Walk (or maybe just stroll) the Talk

Yesterday J and I were joined by two of our children for a brief stroll around the hills of Whalley, Lancashire. It was lovely to get out and the weather was kind to us. We were able to sit in the grounds of Whalley Abbey (ruins now) and enjoy a picnic together. Much of the way I led out front. Indeed, J has many photos of me taken from behind. It’s not that I like to lead, but I have longer legs than she does and a walking pace that is much faster than hers. Without even trying, walking at my now natural pace, I’m soon in front of her, resulting in plaintive pleas of ‘wait for me’. And so I indulge in a little mindfulness and wait.

Now one of the side effects of our different length legs, striding length and walking pace is that whilst we will walk the same distance in miles, J will always have many more steps recorded on her Fitbit than I do. It’s something guaranteed to make me irritated. Equally irritating is the knowledge that women in general glean greater benefits than men from undertaking the same amount of exercise.   

NHS England recommends that both men and women aged between 19 and 64 should try and take at least 150 minutes of moderate exercise, or 75 minutes of vigorous exercise each week. They also recommend we should do muscle strengthening activities at least twice a week. That might include weight lifting, push-ups, planks, skipping, running or climbing hills (my favourite) or really any type of exercise that increases the heart rate and challenges our muscles. In contrast to our house, the latest research shows that girls and women tend to do far less physical activity than boys and men.

I say ‘in contrast to our house’ as my main exercise is walking, whereas J walks and runs. This year, in our #NHS1000miles challenge, J’s combination is proving to be a winner, as she is consistently clocking up more miles per week than I am! But the fact remains that despite all her extra exercise, she may not be gaining any more physical benefit than me. Now, please don’t think I’m getting peeved by J’s higher weekly mileage (#NHS1000miles is a personal challenge not a competitive one – find out more here); there are many other reasons for exercising and it is not just about the physical benefits.

I know I feel a lot better after a brisk walk, and often walk to generate ideas, work through problems and so on. And of course, Dylan the dog needs a walk at least twice a day. Recent research (see here) suggests that even where women don’t take the recommended 150 minutes of exercise a week, lower levels might still be beneficial for most women. This is particularly the case in reducing the risks of death caused by coronary heart disease, strokes and other related cardiovascular problems.

The research showed that just 140 minutes of exercise a week reduced women’s risk of premature death from any cause by 18%, when compared to women who were inactive. Men, needed to undertake 300 minutes of similar physical activity to gain this benefit. Where women were able to undertake 300 minutes of physical activity a week their risk reduction rises to 24%. The 300 minutes of exercise was the threshold point, at which the greatest benefits were recorded for both men and women.

Interestingly, and perhaps somewhat provocatively in some quarters, the study admitted that one of the limitations they recognised was that what was studied was the relationship between exercise activity and premature death reduction. It did not take into account such activities as housework. Unlike in our house, recent surveys show that many women in a relationship with a man, still do the majority of housework. The study also didn’t take into account that fact that women will have to make a greater physical effort when undertaking the same task as a man. I can bring in an entire day’s logs for the fire in one trip, and do so by loading the logs into the crook of my arm. By contrast, J would need to make three trips to fetch the same quantity of logs.

There were two other points I reflected upon, whilst reading the study. The first was that whilst gym memberships are equally spread between men and women, men spend considerably more time exercising in the gym, and much of this is aimed at gaining that ‘six-pack body’ with highly developed and defined upper body muscles. Many men think such a body is attractive to many women, many women don’t. I think it is mainly men with a six-pack body that think other men with a six-pack body are attractive. I may be wrong, or a little envious.  The more serious other reflection is that perhaps all of us shouldn’t feel guilty that we are not always able to get those steps in or reach the 150 minutes of exercise each week – every little bit we can do helps us achieve a better and healthier life.

Last but not least, and completely unrelated to anything written above, I want to mention the latest strike by doctors. Not the five-day junior doctor strike that started yesterday morning in England, but the doctors’ strike in South Korea. It started last Tuesday and as I write this blog, it continues. They are taking industrial action, not because they want more money, but because of the South Korean government’s plan to train a greater number of doctors. The government has forecast that more than 50% of the population will be aged over 64 by 2025, and many more doctors will be required to meet the healthcare challenges these later life folk might present to the health system. The existing medical profession contend there are already enough doctors. Maybe there is a connection after all. Perhaps South Korea would need fewer doctors in the future, if more could be the done to prevent illness and disease in the first place. Regular exercise is perhaps one way to achieve this.

