Innovative Lifestyle Initiatives for Those that Need it Most
This presentation will explore innovative global initiatives that are effectively overcoming the barriers to lifestyle medicine for disadvantaged groups. Lifestyle medicine is one of the most effective treatments for chronic diseases yet many people living in disadvantaged groups where these diseases are most prevalent continue to have little access to it. This presentation will review the needs and solutions for lifestyle medicine in higher risk disadvantaged groups including those with severe mental illness, low socioeconomic groups, people living in remote regions, Indigenous peoples and those living with disabilities.
In people with severe mental illness, there is a 15-20 year life expectancy gap largely due to diabetes, obesity, COPD and heart disease with the prevalence of metabolic syndrome as high as 65% (John et al., 2009, Lawrence et al, 2013). Some estimates suggest that the lives of both men and women with serious mental illness are up to 30% shorter than those of the general population (Piatt et al, 2010). Research indicates that this gap is increasing rather than diminishing (Lawrence et al, 2013). People living in the most disadvantaged areas have higher death rates for most major causes with rates of avoidable mortality 1.34 times higher for those living in the most disadvantaged areas (Piers et al 2007, Draper et al 2004). In addition, despite significant cultural and personal strengths of Indigenous peoples around the globe their life expectancy is estimated to be around 17 years lower in certain regions with chronic disease rates being up to 7 times higher (SCRGSP 2007, AHMAC 2012, AIHW 2014).
Not only is there a clinical and moral need to provide lifestyle medicine to these populations there is also an economic need. An Australian study proposed that if the average number of medications taken per person could be reduced by one, an annual cost saving of $463 million would result (Reeve et al, 2014). European economists conservatively calculate that the loss of labour productivity associated with the unequal burden of avoidable mortality decreases GDP by 1.4% or 141 billion euro each year (Mackenbach et al 2007).
Lifestyle medicine is not only one of the most effective treatments for the causes of chronic disease sequelae but also an effective treatment of the original cause in the case of mental illness. Four lifestyle interventions can reduce the risk of diabetes by 93%, heart disease by 81%, stroke by 50%, cancer by 35% and improve life expectancy by an average of 14 years (Ford, 2009). Studies have demonstrated 32% of patients with moderate-severe major depression disorder remit with nutritional interventions alone (Jacka et al, 2017) and both exercise and mindfulness-based stress reduction (MBSR) can be as effective as psychological and psychiatric medications in the treatment of depression and anxiety (Goyal et al, 2014, Stubbs et al, 2018). It is well documented that smoking cessation can not only reduce the risk of multiple diseases but also the dose and need of commonly prescribed medications, hence reducing the dose, side effects and costs (Bittoun et al, 2013). Furthermore sleep interventions are of crucial importance in the development and treatment of psychiatric illness (Chan et al, 2017).
There are unique challenges and barriers to disadvantaged groups that require innovation and collaboration in delivery to be overcome. Over the past 10 years, I have been working with teams of doctors, allied health, nurses, peer support workers, health coaches and Indigenous health workers to analyse, problem solve and create innovative lifestyle programs for disadvantaged groups. Crucial to this process has been researching and networking with national and international research teams, clinicians and public health experts to exchange ideas and material to facilitate our respective initiatives.
Fortunately, many fascinating and innovative lifestyle, psychological and social health programs have been created covering a wide variety of approaches personalised to the needs of the specific population they are serving. These have included cost-effective community training models, creative and engaging outreach programs and events, shared medical appointments, collaboration with other health services, economic programs, and lifestyle programs for health staff who deliver care. At the same time, innovative technology like online platforms and apps allows the personalisation and optimisation of these interventions in an effective and attractive format hence improving monitoring, outcomes and interaction.
Whilst many of these initiatives are exciting perhaps it is more important to review the common ground between them. Hence this talk aims not just to explore some of these effective programs but review the underlying principles that led to their success allowing a more rapid proliferation of further initiatives in groups where lifestyle medicine is so desperately needed.
- The participant will be able to describe the lifestyle-related chronic disease challenges to disadvantaged populations including those with severe mental illness, low socioeconomic groups, people living in remote regions, Indigenous peoples and those living with disabilities
- The participant will be able to demonstrate an understanding of the underlying principles and examples of innovative lifestyle medicine programs for disadvantaged population
- The participant will be able to describe the economic and social benefits of providing lifestyle medicine interventions for chronic diseases in the disadvantaged populations described