Further, noncommunicable diseases, those more closely linked to social circumstances, lifestyle and behaviour, such as cardiovascular diseases (e.g. heart attacks and stroke), cancers, chronic respiratory diseases (e.g.chronic obstructive pulmonary disease and asthma) and diabetes, will account for 71 percent of all annual deaths globally and represent an increasing proportion of mortality and morbidity risk.
The impact on healthcare in the UK is already being felt. A population with age and NCD combinations places greater demand on the NHS and with a declining tax base, alternatives will need to evolve. The public health policies of old, focussed on the role of sanitation, workplace reforms and ambitious social health reforms, including the creation of the NHS.
The generation of clinicians brought up since the second world war on the ‘power of the microbe’ as the causal agent of infectious disease has seen a slow but pernicious movement away from public health related social reform to the power of the pharmaceutical and the focus on the individual. In effect, seeing poor health as a matter of personal irresponsibility rather than of societal and nature’s demise became a natural extension.
Individual experience can shape public health, when it is measured and demonstrated to have consequence, something that the recent pandemic has brought to public attention. Yet, meeting the demands of just the NCD burden exceeds all current structural capabilities. Regrettably a shift in focus falls to the hands of politicians, who are generally short sighted, risk averse and mired in conflict.
Agents of Change
One of the most significant drivers of change in Western Society is found in the hands of the insurance companies. As their customer base changes, their financial and actuarial modelling is demonstrating the need for a material shift to engage their clients in participatory medicine.
Life and annuity manufacturers are already engaging customers in the shared-value economics of healthy living to increase policyholder longevity. A process that, as it expands will suck in talent, such as Nutritional Therapists to meet the demand, subject to their ability to support lifestyle changes, with a strong focus on nutrition.
Technology will inevitably play an important part in this transition. The proliferation of data and connected devices, particularly wearables, will continue to make it easier for the NHS, individual practitioners and the insurance companies to play an active role in shaping health determinants to everyone’s benefit.
Armed with this information, respective experts can provide well-timed, personalised reminders or notifications around nutrition, exercise, stress management, sleep, disease management, practitioner appointments, local health resources, and social activity. This will create the opportunity for the development of partnerships beyond the one to one, and draw in whole societies and cultures.
Currently, dynamic adjustment based on behaviour and suggested personalised actions to significantly drive healthier behaviour individually and societally are still in their infancy. However, from the insurance companies’ perspective, this evolution flips their underwriting approach on its head, with environment, health, and lifestyle becoming primary inputs and medical data providing only one part of the picture of sustaining and generating wellbeing.
As you age
There are significant variations in age related decline, determined by a variety of factors, currently out of many people’s control. Equally there are even more within a locus of control, that require allied translation into actionable steps. However, many people remain confused, even more so over the last few months as inexperienced readers have tried to comprehend pre-publication papers, post publication withdrawals and then interpreted these via their own lens. Sometimes a societal one, but in many cases a political one. The back and forth has left many people confused, distrustful in science and prone to emotive and in some cases misguided determinations about the value of self and societal health care actions.
Acting as early as possible in the determination of consistent, positive and personal care steps, is clearly going to be advantageous, to one degree or another. Societal changes, such as those now being proposed for climate mitigation are less easy to feel in control of, and until they impact directly on your current lifestyle very difficult to action.
It would seem that a mix of big picture societal public health care and individual engagement is the best option for all involved – yet it will not be easy to get buy in from all, and as nutritional therapists or lifestyle orientated physicians, it may be a call from one of the large insurance companies, that encourages you to become an ambassador for health.
 World Population Ageing – the United Nations
 The Lancet: Once-in-a-generation opportunity to strengthen the NHS and invest in UK health and care. 6 May 2021
 Kuan V, Fraser HC, Hingorani M, Denaxas S, Gonzalez-Izquierdo A, Direk K, Nitsch D, Mathur R, Parisinos CA, Lumbers RT, Sofat R, Wong ICK, Casas JP, Thornton JM, Hemingway H, Partridge L, Hingorani AD. Data-driven identification of ageing-related diseases from electronic health records. Sci Rep. 2021 Feb 3;11(1):2938.