XR, the new Cool? - if you know you know

Now J may tell you that I spend a great deal of time (and effort) to ensure I’m looking cool. But I don't. However, I think ‘looking cool’ is an interesting concept. The word ‘cool’ can be an adjective, verb, noun, or adverb. Ok that is as far as my understanding of grammar goes. Anyway, I was thinking about this while I watched one of the ‘coolest’ men I have long admired the other evening.

I had been invited to a dinner and celebration meal to both mark the 200 years of the University of Manchester’s existence, and to participate in the award of an Honorary Doctorate in Medicine to Professor Sir Chris Whitty. For me, he is coolness personified. When he speaks, it is with a completely assured approach, built, I guess, on years of education, experience and oodles of confidence that comes from possessing such knowledge. Who could forget his contribution to keeping the UK safe and informed during the pandemic? He had a measured delivery of ‘the science’ we were all expected to follow and a natural assertiveness in recommending adherence to the public safety measures of lockdown, mask wearing and keeping our distance. He was certainly the right person at the right time to provide such leadership.

Well last week, I was privileged to see and hear him in person. His presentation and talk were simply riveting; perhaps, something in itself given his softly spoken delivery. He started by reminding us of what life was like in 1824 (the year the University of Manchester was formed). Disease, environmental conditions, and poverty all contributed to a short life expectancy. Then as Chris Whitty took us through the years following 1824 to the present day, he was able to show how science, particularly medicine (and the University of Manchester) had contributed to the eradication of many diseases, and increased life expectancy. Perhaps, most importantly he was able to show what the health impacting determinants today are and how these are still impacting upon our quality of life and life expectancy.

Poverty, in all its manifestations, still has the largest impact on our health and wellbeing. Whilst many previous killer diseases are no longer with us today, there are other life-shortening health conditions that still impact upon our mortality. Last year, the leading cause of death in the UK was dementia. The sad fact is that if we survive other illnesses, and reach a plus 80 year age we are all likely to develop the condition. Men, however are more likely to die of Coronary Heart Disease (CHD) before dementia.

Smoking, eating high cholesterol saturated and processed food, stress, high blood pressure, obesity, lack of exercise and of course, drinking too much alcohol all contribute to the development of CHD. These are mostly avoidable factors; some folk might describe them as ‘lifestyle choices’ – I don’t. If you live without what might be considered the basic necessities of a good life, with little or limited opportunity to improve your life, finding yourself in such a situation cannot be considered a life choice. When and where you are born will also have an impact. Here is a personal example.

I was born in 1955. My first house cost £6,000. I bought it in 1975. The average cost of a house in the UK at that time was £9,096. So, I was already in a good place. Today, £6,000 equates to £63,077. Now even if I had that money available, would I be able to buy a similar house today? The answer is probably no. These days, J and I live just outside of Blackpool. The average house price in Blackpool is £136,835, so we would be priced out of the house ownership market. To put this fact into context, Blackpool is the local authority in the whole of the UK with the highest mortality rate for people of all ages last year (1,382 per 100,000 population, almost double the rate in the South East of England, which was 718 per 100,000).

It feels to me that we may have a way to go when it comes to levelling up and truly addressing health and other inequalities across all our communities. Chris Whitty was fulsome in his recognition of the way medicine and science have improved all our lives, but was quick to point out that this wasn’t the case with mental health care. He acknowledged that science and medicine have a way to go with levelling up our understanding and response to mental illness and mental health concerns. I wasn’t surprised, but was pleased to hear him recognise the task facing us all in ensuring parity of esteem and resources in how we respond to both physical and mental health challenges.  

So I was really pleased later on in the week to be back at the University of Manchester and to be part of a workshop that was truly at the frontiers of what might be possible in addressing this science gap. The event was facilitated by colleagues from our Trust, and the University of Manchester, and looked at what is best described at immersive technologies. These are, in terms of mental health care, the next generation of precision medicine used to facilitate person-centred care. It was a mind-blowing workshop and a window into a brave new world. The technology was ultra cool – have a look here and consider how you might become what will be a great future that whole heartedly embraces the opportunities a new digital age offers us all.

