMICs and HICs suggest that application of evidence-based guidelines lead to reduction in mortality and improved health outcomes.

Equally, the failure to change and continually improve the processes in health systems that support the workforce takes a high toll on quality of care. During the initial wave of the COVID-19 pandemic, countries such as Taiwan, Hong Kong, Singapore and Vietnam, which adapted and improved their health systems after the SARS and H1N1 outbreaks, were able to rapidly mobilize a large-scale quarantine and contact tracing strategy, supported with effective and coordinated mass communication.

These countries not only mitigated the economic and mortality damage, but also prevented their health systems and workforce from enduring extreme burden and inability to maintain critical medical supplies. In all nations, investing in healthcare organizations to enable them to become true “learning health care systems,” aiming at continual quality improvement, would yield major population health and health system gains.

The COVID-19 pandemic underscores the importance for health systems to be learning systems. Once the dust settles, we need to focus, collectively, on learning from this experience and adapting our health systems to be more resilient for the next one. This implies a need for commitment to and investment in global health cooperation, improvement in health care leadership, and change management.

With strong political and financial commitment to UHC, and its demonstrable effect in addressing crises such as COVID-19, for the first time, the world has a viable chance of UHC becoming a reality. However, without an equally strong political, managerial, and financial commitment to continually improving, high-quality health services, UHC will remain an empty promise.

1. United Nations General Assembly. Political declaration of the high-level meeting on universal health coverage. New York, NY2019.

2. Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. Health equity in England: the Marmot review 10 years on. Institute of Health Equity;2020.

3. National Academies of Sciences, Engineering, and Medicine: Committee on Improving the Quality of Health Care Globally. Crossing the global quality chasm: Improving health care worldwide. Washington, DC: National Academies Press;2018.

4. World Health Organization, Organization for Economic Co-operation and Development, World Bank Group. Delivering quality health services: a global imperative for universal health coverage. World Health Organization; 2018.

5. Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet Global Health. 2018;6(11):e1196-e1252.

6. Ricci-Cabello I, Violán C, Foguet-Boreu Q, Mounce LT, Valderas JM. Impact of multi-morbidity on quality of healthcare and its implications for health policy, research and clinical practice. A scoping review. European Journal of General Practice. 2015;21(3):192-202.

7. Valtis YK, Rosenberg J, Bhandari S, et al. Evidence-based medicine for all: what we can learn from a programme providing free access to an online clinical resource to health workers in resource-limited settings. BMJ global health. 2016;1(1).

8. Institute of Medicine. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America . Washington, DC: National Academies Press 2012.

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7 Positive Lifestyle Factors That Promote Good Health

How to Live Long and Well

You can't change your genes, or even much of the environment around you, but there are lifestyle choices you can make to boost your health. Being informed and intentional about diet, activity, sleep, and smoking can reduce your health risks and potentially add years to your life.

This article looks at seven lifestyle factors that are backed by the best evidence when it comes to your health over the long run. It shows you why they matter and how to begin making positive changes.

Getting the Right Amount of Sleep

Eva-Katalin / E+ / Getty Images

Getting the right amount of sleep, and doing so regularly, is first on the list. It's often missed because people focus on diet and exercise, but the link between sleep and life expectancy is supported by research.

What surprises some people is that the relationship is a U-shaped curve. This means that too little and too much sleep can affect your health. In one study, sleeping for a long duration (defined as more than 10 hours a night) was associated with psychiatric diseases and higher body mass index BMI.

Another study found that sleeping nine or more hours a night had an increased incidence of stroke of 23% compared to those sleeping seven to eight hours a night. Those who slept over nine hours and napped for 90 minutes or more had an 85% increased stroke risk.

A 2021 study of 1.1 million people in Europe and the United States found that 25% of people slept less than what is recommended for their ages. More than half of all teens don't get enough sleep. Adults do better but have more insomnia and poor sleep quality.

A good night's sleep is important to recharge both the body and mind. It helps the body repair cells and get rid of wastes. It also is important in making memories, and sleep deprivation leads to forgetfulness.

Even if you intend to sleep well, health issues can disrupt your plan. Sleep apnea , for example, can greatly increase health risks.

Sleep apnea affects millions of people, but it's believed that many cases are being missed. Part of the reason is that symptoms like snoring, or waking up gasping for air, don't happen in every case. Sleep apnea can present with a number of surprising signs and symptoms , such as teeth grinding and depression.

If you have any concerns, talk to your healthcare provider about a sleep study . There are treatments, like CPAP , that lower risk and improve quality of life. Changes in your sleep patterns can signal other health issues too, so see your healthcare provider for a checkup if anything changes.

Eating Well-Balanced Meals

Gary Houlder / Taxi / Getty Images

A healthy diet gives you energy and lowers your risk for heart disease, diabetes, cancer, and other diseases. Some of these conditions have proven links to food and nutrition, as is the case with red meat and colorectal cancer.

Taking steps toward a lifelong change in diet will help more than jumping on the latest fad diet does. You may have heard author Michael Pollan's signature phrase: "Eat food. Not too much. Mostly plants." Of those plants, choose a rainbow of colors to make sure you get all the nutrients you need.

One place to begin is with the well-regarded Mediterranean diet. It's rich in many of the healthiest foods and naturally limits less healthy choices. The more you follow the Mediterranean diet, the lower your risk of a host of diseases.

A 2018 review looked at over 12 million people and the risk of over a dozen chronic diseases. The researchers found that people who chose a Mediterranean diet lowered their risk of heart disease, stroke, cancer, and other diseases.

The Mediterranean diet includes a lot of fruits and vegetables, whole grains, "good" oils, and plenty of herbs and spices. It doesn't recommend highly processed foods, refined grains, or added sugar.

Making Time for Physical Activity

vgajic / E+ / Getty Images

Thirty minutes a day of physical activity protects heart health. It also lowers the amount of bone loss as you age, and with it the risk of osteoporosis . It's so important that a 2021 study of colon cancer survivors found that living in a "green" community that is friendly for exercise reduced the risk of death.

A 2017 review in Lancet found that people participating in moderate physical activity every day had a lower risk of heart disease and overall mortality, no matter what their income level.

Best of all, physical activity is a low-cost way to boost your health and even save you money. Sometimes your health may limit your exercise options, but you can keep moving by washing your windows, mowing your lawn, sweeping a sidewalk, and other basic tasks.

Once you are past age 65, you may benefit by adding balance and flexibility exercises, but keep moving too. Whether you dance, garden, swim, or go biking, choose moderate-intensity exercise that you know you'll enjoy.

Keeping a Healthy Body Weight

Shelly Strazis / UpperCut Images / Getty Images

Obesity is associated with a shorter lifespan and a higher risk of many diseases. The good news is that just being somewhat overweight does not reduce your longevity. In fact, for those over age 65, it's better to be on the high side of normal than the low side.

A 2018 study looked at body mass index (BMI) and mortality over a period of 24 years. A BMI considered between 19 and 24 is considered "normal" or healthy. For those who were in the range classified as obesity, a BMI of 30 to 35 meant a 27% increase in mortality. A BMI of 35 to 40 was linked to a 93% increase.

Among those with a BMI in the overweight range (BMI 25 to 30), mortality was only higher among those who smoked. People with a BMI on the high side of normal (BMI 24, for example) had the lowest death risks.

BMI Limitations

BMI is a dated, flawed measure. It does not take into account factors such as body composition, ethnicity, sex, race, and age.  Even though it is a biased measure, BMI is still widely used in the medical community because it’s an inexpensive and quick way to analyze a person’s potential health status and outcomes.

There isn't any real magic when it comes to keeping a healthy weight. Eating a nutritious diet and exercising daily   are the true secrets for most people. If you're struggling, talk with your healthcare provider. But keep in mind that fad diets don't work, and your greatest hope for success lies in making long-term changes.

Avoiding Smoking or Chewing Tobacco

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Smoking accounts for some 480,000 deaths per year in the United States alone. Added to this are another 16 million people who are alive but coping with a smoking-related illness . If you want the chance to live well for however long you live, don't smoke or chew tobacco.

The list of diseases and cancers linked to smoking is long. If you're finding it hard to quit, and you think illness comes only later in life, it may help to think of more short-term goals. Perhaps it's too expensive, or indoor smoking bans limit your social outings.

Or maybe the midlife concerns will help you! Smoking speeds up wrinkling of the skin. There's also a link between smoking and erectile dysfunction in men. Quitting, or avoiding tobacco in the first place, will save lives but protect its quality too.

Limiting or Avoiding Alcohol

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Despite the hype over red wine and longevity , alcohol should be used only in moderation, and for many people, not at all. Red wine has been found to offer some protective health effects, but there are other ways to get these benefits.

Red wine is rich in flavonoids, particularly the nutrient resveratrol . Resveratrol, however, is also found in red grapes themselves, in red grape juice, and even peanuts.

Moderate alcohol consumption (one drink per day for women, two for men) may lower heart disease risk. Yet a link between alcohol and breast cancer suggests that even this amount should be used with caution.

Women who have three drinks per week have a 15% higher risk of breast cancer and the risk goes up another 10% for every additional drink they have each day.

It is important to note that alcohol is classified as a Group 1 carcinogen by the International Agency for Research on Cancer. Group 1 is the highest-risk group, which also includes asbestos, radiation, and tobacco. Alcohol causes at least seven types of cancer. The more alcohol you drink, the higher your cancer risk.

Higher levels of alcohol can lead to health and other problems, including a greater risk for:

• High blood pressure
• Heart disease
• Some cancers

Moderate intake of alcohol may be part of a healthy lifestyle in special moments, as long as you have no personal or family problems with alcohol abuse. As long as everyone understands the risks, there are times you may drink a toast to your good health!

Managing Mental Health

Mental health includes emotional, psychological, and social well-being. It affects how we think, feel, act, and relate to others.

Managing mental health includes factors such as managing stress and maintaining social connections. Research shows that people who report being happier live as much as four to 10 years longer than less happy people.

One way to increase happiness is to manage stress. Although we can't eliminate stress entirely, there are some ways to limit it:

• Take time to unwind , such as doing deep breathing exercises, yoga, meditation, taking a bath, or reading a book. Schedule regular times for these and other healthy activities.
• Take breaks from watching, reading, or listening to news and social media.
• Practice gratitude by reminding yourself daily of things you are grateful for. Be specific. Write them down at night, or replay them in your mind.
• Focus on the positive by identifying and challenging your negative and unhelpful thoughts.
• Find a hobby. Research shows activities like gardening, singing, playing a musical instrument, and other hobbies are linked to living longer, healthier lives Hobbies may reduce stress and provide mental stimulation.

Research also shows that staying socially connected positively impacts health and longevity. Getting together regularly with friends or family members can provide emotional support and pleasure. Other ways to foster connection may include:

• Connecting with community or faith-based groups
• Volunteering with others
• Joining a local group, such as a hiking club, knitting group, or other interest group

For a long, healthy life, the seven key lifestyle behaviors include getting enough sleep, eating a healthy diet, being physically active, maintaining a healthy body weight, not smoking, limiting alcohol, and managing mental health.

These factors may seem like a part of the common-sense advice, but there's a reason for that. They're all backed by data, and new medical research continues to point in the same healthy direction.

Frequently Asked Questions

To help strengthen your bones, try the following tips:

• Eat foods that are good sources of calcium and vitamin D.
• Get 30 minutes of exercise a day, especially weight-bearing and strength-building activities like walking, dancing, climbing stairs, and lifting weights.
• Avoid smoking.
• Prevent falls. Exercise may help you improve your balance. Also, remember to check for tripping hazards in your home.

