Beyond Staff Health Screening: The Next Steps

In my last article, I outlined the rationale for staff health screening– namely, the identification of current health status and assessment of risk of ill-health in the future.  But one of the most important functions of a corporate health screening programme is what happens afterwards.  Getting a detailed overview of your health is all well and good, but the guidance you receive about what you can actually do to improve your health status in the future is the key to improving your health and wellbeing.

Personalisation is key

Positively, there has been a growing recognition over the last few decades of the beneficial impact that lifestyle can have on an individual’s health and wellbeing.  Yet despite this, many individuals are still simply given the generic advice of “eat more fruit and vegetables and exercise more often”, often under the flawed assumption that the key to improving health is simply raising awareness of what constitutes a “healthy” lifestyle.  Whilst the basic underlying premise behind these recommendations is undoubtedly true, the overly generic and non-individualised nature of the message means it is unlikely to lead to any meaningful and long-term change in the individual’s behaviour.  We now live in the “Google-generation” and, with the growth of the internet and availability of health-related books, magazines and other media, access to information on healthy lifestyles has never been greater – yet only 39% of men and 29% of women over the age of 16 regularly meet the Chief Medical Officer’s recommendations for physical activity (1) and the average intake of fruit and vegetables (2.8 portions per day) (2) still remains far below the recommended level (at least 5 portions per day).  Clearly, simply raising awareness is not enough to motivate people to change their behaviours for the long-term.  Rather than generic advice and education, individuals want tailored advice that is specific to their health status, their lifestyle and their goals.

Areas of focus

So, what lifestyle areas need to be focused on?  Ultimately, this depends on the individual and their unique lifestyle.  Every single one of us live our lives in different ways and we all have different goals that we want to achieve.  However, there are four areas of modern life that inevitably require some focus in most people (although the relative importance of each one will vary significantly from person to person):

1.    Diet

2.    Exercise and physical activity

3.    Sleep

4.    Stress.

Influence of diet on health and wellbeing

The influence of diet on health and wellbeing is unquestionable – we only need to turn on the TV or open a magazine to see adverts encouraging us to eat more fruit and vegetables and less fat, whilst new studies are released on a weekly basis supporting the benefits of better nutritional habits.  Whilst the key benefits of increasing fruit, vegetable and wholegrain consumption are undeniable, the idea that there is a universally “healthy” diet is now being questioned (3,4).  The growing field of nutrigenomics provides a strong argument for approaching dietary recommendations on an individual nature.  For example, whilst some people may benefit from five portions of fruit and vegetables per day, others may need more portions to get the same benefits, particularly if they have a lifestyle high in stress or are regularly physically active.  The key, then, is to be able to understand the individual and recognise their unique needs.

Benefits of physical activity

Similarly, the benefits of physical activity and exercise are also well known, with clear reductions in the risk of obesity, type II diabetes, heart disease and some cancers for those who are regularly active (5).  It is already known that obese and overweight individuals walk less steps than their lean counterparts (6), and increasing walking and general activity is a vital step in increasing health and wellbeing.  The recommended number of steps is 10,000 per day (roughly 5 miles), but the majority of the population fail to achieve this on a daily basis.  However, simply telling an individual to “walk more” or “exercise regularly” is unlikely to lead to any meaningful change.  For example, does “walk more” mean an extra 50 steps, 500 steps or 5000 steps per day?!  Does “exercise regularly” mean walking twice per week, weight lifting four times per week or cycling six times per week?!  What individuals need are clear action points that are personalised to their lifestyles and goals, not everyone else’s.  For one person it may be to go for a 30-minute walk at 7.00pm every night, for another person it may be to walk up the stairs everyday instead of taking the lift, and for someone else it may be to go for a 30-minute run on Monday, Wednesday and Friday evenings at an intensity of 150 beats per minute.  The underlying aim is the same throughout (i.e. get the person more active), but the method used to achieve this must always be tailored to the individual and what they are currently doing.