A balanced diet is not a chocolate in both hands

Last Wednesday we finally finished eating our Christmas chocolates. I’m already missing going to the cupboard and choosing a soothing chunk of something sweet. Each year, I start preparing our Christmas cupboard in September, buying something every week. This chocolate hoard is supplemented by gifts at Christmas time. Right now the cupboard is bare, and is likely to remain that way for a couple of reasons. The first is despite doing ‘dry January’ the added accumulated weight gained during 2023 stubbornly refused to be shed. I’m still the same weight as I was on the 1st January. Having chocolate every day probably didn’t help. The second reason is that the price of chocolate has risen higher than the already high price of many food stuffs. Maybe, if you can, get your Easter eggs as early as possible.

It is apparently the huge rise in the price of cocoa that is to blame. Cocoa is the key ingredient of chocolate and the global price of cocoa is set to rise above the already record-beating £4,655 a ton. Ghana and the Ivory Coast produce over 60% of all cocoa. Hot and dry weather in both countries reduced the cocoa crop last year and is threatening the crops this year. In addition, the demand for chocolate has grown exponentially, particularly in China and India. According to Barry Callebaut, the world’s biggest chocolate maker (I bet you didn’t know that, see here) the price of your favourite bar of chocolate* will continue to rise during 2024.

Now there is always a silver lining to such ‘bad news’ stories, and stay with me here. The British Heart Foundation (BHF) notes that the average person in the UK will consume 7,560 bars of chocolate, 2,268 slices of chocolate cake, and 8,316 chocolate biscuits in their lifetime. In addition, they are likely to drink 3,204 mugs of hot chocolate, 126 Easter eggs, and my favourite, consume 2,898 miniature chocolate eggs during their life. High cost of chocolate will reduce the demand and perhaps how much we each choose to eat. And that’s a good thing.  

In the BHF study, nearly 40% of folk stated that chocolate is their favourite food, and 40% declared they couldn’t live without it. Despite my own sweet tooth, in no way can chocolate be considered an essential part of a healthy diet. As was proven in my unscientific piece of research over January this year, too much chocolate can lead to weight gain and increase our risk of obesity.

Over 63% of us are above a healthy weight, and half of these folk are living with obesity. In England, 1 in 3 children leaving primary school are overweight or obese. The prevalence of obesity is, like many other poor health indicators, highest in the most deprived communities in England. Obesity is associated with reduced life expectancy and a wide range of other health problems, including diabetes, heart disease, liver disorders and is the second biggest preventable cause of cancer.

A couple of years ago, we took a heritage tour of our local hospital Blackpool Victoria NHS Trust. One of the places we were taken to was the morgue. Our guide explained that the Trust, like many others, was having to consider purchasing new trolleys that would hold up to 60 stones, due to the fact that so many of the people they were dealing with no longer fitted the standard trolley.

Last week Finnair announced that as well as weighing passengers’ luggage, they were introducing weighing the passengers themselves. This story sparked a media storm, with groups complaining about ‘fat shaming‘ on one hand and on the other, of people having to share plane seats with someone grossly overweight and who as a consequence, may unfairly take up  some of their seat space. There was a challenging side story as well. Finnair claimed they were introducing this new measure to ensure they were able to calculate the true weight of the plane and put in the correct amount of fuel for the flight. So, if the weight of the plane increased more fuel would be required. More fuel would mean higher ticket prices. In the longer term, would we all be paying more money for our travel than we needed to because of the lifestyle choices of obese folk? I said it was a challenging debate!

Preventing obesity and helping those living with this condition is a high priority for the UK Government. Obesity costs the NHS £6.5 billion each year in direct and obesity-related disease treatments. As well as these physical health concerns, obesity can also have an impact on mental health and our sense of wellbeing. This was something that was touched upon at a dinner and discussion I attended along with other colleagues from across England last week. It was a Chatham House Rules event so I won’t share the whole conversation, but there was much discussion of how we could and should be doing more around preventing mental health problems and illness.

I couldn’t agree more. The more we can do to keep folk healthy, whether this is good physical health or good mental health, the better the world will be for the individual, our families, and communities. We know some of the proven measures we can all take, one of which is to try and learn how to eat more healthily. It is not easy to cut out chocolate from our everyday diet. Indeed, at the dinner I attended last week we had a gorgeous sticky toffee pudding smothered in the most delicious gooey chocolate sauce, but we can try. To date our Christmas cupboard remains a chocolate free zone. 