Making healthy lifestyle choices can reduce your risk of high blood pressure, heart attack, and stroke. In a study of 55,000 people, those who made healthy lifestyle choices such as avoiding smoking, eating healthy, and exercising lowered their heart disease risk by about 50%.

The World Cancer Research Fund says at least 18% of cancers in the United States are related to preventable risk factors, including obesity, lack of exercise, poor nutrition, and drinking alcohol.

American College of Cardiology. Getting good sleep could add years to your life .

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Wiese D, Stroup AM, Maiti A, et al. Measuring neighborhood landscapes: associations between a neighborhood’s landscape characteristics and colon cancer survival .  IJERPH . 2021;18(9):4728. doi: 10.3390/ijerph18094728

Lear, S., Hu, W., Rangarajan, S. et al. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study . Lancet. 2017. 390(10113):2643-2654. doi:10.1016/S0140-6736(17)31634-3

Xu H, Cupples LA, Stokes A, Liu CT. Association of obesity with mortality over 24 years of weight history: findings from the Framingham Heart Study. JAMA Netw Open . 2018;1(7):e184587. doi:10.1001/jamanetworkopen.2018.4587

Centers for Disease Control and Prevention. Tobacco-related mortality .

Centers for Disease Control and Prevention. Health effects of smoking .

Breastcancer.org. Drinking alcohol.

World Health Organization. No level of alcohol consumption is safe for our health .

Centers for Disease Control and Prevention. Alcohol and cancer .

Centers for Disease Control and Prevention. Alcohol use and your health .

National Institute of Mental Health. Caring for your mental health .

Diener E, Chan MY. Happy People Live Longer: Subjective Well-Being Contributes to Health and Longevity . Social Science Research Network; 2013.

Evans GF, Soliman EZ. Happier countries, longer lives: an ecological study on the relationship between subjective sense of well-being and life expectancy . Glob Health Promot. 2019 Jun;26(2):36-40. doi: 10.1177/1757975917714035

Soga M, Gaston KJ, Yamaura Y. Gardening is beneficial for health: A meta-analysis . Prev Med Rep. 2016 Nov 14;5:92-99. doi: 10.1016/j.pmedr.2016.11.007

McCrary JM, Altenmüller E, Kretschmer C, et al. Association of music interventions with health-related quality of life: a systematic review and meta-analysis . JAMA Netw Open. 2022;5(3):e223236. doi: 10.1001/jamanetworkopen.2022.3236

Tomioka K, Kurumatani N, Hosoi H. Relationship of Having Hobbies and a Purpose in Life With Mortality, Activities of Daily Living, and Instrumental Activities of Daily Living Among Community-Dwelling Elderly Adults . J Epidemiol. 2016 Jul 5;26(7):361-70. doi: 10.2188/jea.JE20150153

Holt-Lunstad J. Why Social Relationships Are Important for Physical Health: A Systems Approach to Understanding and Modifying Risk and Protection . Annu Rev Psychol. 2018 Jan 4;69:437-458. doi: 10.1146/annurev-psych-122216-011902

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Bone health for life: Health information basics for you and your family .

Harvard Health Publishing. Lifestyle changes to lower heart disease risk .

American Cancer Society. Diet and physical activity: What's the cancer connection?

Chaput J-P, Dutil C, Sampasa-Kanyinga H. Sleeping hours: what is the ideal number and how does age impact this?   Nat Sci Sleep . 2018;10:421-430.

National Institute on Aging. A good night's sleep .

By Kirsti A. Dyer MD, MS, FT Kirsti A. Dyer, MD, MS, FT, is a board-certified expert in grief and bereavement, and an associate adjunct professor in hospice and palliative studies.

How to be Healthy Essay

Introduction, keeping fit, eating well, maintain a healthy weight, getting enough sleep, lifestyle choices.

Almost every person hopes to have a long, healthy life. However, many persons do not recognize the fundamental life choices that when made, can enable them live healthy, and often take these choices to be sacrifices that are not worth making. Choosing to adopt a healthy lifestyle has several benefits to the body such as a significant improvement of life expectancy, having a life free of disease and ailments, having a fit body, and the overall well being of the body.

Today, most of us focus on making outside changes in order to look healthy, such as using cosmetics. What we do not realize is that what we put in our body and how we handle it ultimately determines how we look, feel, energy levels, and the general health of the body. In order to be healthy, a person does not necessarily have to make radical changes to the lifestyle, rather, it involves making simple small changes to everyday life.

Changes such as taking the stairs instead of the lift, adding a fruit to a meal, having a glass of water at every opportune instance, and eating snacks in moderation are just some of the few steps to having a healthy life. In order to live healthy, a person should focus on keeping fit, eating healthy, checking on their weight, getting enough sleep, and avoiding risky behaviors such as smoking and taking alcohol in moderation.

One of the greatest impediments to living healthy is the lack of physical activity. Although many people recognize the benefits of keeping fit, they avoid it either because they think it is a waste of time, or they are used to a sedentary lifestyle. The truth is, the more a person engages in physical activity, the healthier they become.

Physical activity does not have to be vigorous, in fact, even simple activities such as gardening, walking, and partaking in domestic chores can greatly improve one’s health. Even recreational activities such as cycling, dancing and swimming can help in keeping fit.

The benefits of physical activity include a reduction of the risks of heart diseases and diabetes, improvement of mental health, strengthening of bones and muscles, and helping with a number of health niggles such as digestion and poor posture, among other benefits.

Eating well entails striving to have a balanced diet at all instances. A good diet not only helps in weight management, but it can also improve a person’s health and the overall quality of life. Every meal should include plenty of fruits and vegetables, grain products and legumes, but less of foods that contain more calories and fats. Although proteins rich foods such as meats are important to the body, they should be taken in moderation, and the focus should be on leaner meats (mainly white meat) and foods with little or no fat.

Consuming dairy products with little or no fats, such as skimmed milk, is another simple plan for reducing the quantity of calories entering the body. Eating habits such as eating while one is not hungry, skipping breakfast, and eating fast should be avoided. A person should also strive to drink as much water as possible since the body requires at least 8 cups of water each day.

One major step to being healthy is to maintain a healthy weight, and this may entail shedding off excess weight, gaining weight for underage persons, or maintaining that ideal weight. Eating right and participating in physical activities can go a long way in having a healthy weight and avoiding the health problems arising from being overweight.

To avoid being overweight or to shed off the extra pounds, a person should avoid high-calorie foods, or consume them in moderation and partake in regular physical activity. Trying to gain weight can be more difficult than losing weight. In gaining weight, one must not focus on consuming junk foods or snacks as this can clog the arteries and lead to heart diseases. Calories and fats must be obtained from healthy foods.

Failure to have enough sleep can have a negative impact on a person’s life, for instance, people who sleep less than seven hours a day are more exposed to catarrhal diseases than those who sleep for at least eight hours. The need for sleep varies among different persons, therefore, one should determine his/her own sleep requirements, and strive to have adequate sleep every day. As a caution, alcohol, or any other drug, should not be used to induce sleep as this would only lead to a pass out, not sleep.

Lifestyle choices such as avoiding cigarettes, avoiding excess calories from alcohol, sugar and fats, reducing the intake of high-fat foods, and partaking in physical activities should be emphasized on a day-to-day basis. Although alcohol has been found to be important to the body, it should be taken in moderation as it exposes the body to harmful compounds (cigarettes have the same effect).

All of us aspire to be healthy and engage in different activities to achieve this objective, however, there is no single way of ensuring that we are healthy for the rest our life. A healthy life is a cumulative product of various activities as outlined above, and discarding certain choices. The activities outlined must be observed on a day-to-day basis, and this does not have to mean making drastic changes, it is the simple, small changes that lead to a healthy life. In fact, drastic changes can lead to failure, or other side effects.

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Bibliography

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Exercise: 7 benefits of regular physical activity.

You know exercise is good for you, but do you know how good? From boosting your mood to improving your sex life, find out how exercise can improve your life.

Want to feel better, have more energy and even add years to your life? Just exercise.

The health benefits of regular exercise and physical activity are hard to ignore. Everyone benefits from exercise, no matter their age, sex or physical ability.

Need more convincing to get moving? Check out these seven ways that exercise can lead to a happier, healthier you.

1. Exercise controls weight

Exercise can help prevent excess weight gain or help you keep off lost weight. When you take part in physical activity, you burn calories. The more intense the activity, the more calories you burn.

Regular trips to the gym are great, but don't worry if you can't find a large chunk of time to exercise every day. Any amount of activity is better than none. To gain the benefits of exercise, just get more active throughout your day. For example, take the stairs instead of the elevator or rev up your household chores. Consistency is key.

2. Exercise combats health conditions and diseases

Worried about heart disease? Hoping to prevent high blood pressure? No matter what your current weight is, being active boosts high-density lipoprotein (HDL) cholesterol, the "good" cholesterol, and it decreases unhealthy triglycerides. This one-two punch keeps your blood flowing smoothly, which lowers your risk of heart and blood vessel, called cardiovascular, diseases.

Regular exercise helps prevent or manage many health problems and concerns, including:

• Metabolic syndrome.
• High blood pressure.
• Type 2 diabetes.
• Depression.
• Many types of cancer.

It also can help improve cognitive function and helps lower the risk of death from all causes.

3. Exercise improves mood

Need an emotional lift? Or need to lower stress after a stressful day? A gym session or brisk walk can help. Physical activity stimulates many brain chemicals that may leave you feeling happier, more relaxed and less anxious.

You also may feel better about your appearance and yourself when you exercise regularly, which can boost your confidence and improve your self-esteem.

4. Exercise boosts energy

Winded by grocery shopping or household chores? Regular physical activity can improve your muscle strength and boost your endurance.

Exercise sends oxygen and nutrients to your tissues and helps your cardiovascular system work more efficiently. And when your heart and lung health improve, you have more energy to tackle daily chores.

5. Exercise promotes better sleep

Struggling to snooze? Regular physical activity can help you fall asleep faster, get better sleep and deepen your sleep. Just don't exercise too close to bedtime, or you may be too energized to go to sleep.

6. Exercise puts the spark back into your sex life

Do you feel too tired or too out of shape to enjoy physical intimacy? Regular physical activity can improve energy levels and give you more confidence about your physical appearance, which may boost your sex life.

But there's even more to it than that. Regular physical activity may enhance arousal for women. And men who exercise regularly are less likely to have problems with erectile dysfunction than are men who don't exercise.

7. Exercise can be fun — and social!

Exercise and physical activity can be fun. They give you a chance to unwind, enjoy the outdoors or simply do activities that make you happy. Physical activity also can help you connect with family or friends in a fun social setting.

So take a dance class, hit the hiking trails or join a soccer team. Find a physical activity you enjoy, and just do it. Bored? Try something new, or do something with friends or family.

Exercise to feel better and have fun

Exercise and physical activity are great ways to feel better, boost your health and have fun. For most healthy adults, the U.S. Department of Health and Human Services recommends these exercise guidelines:

Aerobic activity. Get at least 150 minutes of moderate aerobic activity. Or get at least 75 minutes of vigorous aerobic activity a week. You also can get an equal combination of moderate and vigorous activity. Aim to spread out this exercise over a few days or more in a week.

For even more health benefits, the guidelines suggest getting 300 minutes a week or more of moderate aerobic activity. Exercising this much may help with weight loss or keeping off lost weight. But even small amounts of physical activity can be helpful. Being active for short periods of time during the day can add up and have health benefits.

