May 26, 2017/ Published 9:00 AM EST / Dr. Michael Apkon

In defense of health

The following article was written by Dr. Michael Apkon, President & CEO of Toronto’s SickKids hospital, as part of an exclusive series on wellness. This piece focuses on preventative steps to stay healthy and informed.

Remaining healthy and vigorous is a nearly universal aspiration, yet we don’t always know the best courses of action to achieve that goal. Even when we do, we sometimes don’t do what we know is necessary to maintain our health. Exercise, diet, and lifestyle choices all play a significant role in preserving our strength, flexibility, vigour, and mental wellness These same choices also can help us prevent illness or minimize the impact illness can have on our lives. In addition, prevention, screening, and being an engaged healthcare consumer are all critical defenses that keep us healthy.

Prevention is the investment we make today to see the return in sustained health later in life. Beyond choosing a healthier lifestyle, there are other strategies for prevention we need to consider, including immunization against serious infection and routine dental care to preserve oral health. For example, the World Health Organization (WHO) estimates that the influenza (flu) virus is responsible for as many as 250,000 to 500,000 deaths globally each year1. The annual influenza vaccine varies in effectiveness from year-to-year, but typically reduces the chance of getting infected by one half. The Centers for Disease Control and Prevention in the US now recommends universal annual influenza immunization for all people more than six months old, unless there is a specific reason to not immunize.

Sometimes prevention is not fully effective, and there are many conditions that we don’t know how to prevent. Screening looks for disease in people who are not showing any overt signs of illness; early intervention can provide more effective treatment before an illness has advanced. The US Preventive Services Task Force (USPSTF) has recommended a set of screening tests based on age and gender where early detection makes a difference in disease outcomes. Following the USPSTF guidelines for screening of colorectal cancer, breast cancer, cervical cancer, hypertension and other conditions is an important strategy in minimizing the loss of health. For example, screening for colorectal cancer every two years reduces mortality from that cancer by 15%2.

Prevention and early detection help keep us healthy, but we also can take actions that can reduce the impact of disease should it occur. Modern healthcare has never been more capable, yet the range of treatments available have added to the complexity of living with illness and have increased the need to be an educated and engaged partner in our healthcare. There are practical actions we can all take to ensure we can be as healthy as possible.

First, ensure you understand and adopt the changes in lifestyle that could counteract the problem itself. For example, weight loss and exercise are important complements to medication therapy for diabetes and, for some people, can eliminate the need for medications altogether. Exercise increases the body’s sensitivity to insulin so your body’s tissues are better able to use sugar and also promotes other pathways for sugar use. Understand what dietary changes are important, what exercise regimen is appropriate, and what other activities could be useful or dangerous.

Second, explore approaches to treatment that don’t depend on medications or surgeries. Given the range of naturopathic, homeopathic, and folk remedies that are available, it is important to understand which approaches are grounded in strong evidence. For example, low back pain is a common condition and is one of the most common reasons for people to miss work3. The American College of Physicians reviewed the extensive medical literature on this topic and concluded that non-medication therapy should be the first thing to try with exercise, physiotherapy, tai-chi, yoga, and mindfulness-based stress relief – all potentially eliminating the need for medication. In contrast, opiates are considered a treatment of last resort for this particular condition.

Third, when medications are necessary, be certain you understand which medications you need, how to take them, and any side-effects. Medication regimens can become complex very quickly as medications are changed, particularly when the responsibilities for care are shared by multiple professionals. Despite all good intentions, there are often discrepancies between the medication lists that each physician has for a given patient. These discrepancies can contribute to complications from drug therapy. Take the time to maintain an accurate personal medication record that includes details about medication dosing and schedules. As medications change, understand and keep track of why changes are made and whether a change in one medication is intended to be balanced by a change in another medication.

Fourth, carry a personalized care plan with information about your condition, past and current treatments, and anything else that might help a caregiver if they are not familiar with you. This is particularly important for those living with complex or chronic conditions, as well as those travelling far from home. New mobile applications are available that can simplify the process and ensure that you always have critical information close at hand.

Staying healthy certainly takes planning and disciplined execution. Much like investment planning helps to ensure financial security, so too is being actively engaged in taking care of ourselves the best way to ensure a healthier future.


About Dr. Apkon

Portrait of Dr. Michael Apkon

Prior to joining SickKids, Dr. Apkon was Chief Medical Officer for the Children’s Hospital of Philadelphia (CHOP) and Executive Director leading Yale-New Haven Children’s Hospital. He is currently a Professor of Paediatrics at the University of Toronto and has held faculty positions at University of Pennsylvania, Yale School of Medicine and Yale School of Management.



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