UK, You’ve Had a Heart Attack – How Are You Now?

MIYou might want a cup of tea whilst you read this! I often see patients a week or two after they have been discharged from hospital with a Myocardial Infarction (what we often refer to as a heart attack). In this part of my home county, once someone is diagnosed with having a MI, they are admitted to Blackpool Victoria Hospital, where an amazing team of cardiologists literally save their life by putting stents into arteries in their heart that have become clogged up. It has been a phenomenal breakthrough in medical science in the last 15 years and has revolutionised how cardiology services are configured.

New medicines are prescribed to help keep the heart and kidneys healthy and patients are reviewed to see how they are getting on. What I always love in the initial consultation following a heart attack is how reflective a person becomes. Everything in their life gets assessed and reprioritised. Key questions are asked about how much stress they have been under, and why they were living at such a fast pace whilst forgetting about what is really important – living well, relationships, love, beauty, people and connecting with the story of who they feel they really want to be for the rest of their life. It is very rare to find a person who is desperate to get back to business as usual or someone who doesn’t ask some fundamental questions about what life is for. It is possible in some of these consultations to have some of the best coaching conversations a practitioner can ever hope to participate in. Asking some questions of the patient about what they are going to change and how they are going to do so.

And yet, in the UK (and indeed the west), we suffered a heart attack beyond all proportions with the economic crash of 2008. But we have not really reflected on the major warning sign that it was to us. We have a government and financial system intent on “getting us back on track” – and I wonder to what, exactly? It isn’t that the financial system alone, just happened to have an infarction. It’s like assuming that a heart attack happens simply because of a defect in the cardiac system itself – this simply isn’t true. The crash was only a sign of just how broken our entire body is and we would do well to reflect a great deal more about how we are living as a nation and whether it gives us any real sustainability for the future of the planet and the generations to come. Our current response is not only to “get back on track” with where we were, but  to “tighten our belts” (which means to cut benefits left right and centre without regard for the dehumanisation of people in the process). It’s like believing the correct response following an MI is to emaciate and punish yourself, without asking some fundamental questions about how healthy your whole life is.

So, what about about a national health check – let’s look at each system in turn and ask some questions – because the truth is, we haven’t faced the fact that we are in an age of transition in which answers are not obvious and we don’t have any experts who have been to the alternative future we long for. So, we have to learn together and ask open questions that provoke better conversations to help us.

Let’s start with Education. George Monbiot has written a stunning piece in the Guardian about the current health of the education system: http://www.theguardian.com/commentisfree/2015/jun/09/aspirational-parents-children-elite?CMP=share_btn_fb – well worth a read. Our education secretary, Nicky Morgan on the other hand isNicky Morgan intent on more testing of our children and has recently given a speech in which she claimed that arts and humanities subject choices close down a child’s career options and they will earn 10% more in their life if they do Maths at A level – whooppee do dah. For an alternative and altogether more inspiring approach, look to the lovely Ken Robinson:

Couldn’t education become about real learning in which our children feel inspired and find hope for the future?

Ecology – Oh dear – so far a string of broken promises on the environment from the western governments. It turns out that oil and industry is more important than the future of the planet. Is it? If not, what are we going to do?

Defence – undergirding our entire nation are three things: Money as debt (see finance), the state of the exception (see law and order) and military violence. The ultimate trust of our nation rests on nuclear warheads. How healthy is this? How much fear do we have to create as a narrative to believe this is actually a good thing? Do we want that to be the undergirding faith of our nation? And what about the change in rhetoric regarding soldiers who die in war. David Cameron recently referred to soil from the battle fields of WWI (which was brought to London) as ‘Holy Ground’ and he described those who died fighting for the ‘allied forces’ as ‘martyrs’. Is the nation state therefore the ‘saviour’? If it is, what on earth do we mean by this? If not, then is there other language we can find to use about the two world wars without creating a very dangerous worldview?