• Strength training. Do strength training exercises for all major muscle groups at least two times a week. One set of each exercise is enough for health and fitness benefits. Use a weight or resistance level heavy enough to tire your muscles after about 12 to 15 repetitions.

Moderate aerobic exercise includes activities such as brisk walking, biking, swimming and mowing the lawn.

Vigorous aerobic exercise includes activities such as running, swimming laps, heavy yardwork and aerobic dancing.

You can do strength training by using weight machines or free weights, your own body weight, heavy bags, or resistance bands. You also can use resistance paddles in the water or do activities such as rock climbing.

If you want to lose weight, keep off lost weight or meet specific fitness goals, you may need to exercise more.

Remember to check with a health care professional before starting a new exercise program, especially if you have any concerns about your fitness or haven't exercised for a long time. Also check with a health care professional if you have chronic health problems, such as heart disease, diabetes or arthritis.

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• AskMayoExpert. Physical activity (adult). Mayo Clinic; 2021.
• Physical Activity Guidelines for Americans. 2nd ed. U.S. Department of Health and Human Services. https://health.gov/our-work/physical-activity/current-guidelines. Accessed June 25, 2021.
• Peterson DM. The benefits and risk of aerobic exercise. https://www.uptodate.com/contents/search. Accessed June 24, 2021.
• Maseroli E, et al. Physical activity and female sexual dysfunction: A lot helps, but not too much. The Journal of Sexual Medicine. 2021; doi:10.1016/j.jsxm.2021.04.004.
• Allen MS. Physical activity as an adjunct treatment for erectile dysfunction. Nature Reviews: Urology. 2019; doi:10.1038/s41585-019-0210-6.
• Tips for starting physical activity. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/weight-management/tips-get-active/tips-starting-physical-activity. Accessed June 25, 2021.
• Laskowski ER (expert opinion). Mayo Clinic. June 16, 2021.

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Essay on Health Awareness

Students are often asked to write an essay on Health Awareness in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Health Awareness

Understanding health awareness.

Health awareness is about knowing and understanding health issues. It’s like learning about different diseases, their causes, and how to avoid them. Health awareness helps us make better choices for a healthier life.

Importance of Health Awareness

Health awareness is important because it can save lives. It helps us know what’s good and bad for our health. With this knowledge, we can avoid harmful habits like smoking and eating junk food, and adopt healthy habits like exercising and eating balanced meals.

Health Awareness and Disease Prevention

Health awareness helps in preventing diseases. It tells us about vaccines and regular check-ups that help catch diseases early. Also, it teaches us about hygiene practices like washing hands to prevent disease spread.

Role of Schools in Health Awareness

Schools play a big role in health awareness. They teach students about nutrition, physical education, and hygiene. Schools also organize health camps and invite doctors to talk about different health topics.

Health awareness is a key to a healthy life. It helps us make wise choices, prevent diseases, and lead a happy, healthy life. So, let’s all be aware and spread health awareness for a healthier community.

Also check:

• Speech on Health Awareness

250 Words Essay on Health Awareness

What is health awareness.

Health awareness is about knowing and understanding health issues. It helps us make the right choices for our health. It is about learning how to stay fit, eat right, and take care of our bodies.

Why is Health Awareness Important?

Being aware of health is important for many reasons. It helps us live longer and better lives. When we know about health issues, we can prevent them. For example, knowing that smoking is bad for our lungs can stop us from starting to smoke.

How Can We Improve Health Awareness?

There are many ways to improve health awareness. We can read books, watch videos, or talk to doctors. Schools can also help by teaching students about health. Parents can set a good example by eating healthy food and exercising regularly.

Role of Media in Health Awareness

Media plays a big role in health awareness. TV shows, news, and social media can spread information about health. They can tell us about new research or health risks. But, we must be careful to check if the information is correct. Not all information on the internet is true.

In conclusion, health awareness is very important. It helps us make good choices for our health. We can improve health awareness by learning and sharing information. Let’s all try to be more aware of our health.

500 Words Essay on Health Awareness

Health awareness is knowing about the state of your body, how to keep it healthy, and what can harm it. It is like a guide to help you live a healthy life. It tells you about good habits like eating right, exercising, and getting enough sleep. It also warns you about bad things like smoking, drinking too much alcohol, or not getting enough exercise.

Health awareness is very important for everyone. It helps you stay healthy and avoid diseases. If you are aware of your health, you can take steps to prevent illness. For example, if you know that eating too much sugar can lead to diabetes, you can choose to eat less sugar. This can help you avoid getting diabetes in the future.

Health awareness also helps you know what to do if you get sick. If you are aware of the symptoms of a disease, you can recognize them early and get treatment. This can help you recover faster and prevent the disease from getting worse.

Ways to Increase Health Awareness

There are many ways to increase health awareness. One way is to learn about health from reliable sources. You can read books, watch videos, or talk to health professionals like doctors and nurses. You can also learn about health in school or at health awareness events.

Another way to increase health awareness is to practice healthy habits. This means eating a balanced diet, exercising regularly, getting enough sleep, and avoiding harmful substances like tobacco and alcohol. By doing these things, you can improve your health and learn more about how your body works.

Schools play a big role in health awareness. They teach students about health in science and physical education classes. They also provide healthy meals and opportunities for physical activity. Some schools even have health clinics where students can get check-ups and treatment.

Schools also organize health awareness events. These events can include health fairs, where students can learn about different health topics and get free health screenings. They can also include campaigns to promote healthy habits, like eating fruits and vegetables or walking to school.

In conclusion, health awareness is very important. It helps us stay healthy and avoid diseases. We can increase our health awareness by learning about health and practicing healthy habits. Schools play a big role in health awareness by teaching students about health and organizing health awareness events. By being aware of our health, we can live healthier, happier lives.

That’s it! I hope the essay helped you.

If you’re looking for more, here are essays on other interesting topics:

• Essay on Health Promotion On Diabetes
• Essay on Health Promotion On Alcohol
• Essay on Healthcare Affordability

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Intermittent Fasting

What you can do to maintain your health.

Last Updated May 2023 | This article was created by familydoctor.org editorial staff and reviewed by Leisa Bailey, MD

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A lot of factors play a role in staying healthy. In turn, good health can decrease your risk of developing certain diseases or conditions. These include heart disease, stroke, some cancers, and injuries. Learn what you can do to maintain your and your family’s health.

Path to improved health

Eat healthy.

What you eat is closely linked to your health. Balanced nutrition has many benefits. By making  healthier food choices , you can prevent or treat some conditions. These include heart disease, stroke, and diabetes. A healthy diet can help you lose weight and lower your cholesterol, as well.

Get regular exercise

Exercise can help prevent heart disease, stroke, diabetes, and colon cancer. It can help treat depression, osteoporosis, and high blood pressure. People who exercise also get injured less often.  Routine exercise  can make you feel better and keep your weight under control. Try to be active for 30 to 60 minutes about 5 times a week. Remember, any amount of exercise is better than none.

Lose weight if you’re overweight

Many Americans are overweight. Carrying too much weight increases your risk for several health conditions. These include:  

• High blood pressure
• High cholesterol
• Type 2 diabetes
• Heart disease
• Some cancers
• Gallbladder disease

Being overweight also can lead to weight-related injuries. A common problem is arthritis in the weight-bearing joints, such as your spine, hips, or knees. There are several things you can try to help you  lose weight  and keep it off.

Protect your skin

Sun exposure  is linked to skin cancer. This is the most common type of cancer in the United States. It’s best to limit your time spent in the sun. Be sure to wear protective clothing and hats when you are outside. Use sunscreen year-round on exposed skin, like your face and hands. It protects your skin and helps prevent skin cancer. Choose a broad-spectrum sunscreen that blocks both UVA and UVB rays. It should be at least an SPF 15. Do not sunbathe or use tanning booths.

Practice safe sex

Safe sex  is good for your emotional and physical health. The safest form of sex is between 2 people who only have sex with each other. Use protection to prevent sexually transmitted infections (STIs). Condoms are the most effective form of prevention. Talk to your doctor if you need to be tested for STIs.

Don’t smoke or use tobacco

Smoking and tobacco use are harmful habits. They can cause heart disease and mouth, throat, or lung cancer. They also are leading factors of emphysema and chronic obstructive pulmonary disease (COPD). The sooner  you quit , the better.

Limit how much alcohol you drink

Men should have no more than 2 drinks a day. Women should have no more than 1 drink a day. One drink is equal to 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor.  Too much alcohol  can damage your liver. It can cause some cancers, such as throat, liver, or pancreas cancer. Alcohol abuse also contributes to deaths from car wrecks, murders, and suicides.

Things to consider

In addition to the factors listed above, you should make time for whole body health. Visit your doctors for regular checkups. This includes your primary doctor as well as your dentist and eye doctor. Let your health benefits and preventive care services work for you. Make sure you know what your health insurance plan involves. Preventive care can detect disease or prevent illness before they start. This includes certain doctor visits and screenings.

You need to make time for breast health. Breast cancer is a leading cause of death for women. Men can get breast cancer, too. Talk to your doctor about when you should start getting mammograms. You may need to start screening early if you have risk factors, such as family history. One way to detect breast cancer is to do a monthly self-exam.

Women should get routine pap smears as well. Women ages 21 to 65 should get tested every 3 years. This may differ if you have certain conditions or have had your cervix removed.

Ask your doctor about other cancer screenings. Adults should get screened for colorectal cancer starting at age 45. Your doctor may want to check for other types of cancer. This will depend on your risk factors and family history.

If you smoke more than 30 packs a year (or vape the equivalent), your doctor may recommend a low-dose CT scan (a type of X-ray) to check for cancer.

Your doctor also may recommend a total body skin exam if you are out in the sun a great deal or have a family history of skin cancer.

Keep a list of current medicines you take. You also should stay up to date on shots, including getting an annual flu shot. Adults need a Td booster every 10 years. Your doctor may substitute it with Tdap. This also protects against whooping cough (pertussis). Women who are pregnant need the Tdap vaccine. People who are in close contact with babies should get it as well.

Questions to ask your doctor

• How many calories should I eat and how often should I exercise to maintain my current weight?
• Should I have a yearly physical exam?
• What types of preventive care does my insurance cover?
• When should I start getting screened for certain cancers and conditions?
• Which healthy choice is the most important for me?

American Cancer Society: Cancer Risk, Screening, and Prevention National Institute on Aging: Health and Aging

Last Updated: May 31, 2023

This article was contributed by familydoctor.org editorial staff.

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

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Quality Improvement

How to improve healthcare improvement—an essay by mary dixon-woods.

As improvement practice and research begin to come of age, Mary Dixon-Woods considers the key areas that need attention if we are to reap their benefits

In the NHS, as in health systems worldwide, patients are exposed to risks of avoidable harm 1 and unwarranted variations in quality. 2 3 4 But too often, problems in the quality and safety of healthcare are merely described, even “admired,” 5 rather than fixed; the effort invested in collecting information (which is essential) is not matched by effort in making improvement. The National Confidential Enquiry into Patient Outcome and Death, for example, has raised many of the same concerns in report after report. 6 Catastrophic degradations of organisations and units have recurred throughout the history of the NHS, with depressingly similar features each time. 7 8 9

More resources are clearly necessary to tackle many of these problems. There is no dispute about the preconditions for high quality, safe care: funding, staff, training, buildings, equipment, and other infrastructure. But quality health services depend not just on structures but on processes. 10 Optimising the use of available resources requires continuous improvement of healthcare processes and systems. 5

The NHS has seen many attempts to stimulate organisations to improve using incentive schemes, ranging from pay for performance (the Quality and Outcomes Framework in primary care, for example) to public reporting (such as annual quality accounts). They have had mixed results, and many have had unintended consequences. 11 12 Wanting to improve is not the same as knowing how to do it.