Importance of Sleep to an Employees Health

Another key area of lifestyle that can impact on health and wellbeing is an individual’s sleep health.  Over the last 100 years, the average number of hours that a person sleeps has reduced from 9 to 10 hours per night to 6.8 hours per night, whilst the proportion of individuals who actually manage to sleep for at least 8 hours per night has reduced from 35% in 1998 to 26% in 2005 (7).  Whilst this change in our sleep patterns may not appear as important as other changes in our lifestyle (physical activity and diet, for example), a growing body of evidence is suggesting it may actually be having a hugely significant impact on the health and wellbeing of the UK population.  For example, sleeping less than 7 hours per night is linked to an increased risk of high blood pressure (8,9,10,) diabetes (11,12), obesity (13,14), stroke (15) and cancers (16,17).  Rather than giving general advice, such as “try going to bed earlier”, interventions needs to be focused on addressing what the individual is currently doing in their lifestyle that is affecting their sleep health.  For example, are they overweight, stressed, consuming too much caffeine, eating too late at night or living a sedentary lifestyle?  Each of these may impact on an individual’s sleep health, but the importance of each one will differ from individual to individual.

The consequences of stress

Finally, many people live with high levels of physical, mental or emotional pressure in their lives, which may lead to the negative effect known as stress.  Whilst everyone needs a certain level of pressure in their life to motivate them and prevent them from entering a state of chronic apathy, pressure that exceeds an individual’s ability to cope eventually leads to stress and ill-health, including heart disease (18), obesity (19,20,21) and the exacerbation of type II diabetes (22,23).  Positively, there are a number of changes that a person can make in their lifestyle to increase their resilience-to-pressure, including exercise (24,25), eating oily fish (26) and more fruit and vegetables (27).  Yet each of us has a different level of resilience, which is affected by our health, emotions, diet, exercise levels and age.  As mentioned above, interventions need to be based on each individual’s level of resilience and susceptibility towards poor function.

Understanding an employees health needs

The key message of this article, then, is a relatively obvious one (and yet one that is often difficult to achieve):  improving health and wellbeing over the long-term requires healthcare professionals to take a truly personalised approach.  Every one of us lives our lives in a different way, so tackling health in a generic, one-size-fits-all model is never going to work over the long term.  A healthy lifestyle is far more than what we eat or the level of exercise we perform, it is also how we sleep, what we do to deal with the pressures in our lives and, ultimately, our emotional wellbeing.  Every one of us will undoubtedly benefit from focusing on the four areas discussed above, but the relative contribution of each one to our health and wellbeing will vary significantly and thus the use of an expert healthcare professional becomes vital.  For example, Health and Wellbeing Physiologists, in addition to their standardised degree background, are trained extensively to understand each of these areas, the impact they may have on both health and wellbeing, and evidence-based interventions to improve each of them.  Without this specific training, individualising lifestyle changes becomes difficult to achieve and long-term adherence is impossible.

So, the next time someone tells you to “eat more fruit and vegetables” or “exercise more”, ask them to be more specific – you never know, it could be the difference between success and failure!

About Author: Chris Jones is Professional Head of Physiology for Nuffield Health.

1.    NHS, (2008).  Statistics on obesity, physical activity and diet:  England.  www.ic.nhs.uk

2.    Scientific Advisory Committee on Nutrition, (2008).  The Nutritional Wellbeing of the British Population.

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5.    American College of Sports Medicine, (2010).  ACSM’s Guidelines for Exercise Testing and Prescription (8th Edition).  Baltimore:  Lippincott, Williams & Wilkins

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21.    Kivimäki, M., et al (2006).  Work stress, weight gain and weight loss:  evidence for bi-directional effects of job strain on body mass index in the Whitehall II study.  International Journal of Obesity, 30; 982 – 987

22.    Surwit, R.S., Schneider, M.S., and Feinglos, M.N., (1992).  Stress and diabetes mellitus.  Diabetes care, 15 (10); 1413 – 1422

23.    Wales, J.K., (2009).  Does psychological stress cause diabetes?  Diabetic medicine, 12 (2); 109 – 112

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25.    Stein, P.K., et al, (1999).  Effect of exercise training on heart rate variability in healthy older adults.  American Heart Journal, 138 (3); 567 – 576

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