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Passivity and Health Outcomes

Procrastination is one thing, passivity is a whole different kettle of fish. One that can significantly alter the course of your life, especially when it comes to long-term health aims. It is one thing to postpone a doctor’s visit because of financial reasons or time constraints, but when you decide to hand over all responsibility for your health, excusing yourself of any input, the outcome may be dire.

On one of my recent travels I had the pleasure of meeting Carol and John, a couple in their early sixties from Liverpool, heading out on a 5-day Mediterranean cruise – their first holiday in five years. This most entertaining couple decided many years ago to give a home to two special needs, severely neglected and abused children. What makes this story so heartwarming is that their commitment did not extend to a much needed roof over the children’s head, warmth in winter, ample food in their bellies, and doing the school run. No, these children require life long, 24-hours per day, round the clock care. So Carol gave up her prestigious managerial job to fulfil this vital role. The children are thriving in their care, despite their horrendous past, but friends have all but run for the hills because Carol’s decision to actively look after these neglected children is viewed as going too far.

On another of my journeys I find myself in a car with a very charming lady, in her early 70’s who still displays a spring in her step, literally. On errand day we drive all the way to town and park outside our first port of call, a pharmacy. Business concluded, my hostess heads back to her car and we drive to the next stop on our agenda, across the road, less than 20 m (65 feet) away. Not a busy dual carriage way, no, a two-way street in a sleepy town with minimal traffic, under clear blue skies. Perhaps her conservation of energy for only essential physical activity is what maintains her energetic self.

I have the type of demeanour that make people burst at the seams to tell me their life stories right after the first hello. I am a spill-your-beans-flame to a desperate-individual-moth. I love these moments because not only do I believe a willing ear is a dying art, I am a sucker for a story and I learn so much from my fellow humans on a daily basis. A visit to a physiotherapist, to treat a non-life threatening condition, saw me assume the role of willing ear again. Tiziana, one year my junior and aware of my profession (who knew people actually read those forms you fill out pre-treatment?), proceeds to tell me how she suffers with abdominal symptoms. She is scheduled for a colonoscopy, conveniently at the hospital where she works, to rule out any structural damage – a very sensible approach. However, despite being acutely aware of certain foods that render her incapacitated for days on end, she simply cannot give up those offending options. In her words, “I know what to do, I just can’t seem to force myself to make that change.” These words echo that of a patient who said, “I know your strategy works, I just can’t give up the good stuff.” You mean that ‘good’ stuff that consistently make you ill?

It is one thing to adopt the passive approach to rearing children – it’s the teachers’ responsibility to teach my brood manners – or traveling – why would I walk when I have a car? But what happens when we shun an active approach in dealing with our own long-term health outcomes?

You might have heard the joke, “How many teeth should I floss? Only the ones you want to keep.” Flossing is indeed a pain, right there where the dental floss is wrapped around your fingers. So inventors design more convenient tools, such as dental picks or handy interdental brushes, and yet people still refuse to dedicate a few minutes per day on optimising dental health. The rationale? When something goes wrong a dentist will sort out the problem, i.e. I prefer the passive approach to dental hygiene because I simply cannot be asked to make an effort. The inevitable pain and suffering and expense that allows your dentist to address the outcome of your passivity is simply dismissed until the day of reckoning that is filled with regret. 

My own father calls me up one day asking what I suggest he does concerning a calf muscle injury. I strongly urge him to go see a physiotherapist – he is almost eight decades old so independent mobility is important! A week later I enquire about his injury and he tells me that he did see a physiotherapist but treatment was painful so he went to the doctor to get pain medication instead. There he is proudly flying the flag for a passive healing strategy.

Heart health agencies across the world urge the population to incorporate daily exercise. A mere “150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week. Add moderate- to high-intensity muscle-strengthening activity (such as resistance or weights) on at least 2 days per week.” (American Heart Association) That amounts to just over 20-minutes per day. I spend more time trying to negotiate my way around the new layout of my local supermarket during the festive period – time walking, the exact exercise I am recommended in partaking in. Anyone that lives in a city, especially London, will spend more than that covering the distance between two underground lines in the same station. If you happen to be in Tokyo you will spend considerably more time given that those underground stations are enormous. Any keen gardener will tell you that resistance training is par for the cause when you work in your allotment or back yard. Yet, with the advances in technology we prefer to snub these strategies in favour of home deliveries, gardening services, cleaning agencies, or even working from home.