In response, attention has increasingly turned to a set of approaches known as quality improvement (QI). Though a definition of exactly what counts as a QI approach has escaped consensus, QI is often identified with a set of techniques adapted from industrial settings. They include the US Institute for Healthcare Improvement’s Model for Improvement, which, among other things, combines measurement with tests of small change (plan-do-study-act cycles). 8 Other popular approaches include Lean and Six Sigma. QI can also involve specific interventions intended to improve processes and systems, ranging from checklists and “care bundles” of interventions (a set of evidence based practices intended to be done consistently) through to medicines reconciliation and clinical pathways.

QI has been advocated in healthcare for over 30 years 13 ; policies emphasise the need for QI and QI practice is mandated for many healthcare professionals (including junior doctors). Yet the question, “Does quality improvement actually improve quality?” remains surprisingly difficult to answer. 14 The evidence for the benefits of QI is mixed 14 and generally of poor quality. It is important to resolve this unsatisfactory situation. That will require doing more to bring together the practice and the study of improvement, using research to improve improvement, and thinking beyond effectiveness when considering the study and practice of improvement.

Uniting practice and study

The practice and study of improvement need closer integration. Though QI programmes and interventions may be just as consequential for patient wellbeing as drugs, devices, and other biomedical interventions, research about improvement has often been seen as unnecessary or discretionary, 15 16 particularly by some of its more ardent advocates. This is partly because the challenges faced are urgent, and the solutions seem obvious, so just getting on with it seems the right thing to do.

But, as in many other areas of human activity, QI is pervaded by optimism bias. It is particularly affected by the “lovely baby” syndrome, which happens when formal evaluation is eschewed because something looks so good that it is assumed it must work. Five systematic reviews (published 2010-16) reporting on evaluations of Lean and Six Sigma did not identify a single randomised controlled trial. 17 18 19 20 21 A systematic review of redesigning care processes identified no randomised trials. 22 A systematic review of the application of plan-do-study-act in healthcare identified no randomised trials. 23 A systematic review of several QI methods in surgery identified just one randomised trial. 56

The sobering reality is that some well intentioned, initially plausible improvement efforts fail when subjected to more rigorous evaluation. 24 For instance, a controlled study of a large, well resourced programme that supported a group of NHS hospitals to implement the IHI’s Model for Improvement found no differences in the rate of improvement between participating and control organisations. 25 26 Specific interventions may, similarly, not survive the rigours of systematic testing. An example is a programme to reduce hospital admissions from nursing homes that showed promise in a small study in the US, 27 but a later randomised implementation trial found no effect on admissions or emergency department attendances. 28

Some interventions are probably just not worth the effort and opportunity cost: having nurses wear “do not disturb” tabards during drug rounds, is one example. 29 And some QI efforts, perversely, may cause harm—as happened when a multicomponent intervention was found to be associated with an increase rather than a decrease in surgical site infections. 30

Producing sound evidence for the effectiveness of improvement interventions and programmes is likely to require a multipronged approach. More large scale trials and other rigorous studies, with embedded qualitative inquiry, should be a priority for research funders.

Not every study of improvement needs to be a randomised trial. One valuable but underused strategy involves wrapping evaluation around initiatives that are happening anyway, especially when it is possible to take advantage of natural experiments or design roll-outs. 31 Evaluation of the reorganisation of stroke care in London and Manchester 32 and the study of the Matching Michigan programme to reduce central line infections are good examples. 33 34

It would be impossible to externally evaluate every QI project. Critically important therefore will be increasing the rigour with which QI efforts evaluate themselves, as shown by a recent study of an attempt to improve care of frail older people using a “hospital at home” approach in southwest England. 35 This ingeniously designed study found no effect on outcomes and also showed that context matters.

Despite the potential value of high quality evaluation, QI reports are often weak, 18 with, for example, interventions so poorly reported that reproducibility is frustrated. 36 Recent reporting guidelines may help, 37 but some problems are not straightforward to resolve. In particular, current structures for governance and publishing research are not always well suited to QI, including situations where researchers study programmes they have not themselves initiated. Systematic learning from QI needs to improve, which may require fresh thinking about how best to align the goals of practice and study, and to reconcile the needs of different stakeholders. 38

Using research to improve improvement

Research can help to support the practice of improvement in many ways other than evaluation of its effectiveness. One important role lies in creating assets that can be used to improve practice, such as ways to visualise data, analytical methods, and validated measures that assess the aspects of care that most matter to patients and staff. This kind of work could, for example, help to reduce the current vast number of quality measures—there are more than 1200 indicators of structure and process in perioperative care alone. 39

The study of improvement can also identify how improvement practice can get better. For instance, it has become clear that fidelity to the basic principles of improvement methods is a major problem: plan-do-study-act cycles are crucial to many improvement approaches, yet only 20% of the projects that report using the technique have done so properly. 23 Research has also identified problems in measurement—teams trying to do improvement may struggle with definitions, data collection, and interpretation 40 —indicating that this too requires more investment.

Improvement research is particularly important to help cumulate, synthesise, and scale learning so that practice can move forward without reinventing solutions that already exist or reintroducing things that do not work. Such theorising can be highly practical, 41 helping to clarify the mechanisms through which interventions are likely to work, supporting the optimisation of those interventions, and identifying their most appropriate targets. 42

Research can systematise learning from “positive deviance,” approaches that examine individuals, teams, or organisations that show exceptionally good performance. 43 Positive deviance can be used to identify successful designs for clinical processes that other organisations can apply. 44

Crucially, positive deviance can also help to characterise the features of high performing contexts and ensure that the right lessons are learnt. For example, a distinguishing feature of many high performing organisations, including many currently rated as outstanding by the Care Quality Commission, is that they use structured methods of continuous quality improvement. But studies of high performing settings, such as the Southmead maternity unit in Bristol, indicate that although continuous improvement is key to their success, a specific branded improvement method is not necessary. 45 This and other work shows that not all improvement needs to involve a well defined QI intervention, and not everything requires a discrete project with formal plan-do-study-act cycles.

More broadly, research has shown that QI is just one contributor to improving quality and safety. Organisations in many industries display similar variations to healthcare organisations, including large and persistent differences in performance and productivity between seemingly similar enterprises. 46 Important work, some of it experimental, is beginning to show that it is the quality of their management practices that distinguishes them. 47 These practices include continuous quality improvement as well as skills training, human resources, and operational management, for example. QI without the right contextual support is likely to have limited impact.

Beyond effectiveness

Important as they are, evaluations of the approaches and interventions in individual improvement programmes cannot answer every pertinent question about improvement. 48 Other key questions concern the values and assumptions intrinsic to QI.

Consider the “product dominant” logic in many healthcare improvement efforts, which assumes that one party makes a product and conveys it to a consumer. 49 Paul Batalden, one of the early pioneers of QI in healthcare, proposes that we need instead a “service dominant” logic, which assumes that health is co-produced with patients. 49

More broadly, we must interrogate how problems of quality and safety are identified, defined, and selected for attention by whom, through which power structures, and with what consequences. Why, for instance, is so much attention given to individual professional behaviour when systems are likely to be a more productive focus? 50 Why have quality and safety in mental illness and learning disability received less attention in practice, policy, and research 51 despite high morbidity and mortality and evidence of both serious harm and failures of organisational learning? The concern extends to why the topic of social inequities in healthcare improvement has remained so muted 52 and to the choice of subjects for study. Why is it, for example, that interventions like education and training, which have important roles in quality and safety and are undertaken at vast scale, are often treated as undeserving of evaluation or research?

How QI is organised institutionally also demands attention. It is often conducted as a highly local, almost artisan activity, with each organisation painstakingly working out its own solution for each problem. Much improvement work is conducted by professionals in training, often in the form of small, time limited projects conducted for accreditation. But working in this isolated way means a lack of critical mass to support the right kinds of expertise, such as the technical skill in human factors or ergonomics necessary to engineer a process or devise a safety solution. Having hundreds of organisations all trying to do their own thing also means much waste, and the absence of harmonisation across basic processes introduces inefficiencies and risks. 14

A better approach to the interorganisational nature of health service provision requires solving the “problem of many hands.” 53 We need ways to agree which kinds of sector-wide challenges need standardisation and interoperability; which solutions can be left to local customisation at implementation; and which should be developed entirely locally. 14 Better development of solutions and interventions is likely to require more use of prototyping, modelling and simulation, and testing in different scenarios and under different conditions, 14 ideally through coordinated, large scale efforts that incorporate high quality evaluation.

Finally, an approach that goes beyond effectiveness can also help in recognising the essential role of the professions in healthcare improvement. The past half century has seen a dramatic redefining of the role and status of the healthcare professions in health systems 54 : unprecedented external accountability, oversight, and surveillance are now the norm. But policy makers would do well to recognise how much more can be achieved through professional coalitions of the willing than through too many imposed, compliance focused diktats. Research is now showing how the professions can be hugely important institutional forces for good. 54 55 In particular, the professions have a unique and invaluable role in working as advocates for improvement, creating alliances with patients, providing training and education, contributing expertise and wisdom, coordinating improvement efforts, and giving political voice for problems that need to be solved at system level (such as, for example, equipment design).

Improvement efforts are critical to securing the future of the NHS. But they need an evidence base. Without sound evaluation, patients may be deprived of benefit, resources and energy may be wasted on ineffective QI interventions or on interventions that distribute risks unfairly, and organisations are left unable to make good decisions about trade-offs given their many competing priorities. The study of improvement has an important role in developing an evidence-base and in exploring questions beyond effectiveness alone, and in particular showing the need to establish improvement as a collective endeavour that can benefit from professional leadership.

Mary Dixon-Woods is the Health Foundation professor of healthcare improvement studies and director of The Healthcare Improvement Studies (THIS) Institute at the University of Cambridge, funded by the Health Foundation. Co-editor-in-chief of BMJ Quality and Safety , she is an honorary fellow of the Royal College of General Practitioners and the Royal College of Physicians. This article is based largely on the Harveian oration she gave at the RCP on 18 October 2018, in the year of the college’s 500th anniversary. The oration is available here: http://www.clinmed.rcpjournal.org/content/19/1/47 and the video version here: https://www.rcplondon.ac.uk/events/harveian-oration-and-dinner-2018

This article is one of a series commissioned by The BMJ based on ideas generated by a joint editorial group with members from the Health Foundation and The BMJ , including a patient/carer. The BMJ retained full editorial control over external peer review, editing, and publication. Open access fees and The BMJ ’s quality improvement editor post are funded by the Health Foundation.

Competing interests: I have read and understood BMJ policy on declaration of interests and a statement is available here: https://www.bmj.com/about-bmj/advisory-panels/editorial-advisory-board/mary-dixonwoods

Provenance and peer review: Commissioned; not externally peer reviewed.