Housing – 69% of the land continues to be owned by 0.6% of the population and there is a real lack of social housing available in deprived areas. This is causing significant problems for those already under huge financial strain, given the effects of austerity measures. Who does the land belong to and why?

Justice – How many of the perpetrators of crime are victims of a system that left them with little or no other choice but to commit crime? How restorative is our justice process?

Law and Order – our prisons are full to breaking, our police force is being cut and replaced with private security firms. How effective is our law and order system? And what undergirds it? Georgio Agamben cuts through to the heart of the issue in his exquisite book ‘State of Exception’. Underneath the whole of western ‘democracy’ lies the right for the government to suspend the rule of law i.e. invoke Marshall law if deemed necessary. I look at the people movements emerging across Europe right now and wonder how far we are from the ‘state of exception’ being invoked. All it will prove, as we already know, is that democracy is a vain imagination. What is it that undoes ‘the powers’? Could a movement for positive peace, founded on love offer any realistic alternative? If so, what?

Immigration – apparently the answer to our problems is to become more fearful of the ‘other’, create a politics of fear and blame immigrants for our financial problems. We are barricading our doors Syrian Refugeesand building up our walls to ‘protect our way of life’. And while there are currently 4 million homeless Syrian refugees, the UK has welcomed 147 of them in total. Did you know that the entire world population could fit into Texas? Our concerns about lack of space and lack of jobs is really unfounded and we seem willing to ‘love our neighbours’ with great initiatives like comic relief and generous charitable giving, just as long as it doesn’t actually have to affect us and our way of life…..how loving is that? How healthy is love that does not truly cost us and change us?

Health – this whole blog is about it, but 1 in every 5 pounds spent in the NHS is due to poor lifestyle choices we are making. We can’t live imgresexactly how we want if we hope to continue with a health service that is free for everybody. How will we change the culture? Can we find innovative ways of working collaboratively within the system that breaks down the silos in order to work more effectively for the good of our national health? Is privatisation the answer? If not, what are we willing to change/protest about to keep it public?

Government – a majority with 36.4% of the vote? Deeply wrong. There continues to be profound disengagement with the system and a deep cynicism that the current style of government can bring any real lasting change. We need a new politics – what might that be like? Where are the leaders who will choose to facilitate instead of dominate?

imgresEconomy – ah yes, that old chestnut. Do we want an economy in which the gap between rich and poor continues to widen? Do we want a system in which the poor are punished whilst the rich are exonerated for their greedy crimes? The entire western economy is based on a system of debt that requires us to continually grow and expand our borders so that the debt can be serviced. We have become slaves to the economic beast. Where are the alternative experiments emerging? What can we learn from them? Are we brave enough to try something new? I have posted this before, on my other blog – www.reimaginingthefuture.org  but Charles Eisenstein is so worth watching:

The human heart provides us with a great metaphor. The health of our nation(s) is not good. We’ve had the wake up call, and if we’re not careful (this is a warning from a doctor, so take heed), the next heart attack will be even more catastrophic. We have to reflect on where we are and ask ourselves where our current trajectory will lead us. I don’t want to get back on track if it leads us to more depression, destruction and decay. I want to find the road less traveled by – the one that leads to life, hope, love, regeneration, recreation and a beautiful future for our children. So many questions. So much to learn.

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How Healthy Are You?

imgresAn NHS health check is available to all 40-74 year old citizens of the UK. The idea is to detect problems like hypertension, (pre)diabetes and the risk of heart disease early so that preventative measures – lifestyle changes and possibly medication – can be offered in good time.

 

There is plenty of debate in the public arena as to how helpful and effective they are and also questions about what is the driving force behind them. (If you’re interested you can read more by searching NHS health check evidence base).

 

There is actually some pretty good evidence that they are making a difference. They have actually been a pretty helpful resource in helping practice nurses and GPs have ‘coaching’ conversations with people about their physical health and what they could do to improve this and help them stay healthier in the future.

