A template for dealing with impacts of Covid

In our July-August issue, Dr Robin Clark, Bupa Global and UK’s medical director, explained how the insurer is embarking on the first step towards finding ways to improve the nation’s health with the launch of its new Wellbeing Index. 

Now he digs deeper into what the findings mean for the future – and the challenge for healthcare professionals trying to turn around the impact of Covid-19.

The Wellbeing Index

Carried out by Censuswide, this rolling dataset will track five key health and well-being metrics for 8,000 UK adults each quarter, capturing a range of health, well-being, lifestyle and behaviour datapoints to help us and our healthcare partners understand more about the nation’s health.

The survey population is split by demographics including sex, age and geographic location, which enables us to explore key trends and spotlight where there are potential issues, so that we can continue to design and deliver healthcare in the most impactful way.

Improving physical health is the priority

Unsurprisingly, the Bupa Wellbeing Index shows that physical health aligns with age – 51% of 16 to 24-year-olds and 56% of 25- to 34-year-olds assessed their health positively, compared to 45% of those over 65s. 

And this trend is also seen when looking at those who rated their physical health as ‘very good’ – 18%, 15% and 11% respectively.

For over-65s, the Index shows that some of people’s most pressing health concerns include back, neck or joint pain (27%), their weight (25%), and their level of physical fitness (22%).

One study from the US shows that overall sedentary behaviour has also increased, with physical activity among the already active dropping by a third and already sedentary people remaining so.1 

Sedentary lifestyles are now a public health emergency, with the World Health Organization warning that physical inactivity is the fourth leading risk factor in deaths globally.2

Researchers define sedentary behaviour as anything we do when we are awake which has a metabolic equivalent task (MET) of 1.5 or less. MET is a measure of how many calories we are burning.

This raises important questions about how we can best support an ageing population in continuing in good health for as long as possible. 

However, we should not be disheartened; studies show that each positive change a person makes, no matter how small it may seem, will deliver benefits. Every journey is a series of small steps.

Active hobby

We know that physical activity such as walking, gardening, lawn bowls or swimming is one of the best things people can do to reduce dementia risk. Given rising dementia rates, one of the simplest steps we can take is to encourage people to take up an active hobby. 

In some areas where exercise on prescription is available, it may be suitable to encourage increased activity which has already been used to help mental health. 

The UK Chief Medical Officers recommend3 at least 150 minutes of moderate intensity activity – such as brisk walking or cycling – or 75 minutes of vigorous intensity activity, such as running, a week for adults aged 19-64 years.

And for those aged 65 and over, 150 minutes of moderate intensity aerobic activity is recommended each week, building up gradually from current levels. 

Those who are already regularly active can achieve these benefits through 75 minutes of vigorous intensity activity, or a combination of moderate and vigorous activity, to achieve greater benefits. Weight-bearing activities, which create an impact through the body, are also important in helping to maintain bone health.

We can also harness technology to help us support the ageing population remaining in good health. 

Over time, the data from the Index will tell us where the particular health concerns of our over-65s cohort lie and, as we get a better picture, we can use it to help us plan to address those concerns.

How age and gender divide impact health ambitions

It is encouraging to see that the data highlights people’s renewed focus on the importance of health and well-being, and the breadth of their good intentions. 

Over the past year, four out of five respondents (84%) have taken steps to improve their diet or lifestyle, with the most common interventions being:

 Better diet (35%);

 Exercising more regularly (30%); 

 Trying to get a full night’s sleep (28%).

Women were slightly more likely to have made positive changes (88% compared to 80% of men), as were younger adults – 87% of 16 to 24-year-olds compared to 81% of 55- to 64-year-olds and 71% of over-65s.

As we might expect, over-65s were the most likely to have had a full health check in the previous 12 months (10%), closely followed by the 55- to 64-year-olds. 

This is good news, as these are the years when the risk of many age-related issues such as heart disease, diabetes, cancers and musculoskeletal problems begin to climb significantly.

Health checks

Regular health checks increase the chances of catching problems quickly and we know that early diagnoses and interventions can make a huge difference in terms of treatment options and outcomes. 

However, it is concerning that nine out of ten over-65s have not had a health check over this period.

Another finding which also points to potential for improvement was the fact that 29% of over-65s take regular exercise to try to improve their health and head off problems – the same percentage as those aged 35 to 54 and ahead of the youngest demographic –16- to 24-year-olds, at 26%.

The data highlights some important gender divides. Twice as many women as men attempted a weight loss diet in the past year – 23% compared to 11%. They are also more likely to have tried to improve their diet – 41% of women compared to 28% of men.

Similar gender divides can be seen on sleep-related interventions, with 36% of women having tried to improve their sleep patterns compared to 20% of men, and also efforts to maintain a better work-life balance, with 29% of women trying versus 17% of men.

Men were marginally more focused on regular exercise (30% compared to 29% of women), cutting down on alcohol (23% versus 22%) and stopping smoking (8% versus 6%).

These findings show that there is clearly a strong appetite for healthier lifestyles and each and every one of these interventions will deliver real benefits for both physical and mental health. 

As positive steps also have a habit of snowballing, we need to encourage our patients to continue on this journey. 

Regular exercise supports weight loss and improves mood and sleep patterns, a healthier diet makes it easier to lose weight and generally makes people feel more energised and upbeat, and everyone feels better after a good night’s sleep.

What motivates people to change

One of the biggest motivators for those who took part in the Index was family.

Family is hugely influential – more than two-thirds (69%) of those surveyed said the biggest driver for taking care of their health and well-being was the desire to ‘be there for my family’. 

The other top motivators the panel reported was wanting to improve their life expectancy (67%) and 66% wanted to do what they could to head off serious health problems. 

Knowing this is a great tool to have when we need to persuade a patient to consider making a lifestyle change. 

We need to lock onto these drivers and develop support which will encourage people to take more ownership of their health and well-being.

It is also important to recognise that the pandemic has impacted people in very different ways. For example, while 33% of those surveyed reported a decline in their mental health as a result of two years of home-working, almost a quarter (23%) say their emotional well-being is better than before.

Similarly, although 22% believed their overall health has declined, 16% say it has improved over the past two years. 

One in five (19%) of those surveyed has become more anxious about their appearance as a result of more online meetings, but 16% are now less likely to worry about the way they look.

Positive changes

More work is needed to identify why some groups have been more resilient than others and we must find ways to tackle the negative impacts while also exploring strategies and support which will amplify the positive changes.

The evidence is beyond doubt. People who are active and healthy are less likely to develop a huge number of health issues including coronary heart disease, high blood pressure, diabetes and many cancers. 

Dr Robin Clark

Older adults who are active experience fewer musculoskeletal aches and pains and are less likely to suffer falls and the pain and problems which can flow from them.4

Identifying the barriers to good health and well-being will be essential if we are going to find ways to overcome them and develop health systems which focus on prevention and reducing the burden of avoidable issues, rather than dealing with the damage they cause. 

The Bupa Wellbeing Index will help provide the data and insight needed to help achieve this.

1. Changes in physical activity and sedentary behaviour due to the COVID-19 outbreak and associations with mental health in 3,052 US adults. International Journal of Environmental Research and Public Health, 2020.
2. Global Recommendations on Physical Activity for Health, World Health Organization, 2010.
3. UK Chief Medical Officers’ Physical Activity Guidelines, 7 September 2019.
4. Risks of Physical Inactivity, John Hopkins Medicine