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How to improve healthcare improvement—an essay by Mary Dixon-Woods

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As improvement practice and research begin to come of age, Mary Dixon-Woods considers the key areas that need attention if we are to reap their benefits

In the NHS, as in health systems worldwide, patients are exposed to risks of avoidable harm 1 and unwarranted variations in quality. 2 3 4 But too often, problems in the quality and safety of healthcare are merely described, even “admired,” 5 rather than fixed; the effort invested in collecting information (which is essential) is not matched by effort in making improvement. The National Confidential Enquiry into Patient Outcome and Death, for example, has raised many of the same concerns in report after report. 6 Catastrophic degradations of organisations and units have recurred throughout the history of the NHS, with depressingly similar features each time. 7 8 9

More resources are clearly necessary to tackle many of these problems. There is no dispute about the preconditions for high quality, safe care: funding, staff, training, buildings, equipment, and other infrastructure. But quality health services depend not just on structures but on processes. 10 Optimising the use of available resources requires continuous improvement of healthcare processes and systems. 5

The NHS has seen many attempts to stimulate organisations to improve using incentive schemes, ranging from pay for performance (the Quality and Outcomes Framework in primary care, for example) to public reporting (such as annual quality accounts). They have had mixed results, and many have had unintended consequences. 11 12 Wanting to improve is not the same as knowing how to do it.

In response, attention has increasingly turned to a set of approaches known as quality improvement (QI). Though a definition of exactly what counts as a QI approach has escaped consensus, QI is often identified with a set of techniques adapted from industrial settings. They include the US Institute for Healthcare Improvement’s Model for Improvement, which, among other things, combines measurement with tests of small change (plan-do-study-act cycles). 8 Other popular approaches include Lean and Six Sigma. QI can also involve specific interventions intended to improve processes and systems, ranging from checklists and “care bundles” of interventions (a set of evidence based practices intended to be done consistently) through to medicines reconciliation and clinical pathways.

QI has been advocated in healthcare for over 30 years 13 ; policies emphasise the need for QI and QI practice is mandated for many healthcare professionals (including junior doctors). Yet the question, “Does quality improvement actually improve quality?” remains surprisingly difficult to answer. 14 The evidence for the benefits of QI is mixed 14 and generally of poor quality. It is important to resolve this unsatisfactory situation. That will require doing more to bring together the practice and the study of improvement, using research to improve improvement, and thinking beyond effectiveness when considering the study and practice of improvement.

Uniting practice and study

The practice and study of improvement need closer integration. Though QI programmes and interventions may be just as consequential for patient wellbeing as drugs, devices, and other biomedical interventions, research about improvement has often been seen as unnecessary or discretionary, 15 16 particularly by some of its more ardent advocates. This is partly because the challenges faced are urgent, and the solutions seem obvious, so just getting on with it seems the right thing to do.

But, as in many other areas of human activity, QI is pervaded by optimism bias. It is particularly affected by the “lovely baby” syndrome, which happens when formal evaluation is eschewed because something looks so good that it is assumed it must work. Five systematic reviews (published 2010-16) reporting on evaluations of Lean and Six Sigma did not identify a single randomised controlled trial. 17 18 19 20 21 A systematic review of redesigning care processes identified no randomised trials. 22 A systematic review of the application of plan-do-study-act in healthcare identified no randomised trials. 23 A systematic review of several QI methods in surgery identified just one randomised trial. 56

The sobering reality is that some well intentioned, initially plausible improvement efforts fail when subjected to more rigorous evaluation. 24 For instance, a controlled study of a large, well resourced programme that supported a group of NHS hospitals to implement the IHI’s Model for Improvement found no differences in the rate of improvement between participating and control organisations. 25 26 Specific interventions may, similarly, not survive the rigours of systematic testing. An example is a programme to reduce hospital admissions from nursing homes that showed promise in a small study in the US, 27 but a later randomised implementation trial found no effect on admissions or emergency department attendances. 28

Some interventions are probably just not worth the effort and opportunity cost: having nurses wear “do not disturb” tabards during drug rounds, is one example. 29 And some QI efforts, perversely, may cause harm—as happened when a multicomponent intervention was found to be associated with an increase rather than a decrease in surgical site infections. 30

Producing sound evidence for the effectiveness of improvement interventions and programmes is likely to require a multipronged approach. More large scale trials and other rigorous studies, with embedded qualitative inquiry, should be a priority for research funders.

Not every study of improvement needs to be a randomised trial. One valuable but underused strategy involves wrapping evaluation around initiatives that are happening anyway, especially when it is possible to take advantage of natural experiments or design roll-outs. 31 Evaluation of the reorganisation of stroke care in London and Manchester 32 and the study of the Matching Michigan programme to reduce central line infections are good examples. 33 34

It would be impossible to externally evaluate every QI project. Critically important therefore will be increasing the rigour with which QI efforts evaluate themselves, as shown by a recent study of an attempt to improve care of frail older people using a “hospital at home” approach in southwest England. 35 This ingeniously designed study found no effect on outcomes and also showed that context matters.

Despite the potential value of high quality evaluation, QI reports are often weak, 18 with, for example, interventions so poorly reported that reproducibility is frustrated. 36 Recent reporting guidelines may help, 37 but some problems are not straightforward to resolve. In particular, current structures for governance and publishing research are not always well suited to QI, including situations where researchers study programmes they have not themselves initiated. Systematic learning from QI needs to improve, which may require fresh thinking about how best to align the goals of practice and study, and to reconcile the needs of different stakeholders. 38

Using research to improve improvement

Research can help to support the practice of improvement in many ways other than evaluation of its effectiveness. One important role lies in creating assets that can be used to improve practice, such as ways to visualise data, analytical methods, and validated measures that assess the aspects of care that most matter to patients and staff. This kind of work could, for example, help to reduce the current vast number of quality measures—there are more than 1200 indicators of structure and process in perioperative care alone. 39

The study of improvement can also identify how improvement practice can get better. For instance, it has become clear that fidelity to the basic principles of improvement methods is a major problem: plan-do-study-act cycles are crucial to many improvement approaches, yet only 20% of the projects that report using the technique have done so properly. 23 Research has also identified problems in measurement—teams trying to do improvement may struggle with definitions, data collection, and interpretation 40 —indicating that this too requires more investment.

Improvement research is particularly important to help cumulate, synthesise, and scale learning so that practice can move forward without reinventing solutions that already exist or reintroducing things that do not work. Such theorising can be highly practical, 41 helping to clarify the mechanisms through which interventions are likely to work, supporting the optimisation of those interventions, and identifying their most appropriate targets. 42

Research can systematise learning from “positive deviance,” approaches that examine individuals, teams, or organisations that show exceptionally good performance. 43 Positive deviance can be used to identify successful designs for clinical processes that other organisations can apply. 44

Crucially, positive deviance can also help to characterise the features of high performing contexts and ensure that the right lessons are learnt. For example, a distinguishing feature of many high performing organisations, including many currently rated as outstanding by the Care Quality Commission, is that they use structured methods of continuous quality improvement. But studies of high performing settings, such as the Southmead maternity unit in Bristol, indicate that although continuous improvement is key to their success, a specific branded improvement method is not necessary. 45 This and other work shows that not all improvement needs to involve a well defined QI intervention, and not everything requires a discrete project with formal plan-do-study-act cycles.

More broadly, research has shown that QI is just one contributor to improving quality and safety. Organisations in many industries display similar variations to healthcare organisations, including large and persistent differences in performance and productivity between seemingly similar enterprises. 46 Important work, some of it experimental, is beginning to show that it is the quality of their management practices that distinguishes them. 47 These practices include continuous quality improvement as well as skills training, human resources, and operational management, for example. QI without the right contextual support is likely to have limited impact.

Beyond effectiveness

Important as they are, evaluations of the approaches and interventions in individual improvement programmes cannot answer every pertinent question about improvement. 48 Other key questions concern the values and assumptions intrinsic to QI.

Consider the “product dominant” logic in many healthcare improvement efforts, which assumes that one party makes a product and conveys it to a consumer. 49 Paul Batalden, one of the early pioneers of QI in healthcare, proposes that we need instead a “service dominant” logic, which assumes that health is co-produced with patients. 49

More broadly, we must interrogate how problems of quality and safety are identified, defined, and selected for attention by whom, through which power structures, and with what consequences. Why, for instance, is so much attention given to individual professional behaviour when systems are likely to be a more productive focus? 50 Why have quality and safety in mental illness and learning disability received less attention in practice, policy, and research 51 despite high morbidity and mortality and evidence of both serious harm and failures of organisational learning? The concern extends to why the topic of social inequities in healthcare improvement has remained so muted 52 and to the choice of subjects for study. Why is it, for example, that interventions like education and training, which have important roles in quality and safety and are undertaken at vast scale, are often treated as undeserving of evaluation or research?

How QI is organised institutionally also demands attention. It is often conducted as a highly local, almost artisan activity, with each organisation painstakingly working out its own solution for each problem. Much improvement work is conducted by professionals in training, often in the form of small, time limited projects conducted for accreditation. But working in this isolated way means a lack of critical mass to support the right kinds of expertise, such as the technical skill in human factors or ergonomics necessary to engineer a process or devise a safety solution. Having hundreds of organisations all trying to do their own thing also means much waste, and the absence of harmonisation across basic processes introduces inefficiencies and risks. 14

A better approach to the interorganisational nature of health service provision requires solving the “problem of many hands.” 53 We need ways to agree which kinds of sector-wide challenges need standardisation and interoperability; which solutions can be left to local customisation at implementation; and which should be developed entirely locally. 14 Better development of solutions and interventions is likely to require more use of prototyping, modelling and simulation, and testing in different scenarios and under different conditions, 14 ideally through coordinated, large scale efforts that incorporate high quality evaluation.

Finally, an approach that goes beyond effectiveness can also help in recognising the essential role of the professions in healthcare improvement. The past half century has seen a dramatic redefining of the role and status of the healthcare professions in health systems 54 : unprecedented external accountability, oversight, and surveillance are now the norm. But policy makers would do well to recognise how much more can be achieved through professional coalitions of the willing than through too many imposed, compliance focused diktats. Research is now showing how the professions can be hugely important institutional forces for good. 54 55 In particular, the professions have a unique and invaluable role in working as advocates for improvement, creating alliances with patients, providing training and education, contributing expertise and wisdom, coordinating improvement efforts, and giving political voice for problems that need to be solved at system level (such as, for example, equipment design).

Improvement efforts are critical to securing the future of the NHS. But they need an evidence base. Without sound evaluation, patients may be deprived of benefit, resources and energy may be wasted on ineffective QI interventions or on interventions that distribute risks unfairly, and organisations are left unable to make good decisions about trade-offs given their many competing priorities. The study of improvement has an important role in developing an evidence-base and in exploring questions beyond effectiveness alone, and in particular showing the need to establish improvement as a collective endeavour that can benefit from professional leadership.

Mary Dixon-Woods is the Health Foundation professor of healthcare improvement studies and director of The Healthcare Improvement Studies (THIS) Institute at the University of Cambridge, funded by the Health Foundation. Co-editor-in-chief of BMJ Quality and Safety , she is an honorary fellow of the Royal College of General Practitioners and the Royal College of Physicians. This article is based largely on the Harveian oration she gave at the RCP on 18 October 2018, in the year of the college’s 500th anniversary. The oration is available here: http://www.clinmed.rcpjournal.org/content/19/1/47 and the video version here: https://www.rcplondon.ac.uk/events/harveian-oration-and-dinner-2018

This article is one of a series commissioned by The BMJ based on ideas generated by a joint editorial group with members from the Health Foundation and The BMJ , including a patient/carer. The BMJ retained full editorial control over external peer review, editing, and publication. Open access fees and The BMJ ’s quality improvement editor post are funded by the Health Foundation.