The aftereffect of this kind of passivity? We see an increase in cardiovascular disease, in fact the World’s number 1 killer by far, according to the World Health Organisation, is Ischaemic heart disease. The heart is a muscle and muscles need exercise to gain strength and optimal function. It also needs to be nurtured properly and when we look at current dietary habits we stare the proverbial elephant in the room squarely in the eyes.

How do we justify the passive approach?

  1. I will never get sick
  2. If I do I can take medication
  3. If the medication doesn’t work my doctor will fix it
  4. If my illness progresses a surgical team will sort it out
  5. That’s what the NHS or private medical insurance is there for.

All these points shift responsibility to someone or something else whilst you profess to having done all in your power to address your health concerns.

The epitome of passivity is when you pin all your long-term health hopes on a sugar pellet (liquid drop, cream, gel, or tablet) that has been infinitesimally diluted or a capsule with actual active ingredients. Similarly when you appeal to a higher power to grant your improved health whilst you take no active part in the process. When you pass responsibility squarely onto the shoulders of your health care provider, absconding all active involvement. Like expecting your physiotherapist (chiropractor or osteopath) to work the affected areas on your body and choosing not to do any of the exercises you are told to practice between sessions. “I don’t have time”, is a feeble excuse at best.

Type II (late onset) diabetes, is a growing global health concern and diet and lifestyle choices are undeniably the root causes. Despite readily available information and education, patients still choose to pass the buck rather than tackle the bull by the horns. The first line drug of choice belongs to the pharmacological class of biguanides. These drugs work by preventing glucose (sugar) absorption into the blood stream and increasing insulin (a blood glucose regulating hormone) action. A diet rich in carbohydrates increases the glucose load in the body. Actively reducing your sugar intake and starch food choices is an excellent dietary approach. Given our love for pasta, pizza, bread, rice, and potatoes and our insatiable desire for alcohol, biscuits, desserts, and crisps, too many type II diabetic patients pin all their hope on medication to regulate their blood glucose levels – the passive approach. The development of this preventable disease is grim – necrosis (dead tissue), vision impairment (blindness), and cardiovascular disease (heart failure). Despite the bleak disease outcome, too many affected patients consciously shun diet and exercise, the foundation of the treatment program.

Advances in technology allow us to communicate via abbreviated text language instead of phoning people. Social media platforms gifted us the opportunity to use a generic shout out (dear all) instead of making contact with each individual. We buy our groceries via the internet and wait for the delivery man to cart it to our front door. We pledge money during Red Nose Day to charities rather than cooking an extra portion and sharing a meal with a person in need or even donating blood regularly – a life saving commodity that is always in short supply. When it comes to everyday health, we would rather swallow ant-acid tablets than eat slower. We bulk buy anti-diarrhoeal medication rather than forego an offending food option. We eagerly sign up and take out expensive loans to fund liposuction or gastric bypass surgery instead of adopting sound nutrition and regular exercise. We order take-out coffee and meals rather than make our own. We have become so passive in our day-to-day life that we forget there is a viable, healthy, innately natural alternative mode of being. An active role that is promoted by all health agencies and supported by extensive research. 

You can believe the Earth is flat and the consequence is at worse public ridicule. You can choose to delay medical intervention and pass the point of no return. You can do everything in your power to prevent an illness and still be struck down. You can roll the dice and hope for that lucky 7, but when you choose to sit back in your chair of passivity your chances of a good health outcome are tentative at best.

References

American Heart Association (2018) American Heart Association Recommendations for Physical Activity in Adults and Kids. Available at https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults#:~:targetText=Get%20at%20least%20150%20minutes,least%202%20days%20per%20week.

WHO (2018) The top 10 causes of death. Available at https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death#:~:targetText=Ischaemic%20heart%20disease%20and%20stroke,in%20the%20last%2015%20years.