“If I knew I was going to live this long, I’d have taken better of myself.”
Mickey Mantle, baseball player (1931-1995)
I recently had a ‘health check’ at my GP surgery here in the village. Nothing very ground breaking – they look at a few simple things like cholesterol levels, how active you are, how much you drink and your BMI and from that derive an assessment of your risk of developing things like diabetes or heart disease in the next ten years. I’ve never had one of these checks before (I must be getting older) but the whole thing got me thinking about what health care really is, about the Chinese Yangsheng or ‘Nourishing Life’ tradition and what it might have to teach us in the context of an increasingly overstretched NHS and a society in which chronic health conditions are afflicting ever greater numbers at ever lower ages.
So the good news was that my cholesterol level is fine and my BMI was okay as well, but that BMI thing was really where I started thinking about all this.
A healthy BMI for a man my age and height is between 19 and 24 and mine was 23, so towards the upper end of the range. I thought this was interesting because many people I know would say I’m fairly skinny and the nurse doing the assessment said she’d never come across anyone on the low end of the healthy range, both of which suggest that as individuals we no longer have a good idea of what a healthy weight is. I’m not going to say that BMI is the be all and end all when it comes to assessing a healthy weight but we do know that a higher BMI is correlated with a range of health risks. These include diabetes, heart disease, some cancers, osteoarthritis, kidney disease, fatty liver etc. Excess weight may also be associated with mental health disorders such as depression and it increases a range of risks for pregnant women. Looking at that list it seems that to a great extent its a list of preventable illnesses, which is why the NHS is now looking at the sort of ‘health check’ they gave me – its cheaper and more efficient to prevent disease than to try and treat it once its occurred. But it seems to me that as a society we don’t have a culture of caring for our health in this way.
We do have a fitness industry and there’s no doubt that improved levels of cardiovascular fitness have health benefits. But I would argue that as a general rule the fitness industry is focused on things other than health. Firstly it’s an industry and so its primary purpose is to make money, mostly by selling things to us. It sells gym memberships, clothing, equipment etc, etc and so the cost of being healthy appears to be beyond the means of many people. One of the techniques it uses to sell these things, in common with most advertising, is the presentation of a particular image it wishes to associate with its products. Often an image that defines ‘healthy’ as young, tanned, slim, muscular, happy. This is an image that excludes a lot of people and particularly many of the people who might most benefit from a genuine culture of health care.
Participation in sport may be closer to the sort of health cultivation that I think we should be aspiring to. Such participation not only increases physical fitness but can also positively impact mental health as well. Participation in team sports in particular may well have positive effects on participants mental health. But even so I’m not sure sport really provides the sort of culture of health care that we need and are going to need as the strain on the NHS gets worse. For a start its often not something that people continue as they get older and for those that do the risk of injury get greater the longer they continue. While those participating at higher levels may take diet and nutrition very seriously at a more ‘recreational’ level some team sports may be associated with higher levels of alcohol consumption. So participation in sport may be of value but it may also have some downsides in terms of really caring for our health over the long term.
The other area where we’re often encouraged to pay attention to our health is in what we eat. Paying attention to what we eat is certainly a good thing but unfortunately instead of a well rooted culture of eating for health we have a diet industry. That industry is worth about £2 billion a year in the UK, but despite all that money spent on books and super-foods and supplements we have increasing levels of obesity, type 2 diabetes and rising levels of eating disorders (particularly among young people ). Much of the advice is faddy – eat low carb, eat paleo, eat keto, fast intermittently, eat only plant based foods etc etc etc and the average time someone sticks to a diet is apparently just 19 days. But the real problem with these diets is they suggest that there’s a perfect diet when the reality is that a perfect diet for you when you were 20 might not be the same as the perfect diet for you aged 40 or 60. There is no generic ‘good’ diet but maybe there is a diet that’s ‘good’ for you at your age and with your particular constitution and health issues. But that message probably doesn’t come with a book deal.
And then there’s the NHS itself. Wonderful though it is, and I’d hate to be without it in an emergency, its focus has always been on treating ill health rather than cultivating good health. My recent ‘health check’ suggests this may be starting to change but there’s a long way to go. The health care system in Cuba is often held up as a model of what preventative medicine can achieve. While there’s a somewhat polarised debate about the Cuban healthcare system, what does seem clear is that working to prevent illness is a better strategy than simply aiming to provide cures, especially when resources are limited.
So what would a culture of caring for our health look like? I think it would look something like the ancient Chinese Yangsheng tradition. Perhaps I ought to define what I mean by ‘a culture of caring for our health’. What I don’t mean is being super fit, or having some specific percentage of body fat versus muscle mass or endlessly aspiring to youth. What I do mean is being able to fully participate in the life we have at the age we are. What I do mean is caring for ourselves in such a way that we’re able to participate in that way for as long as possible and I think the Yangsheng tradition offers a good framework for this. The tradition addresses a wide range of ways in which we can or perhaps should nourish and cultivate our lives, including caring for our mind and emotions, paying attention to diet, exercise and sleep, having a full sex life and caring for mothers through pregnancy, childbirth and breastfeeding, as well as addressing aging and the inevitability of death.
I’m going to try and write something about all of these over the coming months, about what the Yangsheng tradition has to say about them and how that may or may not align with the latest research. And hopefully I’ll be able to offer practical advice that can help you better care for your health.
Bruce Bell is an acupuncturist working from clinics in Midsomer Norton and Keynsham.