Competing interests: I have read and understood BMJ policy on declaration of interests and a statement is available here: https://www.bmj.com/about-bmj/advisory-panels/editorial-advisory-board/mary-dixonwoods

Provenance and peer review: Commissioned; not externally peer reviewed.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

• Neuburger J ,
• Hutchings A ,
• Stewart K ,
• Buckingham R
• Castelli A ,
• Verzulli R ,
• Allwood D ,
• Sunstein CR
• Healthcare Quality Improvement Partnership
• Shortell SM
• Martin GP ,
• Dixon-Woods M
• Donabedian A
• Himmelstein DU ,
• Woolhandler S
• Woolhandler S ,
• Himmelstein DU
• Dixon-Woods M ,
• Ioannidis JPA ,
• Marshall M ,
• Pronovost P ,
• Glasgow JM ,
• Scott-Caziewell JR ,
• Nicolay CR ,
• Deblois S ,
• Moraros J ,
• Lemstra M ,
• Amaratunga T ,
• Dobranowski J
• van Leijen-Zeelenberg JE ,
• Elissen AMJ ,
• Taylor MJ ,
• McNicholas C ,
• Nicolay C ,
• Morgan DJ ,
• Diekema DJ ,
• Sepkowitz K ,
• Perencevich EN
• Benning A ,
• Ouslander JG ,
• Huckfeldt P ,
• Westbrook JI ,
• Hooper TD ,
• Middleton S ,
• Anthony T ,
• Murray BW ,
• Sum-Ping JT ,
• Portela MC ,
• Pronovost PJ ,
• Woodcock T ,
• Ramsay AIG ,
• Hoffman A ,
• Richardson A ,
• Hibbert P ,
• Matching Michigan Collaboration & Writing Committee
• Tarrant C ,
• Pearson M ,
• Hemsley A ,
• Blackwell R ,
• Custerson L
• Goodman D ,
• Watson SI ,
• Taylor CA ,
• Chazapis M ,
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• “Psychological Theory” Group
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• Ramtale SC ,
• Boozary AS ,
• Shojania KG
• Pronovost PJ
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• Greenhalgh A ,

Importance of Exercise Essay

500 words essay on exercise essay.

Exercise is basically any physical activity that we perform on a repetitive basis for relaxing our body and taking away all the mental stress. It is important to do regular exercise. When you do this on a daily basis, you become fit both physically and mentally. Moreover, not exercising daily can make a person susceptible to different diseases. Thus, just like eating food daily, we must also exercise daily. The importance of exercise essay will throw more light on it.

Importance of Exercise

Exercising is most essential for proper health and fitness. Moreover, it is essential for every sphere of life. Especially today’s youth need to exercise more than ever. It is because the junk food they consume every day can hamper their quality of life.

If you are not healthy, you cannot lead a happy life and won’t be able to contribute to the expansion of society. Thus, one needs to exercise to beat all these problems. But, it is not just about the youth but also about every member of the society.

These days, physical activities take places in colleges more than often. The professionals are called to the campus for organizing physical exercises. Thus, it is a great opportunity for everyone who wishes to do it.

Just like exercise is important for college kids, it is also essential for office workers. The desk job requires the person to sit at the desk for long hours without breaks. This gives rise to a very unhealthy lifestyle.

They get a limited amount of exercise as they just sit all day then come back home and sleep. Therefore, it is essential to exercise to adopt a healthy lifestyle that can also prevent any damaging diseases .

Benefits of Exercise

Exercise has a lot of benefits in today’s world. First of all, it helps in maintaining your weight. Moreover, it also helps you reduce weight if you are overweight. It is because you burn calories when you exercise.

Further, it helps in developing your muscles. Thus, the rate of your body will increases which helps to burn calories. Moreover, it also helps in improving the oxygen level and blood flow of the body.

When you exercise daily, your brain cells will release frequently. This helps in producing cells in the hippocampus. Moreover, it is the part of the brain which helps to learn and control memory.

The concentration level in your body will improve which will ultimately lower the danger of disease like Alzheimer’s. In addition, you can also reduce the strain on your heart through exercise. Finally, it controls the blood sugar levels of your body so it helps to prevent or delay diabetes.

Get the huge list of more than 500 Essay Topics and Ideas

Conclusion of Importance of Exercise Essay

In order to live life healthily, it is essential to exercise for mental and physical development. Thus, exercise is important for the overall growth of a person. It is essential to maintain a balance between work, rest and activities. So, make sure to exercise daily.

FAQ of Importance of Exercise Essay

Question 1: What is the importance of exercise?

Answer 1: Exercise helps people lose weight and lower the risk of some diseases. When you exercise daily, you lower the risk of developing some diseases like obesity, type 2 diabetes, high blood pressure and more. It also helps to keep your body at a healthy weight.

Question 2: Why is exercising important for students?

Answer 2: Exercising is important for students because it helps students to enhance their cardiorespiratory fitness and build strong bones and muscles. In addition, it also controls weight and reduces the symptoms of anxiety and depression. Further, it can also reduce the risk of health conditions like heart diseases and more.

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How to achieve great health for all? Start in your city.

At a glance.

• The global population living in cities is projected to grow to about 70 percent by 2050. Large disparities in health outcomes within urban populations suggest that a city-level focus has significant potential to improve health.
• The McKinsey Health Institute (MHI) estimates that a focus on improving health at the city level can unlock 20 billion to 25 billion additional years of higher-quality life across cities globally (approximately five years per person living in urban areas). All organizations across sectors have a role to play to capture this opportunity.
• Immediately influenceable interventions, grounded in a rich existing evidence base, are a starting point to improve health at a city level. For example, interventions could add to residents’ healthy longevity and brain health, lessen the impacts of climate exposure, and improve health-worker capacity.

In the past 60 years, global longevity rates have risen substantially, increasing life spans for individuals by 20 years on average. 1 “Life expectancy at birth, total (years),” World Bank, 2022; “Global burden of disease study 2019: Population estimates 1950-2019,” Institute for Health Metrics and Evaluation, 2023. Yet that accomplishment has not resulted in an equivalent gain in time spent in good health: at a global level, every additional year of life means an average of six months in ill health (Exhibit 1).

Why has time spent in ill health increased so much? As the global population ages, the burden has shifted to three fields of age-related noncommunicable diseases (NCDs) broadly associated with the wear and tear of body and mind: cardiometabolic diseases, cancers, and mental, substance use, and neurological conditions. Today, all NCDs account for 69 percent of the global disease burden (Exhibit 2). The three big fields of age-related illness 2 Angela Chang et al., “Measuring population ageing: An analysis of the Global Burden of Disease Study 2017,” The Lancet Public Health , March 2019, Volume 4. account for 65 percent of the NCD burden, a trend that is expected to accelerate: one in six people worldwide will be over 60 (one in three in some countries) by 2030. 3 “Ageing and health fact sheet,” World Health Organization, October 1, 2022; “World Population Prospects 2022,” United Nations Department of Economic and Social Affairs, Population Division. By 2040, 11 of 14 of the disease categories predicted to increase will be NCDs, with age-related diseases such as diabetes or kidney diseases increasing the most—possibly by more than 60 percent by 2040. 4 Kyle J. Foreman et al., “Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: Reference and alternative scenarios for 2016–40 for 195 countries and territories,” The Lancet , October 2018, Volume 392, Issue 10,159.

External threats to global health, including climate change and antimicrobial resistance (AMR), will further increase the disease burden. The impacts of climate change on human health will be varied and far-reaching—ranging from the direct effects of climate hazards on physical and mental health to effects on water and vector-borne disease transmission, food security, and air pollution. Even under a midrange emissions-reduction scenario, specific climate-change-related mortality is expected to increase to 250,000 excess deaths per year in 2050. 5 “Fact sheet–health,” International Panel on Climate Change, February 2023; impacts on malaria but not other diseases included in the estimate. Any climate-sensitive increase of the disease burden, including mental health, will be on top of that. Deaths from AMR are expected to increase to 10 million or more, up from less than 1.2 million, in the same period. 6 Bracing for superbugs: Strengthening environmental action in the One Health response to antimicrobial resistance , UN Environment Programme, February 7, 2023; Tackling drug-resistant infections globally: Final report and recommendations , Review on Antimicrobial Resistance , May 2016.

Cities are where the drivers of health play out in practice

Many stakeholders influence people’s health in nonobvious ways. In “ The secret to great health? Escaping the healthcare matrix ,” MHI identifies 23 drivers of health and shows how individuals and institutions are part of an interconnected ecosystem of health that they can shape together. Nineteen of these drivers are outside of conventional healthcare.

To succeed in achieving substantial impact in cities, all stakeholders are needed to optimize the drivers of great health. Within conventional healthcare, there is reasonably clear ownership of the best way to diagnose and treat. But who is responsible for ensuring that people eat better, exercise, sleep well, have less negative stress, spend time in nature, consume content that is good for them, and have meaningful social interactions? While individuals have an important role, a virtuous cycle between institutions and individuals is needed to optimize these drivers truly. Governments, including national and subnational levels that enable cities to play their part, businesses, civil society, employers, philanthropic organizations, and academia are all part of the picture.

In this way, cities shape the institutional context for individuals’ health and daily lives. For example, a city dweller who can pick up fresh produce along the daily commute can take up a healthier diet; a young professional might identify their risk of disease sooner when taking part in a screening initiative offered by their employer; or a retiree can join an exercise session and connect with their community at a local green space.

Addressing the shifting disease burden requires looking at factors beyond healthcare, including prevention and health promotion across all fields. MHI estimates that, by embracing a more comprehensive definition of health and actively working to address the drivers of health throughout life, each person on the planet could have up to six years of higher-quality life over the next decade. 7 Reflects global average. Lars Hartenstein and Tom Latkovic, “ The secret to great health? Escaping the healthcare matrix ,” McKinsey Health Institute, December 20, 2022. Every institution and every individual has a role to play (see sidebar “Cities are where the drivers of health play out in practice”).

Cities are a hub of opportunity to realize this potential. They are where many of the long-term drivers of health that can help address this shifting disease burden are playing out. Cities have a unique ability to mobilize cross-sectoral stakeholders quickly to create an enabling environment and focus on near-term, influenceable interventions. In the next section, we lay out three reasons why cities have a vital role to play in enabling better health for their citizens.

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Focusing on healthy cities: cities are a critical nexus to advance health.

For decades, groups such as the World Health Organization (WHO) have heralded cities for the health-related opportunities they present. 8 “WHO European Healthy Cities Network,” World Health Organization, accessed January 2024. Cross-city and local initiatives to improve health in cities, whether led by governments, nonprofit organizations, or the private sector, have been successful. For example, C40 Cities, a network of mayors from the world’s leading cities, is collaborating on climate-focused initiatives, including health-focused ones like air pollution reduction. 9 “Our cities,” C4 Cities, accessed January 2024. Global efforts such as the Partnership for Healthy Cities, the WHO European Healthy Cities Network, the International Society for Urban Health, and Fast-Track Cities, as well as private sector foundations such as the Novo Nordisk Foundation and Novartis Foundation, are other examples of city-focused health collaborations.

At the same time, the opportunity to do better and achieve improved and more equitable health outcomes in cities is still large. Attention on health at a city level could still be much higher. For example, while 100 percent of countries have a top official responsible for health at a national level, 10 These officials oversee programs that include health and well-being, public health, disease prevention, and health promotion. only 37 percent of the largest cities in the world 11 Top five most populous cities per continent, as well as Dubai, Mumbai, Nairobi, Singapore, and Santiago de Chile. have a top official who is similarly focusing on health (Exhibit 3). Having a dedicated senior city leader for health can signal the city’s prioritization of health and facilitates the mobilization of city leaders to focus on health-related issues. 12 The role of national health departments in cities can vary significantly by country.