*Snickers is the UK’s favourite chocolate bar, beating the classic Cadbury Dairy Milk by a narrow margin. Galaxy is the third favourite followed by Bounty, KitKat and Twix, Mars Bar and Flake     

It’s not all about location, location, location

One of the papers I read last week was published way back in 2012. I was looking for references I could use about choice, and how many of us have actual choices over important aspects of our life. Choice is possibly best described as being able to choose a preferred option from a range of distinctive alternatives. The paper was written in the context of choices people can make when actively trying to engage with the housing market. For example, how many homeless people choose to be or to remain homeless, and in terms of the basic need for shelter, they have no choice.

As Phil and Kirstie have pointed out over many years, choosing a house can be dependent on money, location, whether folk are upsizing or downsizing and lifestyle. When J and I bought our house, we had plenty of choices to think about, but there were also some limitations. I didn’t want to live in Wales again and J didn’t fancy Scotland, and after a brief flirtation with the thought of living on a narrow boat, we agreed to compromise.

We chose to buy our little house for five reasons. One, it was somewhere neither of us knew that we could discover in our new life together, two it is just a 10-minute walk from the beach, three, we can easily commute into Manchester, the Lake District and Lancashire, four, the house is like a Dr Who Tardis in that it looks like a small cottage from the outside, but inside it is a house with many rooms, and for much of the year, it is a sunshine-filled house. There are plenty of windows, big and small. In the summer, we tend to live in the end of the house that is nearly all glass, and in the winter, live in the other end of the house that has smaller more traditional windows, and a lovely log fire. The fifth reason is that it has an extra-large garden for our hens and goats to live in and me to potter. It suits us and does wonders for our sense of wellbeing.

The environment, in all its senses, can have a profound impact upon our mental health and wellbeing, good and bad. We can’t escape the environment, and it exists at spaces we call home, work, and even socially - the people we are around and the communities in which we live and are a part of. We know that young children who live in conditions of poverty, with poor housing, nutrition, and stimulation, are more at risk of mental health and behavioural problems. At the other end of the spectrum, and particularly with people living with dementia, the use of colour and simplicity in the home can soothe, signpost and reassure people with cognitive difficulties.

Where someone lives is not just about the house they reside in. Where the home is situated can also have an impact. We live on a fairly busy road and sometimes the traffic noise can be irritating and intrusive. Ours is a generally safe area, it seldom snows, there are plenty of green spaces and we are blessed with a wonderfully diverse community. We benefit from tourism and the attractions that draw people to holiday here. That said, there are pockets of extreme poverty close by, and unemployment levels are high. There is a thriving community grocery store/foodbank just up the street. Sadly, this continues to be very busy.

Now you might wonder why I am rambling on about the impact of the environment on our mental health and wellbeing? Well last week I was reminded of this connection in a couple of ways. The first followed a visit to Atherleigh Park, one of our inpatient and community services in Wigan. What a place. It was a purpose built, modern, spacious, light, airy and sunshine-filled environment. It was also one of the cleanest and uncluttered places I had come across in many a day. An air of calm pervaded the clinical areas, and it felt a very comfortable place to be. The design of Atherleigh Park, both promoted a sense of wellbeing and provided a great environment for contemporary mental health care.

I was hosted by the energetic, knowledgeable, and happy Head of Nursing and Quality, Natalie Molyneux. She had clearly embraced, and practised, the art of visible leadership. As we walked around the unit, she greeted colleagues and service users by name and knew something about each of them. I learned a lot and will definitely be returning very soon.

The second reminder arose from the publication, last week, of the NHS England-commissioned independent review into the care and treatment provided by GMMH, following failings within the Trust’s services, particularly the Adult Forensic Services. The review was commissioned following concerns by patients, their families, and colleagues, some of which were presented through the media, most notably a Panaroma programme based upon the findings of an undercover reporter. The report makes for a challenging read, and its publication will have impacted in many different ways upon all those working for our Trust and served by our Trust. Supporting our colleagues and services users was the number one priority last week, and being there for others will continue to be something we continue to do for some time yet.

Among other things, the report notes that the environment was not conducive to providing high quality mental health care, both from a physical and cultural point of view. Much work has been done to address these issues since the review was undertaken and there remains, of course, much more to be done. Meeting Natalie and her colleagues gave me the reassurance that we have many other folk who are willing, capable and passionate enough to really make a difference to the services we provide.