 

Ken WilberHowever, does a Q Risk score (something that tells you how likely you are to have a heart attack or a stroke in the next 10 years) really measure how healthy you are? What does it mean to be healthy? If we take Wilber’s work on health and well being (1997), physical health is only a part of what it means to be truly well. If we are to embrace a more holistic understanding of what it means to be healthy people, who live in healthy communities which are part of healthy towns and cities, then we need to take a much wider view of how we measure this.

 

So how healthy are you. Starting with the physical – how is your diet and exercise? How much responsibility do you take over the substances you put into your body – alcohol, cigarette smoke, recreational drugs, sugars, caffeine, toxins like aspartame……? And if you take little responsibility for your physical health, what should the response of a ‘free’ health care service be that currently spends 1 in every 5 pounds mopping up the consequences of people’s poor lifestyle choices? And what about the leaders within our cities – what will they do to tackle the fast food/alcohol/sugar/tobacco industries and the supermarkets who cream profits from product placement and advertising of hugely unhealthy foods? I could go on……

 

And what about your mental health? The fact is: the UK has some of the unhappiest children in the developed world  http://www.bbc.co.uk/news/uk-14908194 (this is always true of places where the gap between the rich and poorest is wider and where materialism is prioritised over time). Anxiety and depression are on the increase and stress continues to be a major reason for consulting the GP. Some of this is systemic and it is a challenge to policy makers to think about the impact of their decisions on the mental health of the population. Austerity and deeper benefits cuts are having a profoundly negative impact on those already struggling. But there is also a challenge to individuals about what we allow our minds to be filled with. How much time in a day do you stop to be grateful, or to be still? How much of your mind space is taken up with addictive tendencies, be that to social media or pornography? How are you at forgiving others who have hurt you? If not very good – how much is the bitterness inside you having a good effect? If the bitterness is eating you up – what are you going to do – hold on to it? How much time do you give to things like singing and volunteering which are seriously good for your mental health?

 

To take Wilber further, we must ask how well we are socially. How connected are you to the people around you? According to the Office of National Statistics (ONS), the UK is in the bottom three nations in Europe for feeling attached to our local communities and for feeling like we can ask for help from people who love us in times of need – what is that about?! How much of our time these days is given over to screens and social media instead of actually having conversations that matter with people in the same street or even the same room as us? What is the social make up of our communities like? Can we see alternative economies springing up like time-banking? What is the provision like for children and old people? Who looks after your elderly neighbour when she’s just come out of hospital with a new hip? Could there be a meal rota on your street?

 

There is one other measure to look at – our systemic health. How much do we feel empowered within society to make a difference and effect change? If not much, then we generally don’t feel very healthy. For me, it’s one of the reasons why community involvement is important so that the unheard voices are given space to speak and to be listened to. How much do leaders within cities think about the impact of their decisions on the poor and marginalised? For some truly incredible work on this, check out the Leeds Poverty Truth Challenge (https://leedspovertytruth.wordpress.com/).

 

So, how healthy are you? You as a whole person and you in the corporate sense? Do you want to be well? If so, think more holistically – think about your physical, mental, social and systemic health.

 

My health check would ask these questions:

Are you eating and exercising well?

Are you drinking responsibly?

Are you taking time to be grateful?

Are you looking other human beings in the eye and building intimacy?

Are you connected to other people in your community?

Are you choosing to forgive others when they wrong you?

Are you taking care of others around you?

Are you walking in open spaces and enjoying this beautiful earth?

Are you singing on a regular basis and taking time to be creative?

 

The challenge to us all is to learn what it is to be really well. The challenge to the health service is to work far more integratively and take a much broader, wider, richer and deeper view of what it really means to be healthy.

 

 

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Reimagining Health


Knox Family-59
In this video blog, I tell the story of ‘The Fifth Monk’, taken from Tom Callanan’s blog (http://www.tomcallanan.com). It comes from the buddhist tradition and gives plenty of food for thought about the need for us to take the conversation about the future of healthcare ‘upstream’.

 

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