Opportunities abound at any level of economic development: at all levels of average GDP per capita, the life expectancy in microregions across the world differs by decades (Exhibit 4). While 53 percent of the variation in life expectancy can be explained by a person’s income, the remaining 47 percent can be explained by other factors such as health-related interventions and innovations. 13 “ A dividend paid in years: Getting more health from each dollar of income ,” McKinsey Global Institute, December 7, 2022. These facts indicate that opportunities to improve health outcomes exist beyond growing income or stimulating economic growth.

Based on updates to its foundational analysis , MHI has found that approximately five more years of higher-quality life per person living in urban areas is possible—an additional 20 billion to 25 billion years at a global level. 14 This means a large share of the additional years of higher-quality life in MHI’s foundational analysis can be captured in cities. The potential for adding higher-quality life years is calculated based on sizing three effects on a country’s urban population: increase of life expectancy (“extending”), decrease of lifetime spent in poor health, and decrease of lifetime in moderate rather than good health (“lifting” and “squaring the curve”). For more, see “ Adding years to life and life to years ,” McKinsey Health Institute, March 29, 2022. For major global cities, this could amount to 10 million to 190 million higher-quality life years for their residents (Exhibit 5). 15 The potential is calculated by multiplying each city’s metropolitan population by the number of “good and moderate health years” gained per person (based on previous MHI research outlined in “ Adding years to life and life to years ,” March 29, 2022), which varies depending on the country’s income band. There are three major reasons why cities have this potential (Exhibit 6).

More than half of the global population today lives in cities. City population is projected to grow to about 70 percent by 2050 (high-income economies may see up to 87 percent of their population living in urban areas by that time). 16 World cities report 2022: Envisaging the future of cities , UN-Habitat. Older adults are increasingly living in urban areas and stand to benefit most from improvements in broader population health. 17 “Ageing in Cities: Policy highlights,” OECD, 2015. Between 2000 and 2015, the number of people 60 years or older in urban areas worldwide increased by 68 percent, with many in less-than-great health or socially isolated. 18 World population ageing report , United Nations, 2017; “ Aging with purpose: Why meaningful engagement with society matters ,” McKinsey Health Institute, October 23, 2023.

The large disparities in health outcomes within urban populations suggest that a city-level focus could have substantial potential to improve health. For example, despite being eight miles apart in London, there is a 14-year difference in life expectancy among people who live near Prince Regent station and those who live near Charing Cross. 19 “Lives on the line: A map of life expectancy at birth,” Tube Creature, accessed August 2023. In Chicago, there is a 30-year life expectancy gap between residents in Streeterville, a neighborhood where residents have an average life expectancy of 90, and Englewood, a neighborhood nine miles away where the average is 60 years. 20 “Large life expectancy gaps in U.S. cities linked to racial & ethnic segregation by neighborhood,” NYU Langone Health, June 5, 2019; Sarah Holder and David Montgomery, “Life expectancy is associated with segregation in U.S. cities,” Bloomberg, June 6, 2019. Around the world, rapid urbanization has often meant urban poverty, where growth in population outpaces infrastructure and support. In 2020, one in four urban dwellers lived in informal settlements or slums, 21 Informal settlements and slums are characterized by UN-Habitat as lack of access to improved water, improved sanitation, sufficient living area, and quality/durability of structure. Security of tenure is also an indicator but not included in the estimate due to data limitations. See The sustainable development goals report , United Nations. which translates to more than a billion people worldwide living with barriers such as limited access to a healthy diet 22 Mireya Vilar-Compte et al., “Urban poverty and nutrition challenges associated with accessibility to a healthy diet: A global systematic literature review,” International Journal for Equity in Health , January 2021. and basic services. 23 Aurelio Menendez, “Access to basic infrastructure by the urban poor,” Economic Development Institute of the World Bank, 1991. City-specific interventions show potential to improve population health within cities.

Many of the stakeholders that have a large influence on population health are located in cities. In addition to conventional healthcare players, stakeholders include private sector companies, the government, philanthropists, employers, as well as civil society. Cities are an ideal place to convene all of these players to further health. Usually, a relatively small set of players within a city has an outsize influence on the drivers of health. For example, in Paris, more than 20 percent of employees work in the public sector, and ten hospitals cover 65 percent of hospital capacity. 24 Characteristics of establishments at the end of 2020, Department of Paris (75), Insee, December 13, 2022; MHI analysis based on APMI Partners data, 2023. In London, 86 percent of the supermarkets are run by just four major chains. 25 “Top supermarket chains in the UK: Location analysis,” ScrapeHero, accessed December 2023. In Nairobi and Singapore the situation is similar, with 90 percent of supermarkets operated by five chains in Nairobi, 26 MHI analysis based on Trendtype data, 2023. and 70 percent operated by five players in Singapore. 27 MHI analysis based on Euromonitor data, 2022. In addition, only the five largest employers in each of the 12 cities referenced in Exhibit 5 have a total annual revenue of $600 billion. 28 S&P Capital IQ, 2023; examples of the total revenues of top five companies from individual cities include London (USD $85 billion to $90 billion), Singapore (USD $65 billion), and Tokyo (USD $55 billion to $60 billion). This illustrates that powerful stakeholders are indeed a presence in large cities and that harnessing this power is a great opportunity for human health.

Taking action: Focus on neglected areas and start with immediately influenceable interventions

Where possible, doubling down on what cities are currently doing to improve health with their current resources can be helpful. When investing more to drive initial change, immediately influenceable interventions are an effective way to start, especially for stakeholders that are stepping up their involvement in health. In contrast to large-scale infrastructure investments, for instance, immediately influenceable interventions take a relatively short time to implement, have a relatively short payback period, and can typically be advanced by a number of different stakeholders. In principle, any meaningful company, public agency, or civil-society organization can contribute.

Examples of immediately influenceable interventions to scale in cities worldwide

City interventions can focus on a range of levels, including, but not limited to, the following.

Healthy aging and longevity

• Offering screenings, diagnosis, and proactive treatment (nontherapeutic and/or therapeutic) for cardiovascular diseases and metabolic disorders, including screening for high blood pressure, cholesterol and triglyceride levels, and blood sugar (for example, HbA1c) in a community or workplace setting. Stakeholders may facilitate nontherapeutic and/or therapeutic treatment and employ digital adherence tools (for example, continuous glucose monitoring) for those with elevated levels.
• Expanding nutritional access and food choices, such as by collaborating with convenience store chains and large retailers to integrate healthy portfolios throughout their product offerings, optimize stock displays, and provide discounted rates for fresh, nutritious foods in underserved regions.
• Encouraging societal participation of older people through citywide coalitions to formalize social opportunities for older adults, including age-friendly education programs for lifelong learning, community participation programs for volunteering focused on the elderly, and employment awareness programs for individuals seeking work.
• Offering early detection and treatment for breast and colon cancers through improved accessibility and artificial intelligence-driven data/image analysis.

Brain health

• Upskilling and training clinical and nonclinical workers on “task sharing” to deliver brief, basic versions of existing evidence-based psychological treatments (for example, cognitive behavioral therapy, interpersonal therapy).
• Supporting community-based crisis care services by deploying clinical and/or nonclinical workers trained in task sharing to support individuals who have experienced or are experiencing a mental health crisis in community settings. This would serve to strengthen the community-based crisis care continuum and prevent overreliance on first responders (emergency medical services, police), emergency departments, and psychiatric hospitals.

Climate-related health

Implementing custom heat-health action plans with immediate response actions for heatwaves, the identification of heat respite spaces, and the enhancement of urban greening to mitigate extreme-heat impacts.

Health-worker capacity

Training health workforce through at-scale training programs (including certification and upskilling) to grow paramedical/paraclinical workforce (nursing and therapeutical staff) and community health workforce by establishing linkages to suitable employment opportunities.

Four categories of interventions can harness cities’ unique potential to tackle the growth in noncommunicable diseases: healthy longevity interventions (including those that address cancers, cardiovascular diseases, and diabetes), brain health interventions (including initiatives that address mental, substance use, and neurological conditions), climate-related health interventions, and interventions that improve health-worker capacity. All of these intervention groups are highly relevant across the globe, addressable, and underresourced. Immediately influenceable interventions for each of these areas can take a variety of forms (see sidebar “Examples of immediately influenceable interventions to scale in cities worldwide”).

Healthy aging and longevity. Many interventions can materially contribute to healthy longevity, including effective screening and treatment for cardiometabolic conditions or cancer, as well as interventions enabling better diets or societal participation of older people. For instance, high blood pressure is a critical early marker of compromised cardiometabolic health, and early action can materially improve health outcomes. Even smaller-scale low-cost interventions can make a big difference: providing blood pressure testing kits with appropriate cuff sizes to health workers can increase the share of people with accurate blood pressure measurements.

Effective screening interventions paired with appropriate follow-up interventions, such as enabling healthier nutritional choices in collaboration with local stores, can unlock years of higher-quality life per person. For starters, employers and businesses could raise awareness, provide spaces, or offer incentives for employees to increase testing. There is opportunity to work with city stakeholders to proactively improve health and quality of life of its older residents through enabling their more meaningful participation and contribution. Examples include the following:

• Childhood obesity. In New York City, a public–private partnership for food security among a nongovernmental organization, a philanthropic foundation, and the New York City government to deliver produce prescription programs 29 Wholesome Wave’s fruit and vegetable prescription program, New York City: 2013 outcomes , Wholesome Wave, 2014. and home delivery of fresh produce 30 “NYC Health + Hospitals launches produce prescription program study to improve the health of children with overweight and obesity,” NYC Health + Hospitals press release, June 2, 2022. led to 40 percent of children lowering their BMI after four months. 31 “Doctors at HHC Elmhurst and Bellevue Hospitals write fruit & vegetable ‘prescriptions’ for vulnerable children and their families,” NYC Health + Hospitals press release, October 16, 2014. In Amsterdam, a program targeting childhood obesity led to a 12 percent decrease in obesity over a three-year period. 32 The Amsterdam healthy weight approach: Investing in healthy urban childhoods: A case study on healthy diets for children , UNICEF, City of Amsterdam, EAT, November 2020. The program involves citywide government-led initiatives and policies, including screening infants at risk of obesity, implementing healthy corner stores, curtailing junk food marketing, and subsidizing sports clubs. For those living with obesity or are overweight, the city provides tailored nutrition and exercise plans from child-health nurses, alongside regular check-ins from a volunteer buddy network.
• Societal participation of older people. Age Friendly Seoul’s 2012 Comprehensive Plan for Senior Citizens included the creation of and support for senior-community organizations, senior clubs, and cultural programs and a skills-matching volunteer program. Building on its 2012 plan, Seoul published its Aging Society Master Plan in 2020, which set “the realization of an age-friendly city” as its main policy goal. 33 “Progress of Seoul’s Join,” Age Friendly Seoul, accessed January 2024. Seoul became the first Korean city to join the WHO’s Global Network of Age-Friendly Cities & Communities in 2013. 34 “Age-friendly world: Seoul,” World Health Organization, accessed January 2024.

