Prevention over Prescription

I am a critical care doctor. I have been practicing medicine in the intensive care unit (ICU) for over 10 years, and I had an epiphany during Covid. In that first wave in early 2020, the ICU was filled with a disproportionate number of people with Covid who had underlying metabolic disease — namely obesity and associated cardiovascular problems.

This opened my eyes. Maybe in addition to looking at ways to treat people for Covid, we should be looking at ways to prevent them from landing in the ICU in the first place.

After all, patients who leave the ICU not only have to recover from whatever illness brought them there, they have to cope with associated PTSD, anxiety, and depression, not to mention the significant suffering for their caregivers and their families. Let me also remind you that a Covid admission, for example, can cost an average of $50,000.

It was clear to me from the early days of the pandemic that we should be looking at ways to prevent these huge medical, societal, and economic costs from happening.

What are the interventions to help prevent an ICU admission?

First, let’s acknowledge that the metabolic problems (like obesity and associated cardiovascular risks) that put people at high risk for serious Covid outcomes can be greatly improved and even reversed. This is not to say that losing weight, getting fit, or changing how we eat is easy. In fact, making lifestyle and habit changes is extremely difficult for a lot of people. It’s harder than taking a Covid vaccine, for example (something I also believe in strongly). But if I can help someone avoid landing in my ICU by sticking to a low-carb, high-fiber diet, consuming whole foods, and engaging in routine exercise including resistance training, I feel I’ve done my job well.

So during the pandemic I got serious about trying to help people this way. I used my podcast Solving Healthcare and my social media feeds to reach people about simple ways to get healthy. There was so much talk about isolation and hand washing—but what about caring for our bodies and minds? Yes, the vaccines are amazing at preventing hospitalization and death, but what about caring for our underlying conditions? To prevent serious Covid outcomes and help their overall health, I wanted to create that example for people to keep moving.

I started a casual conversation on Tiktok sharing how I approach wellness. I shared a video each day because I saw people responding to my content as a doctor—but also as a Black doctor and leader. I want people to know that how we treat our bodies every day has a compound impact on our health over time. And empower people to change. We can reverse a lot of what’s hurting our health if we share the right information and access the right tools. It doesn’t have to be expensive or rigid. You just have to do it.

Then what if we take collection again and support discount rebates for gyms, particularly in the hardest-hit, racialized communities? What if we provide subsidized meals for high quality foods? Let’s think about ways that we can reach out, educate, and reach those that are at highest risk. This is where I think more of our energy and communication needs to lie. Honestly, investing in prevention has such huge compounding effects and could be generational.

Improving metabolic health not only improves Covid outcomes but also reduces risk for cancer, cardiovascular and heart disease, and stroke, to name a few. These are all things I see in my ICU on a daily basis. So why don’t we invest in ways to let people have access to higher quality foods, non processed foods, make our cities more walkable, and promote healthy living? Why not make that the focus?

Personally, I get inspired when I see the “contagiousness” effect of a loved one, for example, getting healthy. You can see a ripple-down effect. I see people in my neighborhood say, “Hey Charles, I hear you came off your diabetic meds. How did you do that?” Then Charles becomes a champion — a go-to for information — that only amplifies his success and helps the next person.

What else can we do?

We need to invest in mental health. In Canada where I live, we claim to have universal health care but it can cost up to $200 per session for psychotherapy for a child. Mental health is part of the human condition. It shouldn’t be considered a luxury to get help with it. And we all know how much people have suffered during the pandemic from social isolation, depression, anxiety, bullying, and eating disorders (to name a few). Kids in particular have suffered, and it’s time we help the kids recover from the last two-plus years and get them the resources and tools they need. Childhood is where we lay the foundation for health habits long term. (This is why Lucy and I have advocated so strongly together for meeting kids’ broad human needs beyond simply not getting Covid.)

We also should be thinking about surging resources to marginalized, low socioeconomic and racialized communities where they are the hardest hit with metabolic disease and, of course, Covid. We know that there is a direct association with socioeconomics and health outcomes. We saw this amplified during the pandemic. We saw racialized communities hardest hit by hospitalizations and by the mitigation measures themselves — which is why balancing the harms of the virus and the harms of the mitigation measures themselves is so crucial.

Now is the time for innovative thinking. Increasing access to mental health services — in addition to outdoor public activities, gyms, and subsidized high quality foods — plus improved education on the fundamental importance of staying mentally and physically healthy is the path forward. Collectively we get healthier and reduce the demands of hospitalizations and ICU visits. To do this will take a shift in mindset and a shift in priorities but honestly, I think we could do this. These changes need to be intentional, and, in my opinion, the effects on our health and well-being could be dramatic.

Kwadwo Kyeremanteng

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals

SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness

KEYNOTE SPEAKING

solvinghealthcare.ca or kwadcast99@gmail.com

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