Brain health. Increasing access to effective mental health supports by training clinical and nonclinical workers 35 Clinical workers could include doctors, nurses, and clinical social workers. Nonclinical workers could include school counselors, caregivers, and community health workers. to provide brief, basic versions of existing evidence-based psychological treatments (for example, cognitive behavioral therapy, interpersonal therapy, problem-solving therapy) is an approach that can help address a range of common mental disorders, including low to moderate symptoms of anxiety and depression, and substance use. Data shows that this “task sharing” of psychosocial interventions can have a positive impact on patient outcomes, particularly for those with anxiety and mood conditions. 36 Nadja Ginneken et al., “Primary‐level worker interventions for the care of people living with mental disorders and distress in low‐ and middle‐income countries,” Cochrane Database of Systematic Reviews, 2021.

Task sharing can also be utilized to strengthen the community-based crisis care continuum and prevent overreliance on first responders (such as emergency medical services), emergency departments, and psychiatric hospitals. For example, clinical and/or nonclinical workers trained as part of a task-sharing approach can be deployed in community mental health settings to support individuals who have experienced or are experiencing a mental health crisis. In order to expand access to mental health supports in a wide range of contexts, there is an opportunity to move toward long-term sustainability of task-sharing models by leveraging technology, health system innovation, and community support.

A practical example of what task sharing may look like in practice is the Common Elements Treatment Approach (CETA). CETA teaches clinical and nonclinical mental health practitioners how to address a range of mental health issues (for example, trauma, depression, anxiety, and substance use) in a single treatment flow. CETA’s system of care includes a mental health assessment, triage, treatment, safety for suicide/violence/abuse, and monitoring and evaluation. Another task-sharing model, Friendship Bench, was developed in Zimbabwe to enhance mental well-being and improve quality of life through the use of problem-solving therapy delivered by lay health workers. Uniquely, the Friendship Bench engages “grandmothers”—trained community volunteers, without prior medical or mental health experience—to counsel patients on wooden benches in their communities. Other effective task-sharing models under consideration include mhGAP Intervention Guide, EMPOWER, the Shamiri Model, and Group Interpersonal Therapy.

Climate-related health. There are a wide range of climate-related health challenges in cities such as heat, air pollution, and flooding. Cities are developing climate and heat action plans to counter the health effects of climate change. Such plans set guidelines for managing acute emergencies, such as working with local government and outdoor-labor-intensive businesses to ensure that employees are protected from working during the most heat-exposed hours of the day and that vulnerable residents have a place to go. Other efforts enhance urban greening to mitigate the impact of extreme heat. There is potential to work with key stakeholders to further prioritize climate-related health issues on public health agendas and improve data and technology and healthcare systems to prepare for the upcoming challenges. The following are examples of existing heat action plans.

The government in Ahmedabad, India, developed South Asia’s first heat action plan in 2013. 37 Ahmedabad heat action plan: Guide to extreme heat planning in Ahmedabad, India , Ahmedabad Municipal Corporation, 2019. The plan had three components: an emphasis on increased public awareness through billboards, digital marketing, and partnerships with local organizations; the development of an early-warning system with a seven-day heatwave forecast and plans to mobilize first responders, media agencies, and community groups; and improved health-worker training to recognize and treat heat-related illness. The heat action plan contributed to the prevention of deaths both during and outside of heatwaves, with an estimated 1,190 lives saved per year. 38 Jeremy Hess et al., “Building resilience to climate change: Pilot evaluation of the impact of India’s first heat action plan on all-cause mortality,” Journal of Environmental and Public Health , 2018. In Miami, the world’s first chief heat officer launched the Climate and Heat Health Task Force in 2021, in partnership with academia, the private sector, and community groups, to shape the city’s extreme-heat action plan. 39 “Extreme heat action plan,” Miami-Dade County Office of Resilience, November 2021.

A road map for driving health in cities

So how, in practice, can cities start on the journey to becoming a healthy city? A four-step approach could allow stakeholders to rapidly mobilize around a joint aspiration for their city and get going (Exhibit 7).

To make this approach work in practice, it is important to learn from both past experiences as well as emerging successes. Early successes are critical, as they can help to set in motion a sustainable, virtuous cycle between institutional action and individual behaviors on city level. The following factors can help ensure that residents and stakeholders fully capture the potential of this approach:

• Understanding the “unlock”: identifying root causes for the problems with known solutions and tailoring the design to local needs
• Focusing on the “point” intervention: picking a few effective actions to speed up progress and deliver efficiency
• Enhancing the execution engine: concentrating on running a well-organized system that can help people quickly
• Mixing the old with the new: combining long-proven methods with innovation and new technologies (such as artificial intelligence)
• Making the investment attractive: identifying allies, as this is crucial for obtaining the resources needed to advance
• Identifying anchor stakeholders: starting with a small group of senior leaders, ideally of leading social, public, and private sector institutions, who are ready to own this effort

Everybody stands to gain, and the prize could be huge. Businesses could see healthier, happier, and more productive workforces and customers. For health innovators, cities can present an interesting lead market for the large and largely untapped healthcare-adjacent market of prevention and promotion. Residents—both older people and younger generations—stand to gain years of healthy additional life. Cities have the potential to add an extra five years of healthier life per person—up to 25 billion years in total. For all city stakeholders, it’s worth considering how best to get involved, and to do so now.

As part of its commitment to help people live longer and healthier lives, MHI is taking action to advance health in cities by partnering with city-level, national, and global stakeholders. As a non-profit-generating entity, MHI aspires to help advance health on the ground in selected cities across continents and to then share findings, innovation, resources, and data in the public domain. The aim is to enable others to replicate what proves effective.

Hemant Ahlawat is a senior partner in McKinsey’s Zurich office and a coleader of the McKinsey Health Institute (MHI), Erica Coe is a partner in the Atlanta office and an MHI coleader, Lars Hartenstein is an MHI coleader in the Paris office, Pooja Kumar is a senior partner in the Philadelphia office and an MHI coleader, and Drew Ungerman is a senior partner in the Dallas office and an MHI coleader.

The authors wish to thank Manish Binukrishnan, Jacqueline Brassey, Kana Enomoto, Ellen Feehan, Tansylu Gimadeeva, Mona Hammami, Anna Hextall, Michael Korenberg, May Lim, Cary Mei, Sara Rasul, Taylor Saunders-Wood, Konstantin Sietzy, Oliver Walker, Claudia von Hammerstein, Nina Zoric, and for their contributions to this article. The authors would also like to thank José M. Zuniga from Fast-Track Cities, Giselle Sebag and Jeffrey L. Sturchio from the International Society for Urban Health, and Franciscka Lucien from the Clinton Global Initiative for their contributions to this article.

This article was edited by Elizabeth Newman, an executive editor in the Chicago office.

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Glasses Improve Income, Not Just Eyesight

A study found that when older workers in Bangladesh were given free reading glasses, they earned 33 percent more than those who had not.

By Andrew Jacobs

If you’re 50 or older and reading this article, chances are you are wearing a pair of inexpensive reading glasses to correct your presbyopia, the age-related decline in vision that makes it progressively more difficult to see fine print and tiny objects.

Eventually, everyone gets the condition.

But for nearly a billion people in the developing world, reading glasses are a luxury that many cannot afford. According to the World Health Organization, the lack of access to corrective eyewear inhibits learning among young students, increases the likelihood of traffic accidents and forces millions of middle-age factory workers and farmers to leave the work force too early.

Uncorrected presbyopia, not surprisingly, makes it harder for breadwinners to support their families. That’s the conclusion of a new study which found that garment workers, artisans and tailors in Bangladesh who were provided with free reading glasses experienced a 33 percent increase in income compared to those who were not given glasses.

A normal part of aging, presbyopia occurs when the eye becomes increasingly rigid, making it harder to focus on nearby objects.

The study, published on Wednesday in the journal PLOS One, included more than 800 adults in rural Bangladesh, many of whom work in jobs that require intense attention to detail. Half of the participants — a mix of tea pickers, weavers and seamstresses between 35 and 65 — were randomly chosen to receive a free pair of reading glasses. The others were not given glasses.

Researchers followed up eight months later and found that the group with glasses had experienced a significant bump in income, receiving an average monthly income of $47.10, compared to $35.30 for the participants who did not have glasses.

The study subjects were evenly divided between male and female, and slightly more than a third were literate.

Dr. Nathan Congdon, the study’s lead author and an ophthalmologist at Queen’s University Belfast in Northern Ireland, said the results added to a mounting body of evidence that quantifies the economic impact of uncorrected vision in parts of the world where the roughly $1.50 it costs to buy a pair of so-called readers is out of reach for many.

“All of us would be happy with a 33 percent jump in income,” said Dr. Congdon, who specializes in low-cost models of eye care delivery. “But what makes the results especially exciting is the potential to convince governments that vision care interventions are as inexpensive, cost effective and life-changing as anything else that we can offer in health care.”

Dr. David S. Friedman, a professor of ophthalmology at Harvard Medical School who was not involved with the study, said he was struck by the results and hoped future studies would confirm the findings. “These economic impacts are large, real and could have a substantial impact on people’s lives,” he said.

Eye care has long been the neglected stepchild of public health in the developing world; infectious diseases like tuberculosis, malaria and AIDS tend to draw more robust government and philanthropic support. But vision impairment is a serious global issue, with a projected cost of more than $400 billion in lost productivity , according to the W.H.O.

Experts say spending on eye care can have a considerable impact on communities, both in terms of increased economic output and improved quality of life. Compared to other, more intractable health problems, addressing presbyopia is fairly inexpensive. Glasses can often be produced for less than $2 a pair, and fittings are usually carried out by community workers who can be trained in just a day.

Misha Mahjabeen, the Bangladesh country director for VisionSpring , which along with another nonprofit organization, BRAC , participated in the study, said a lack of resources was just one impediment to the increased distribution of reading glasses. In many Bangladeshi villages, she said, community workers must contend with the social stigma associated with wearing glasses, especially for women.

Overall, the health needs of women in Bangladesh take a back seat to those of men. “In our male-dominated society, when the man has a problem, it requires immediate attention, but women, they can wait,” she said.

But the effects of declining vision can be especially pronounced for women, who are often responsible for earning extra income for their families in addition to the child care and household chores, Ms. Mahjabeen said. “When it takes longer to sew and clean, or you can’t pick out all the stones from the rice, in some households it results in domestic violence,” she said.

VisionSpring distributes more than two million pairs of glasses a year throughout South Asia and Africa, up from 300,000 in 2018.

The study in PLOS One builds on previous research involving tea pickers in India that found a significant jump in productivity among study participants given reading glasses. The paper, a randomized study published in The Lancet Global Health in 2018, documented a 22-percent increase in productivity among workers who had been given glasses. For those over 50, productivity increased by nearly 32 percent.

Agad Ali, 57, a Bangladeshi tailor in the town of Manikganj, was among those who received a pair of glasses as part of the study that was published this week. In an interview conducted by a community health worker and sent via email, he described how worsening presbyopia had made it increasingly hard to thread needles and stitch clothing, adding to the time required to finish each tailoring job. Over time, he said, some customers went elsewhere, and his income began to decline. “It made me feel very helpless,” he said.

Since receiving the glasses, he said, his income had doubled. “These glasses are like my lifeline,” he told the community health worker. “I could not do my job without them.”

An earlier version of this article mischaracterized an eyesight condition, presbyopia, as farsightedness. People with presbyopia, including those who are farsighted, can’t see things up close.

How we handle corrections

Andrew Jacobs is a Times reporter focused on how healthcare policy, politics and corporate interests affect people’s lives. More about Andrew Jacobs

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