Medicine has to become Sustainable

Technology-based modern medicine is reaching its limits in the treatment of common and chronic diseases; interventions and surgeries cannot be repeated indefinitely and often do not lead to a change in pathophysiology. Hence, medicines become costly due to their long-term use. In contrast, lifestyle plays an important role in the development and maintenance of chronic diseases and must be considered in their treatment. For example, a behavioral, very brief, physician-delivered opportunistic intervention is acceptable to patients and is already an effective means of reducing the average weight of the population (3).

Yet, it is extremely difficult to implement lifestyle modification in the case of an existing disease. It would be much more in everyone‘s interest to prevent diseases before they even develop (21). Preventive measures can not only improve the individual well-being and quality of life of individuals, but also reduce the burden of disease on the societies (4, 9, 24). Investing in prevention pays off not only through a reduction in the costs of illness, but also through an increased level of benefits for those affected. A well-intended but serious misunderstanding of people‘s preferences is the belief held by clinical preventionists that individuals will embrace more sophisticated measures of early detection of possible risk. People want to live happy and healthy lives and they rather refrain from being an accumulated assembly of several risks that potentially manifest decades later (7, 13).

While early risk detection has its place, for example in prevention of the consequences of undetected hypertension, the focus needs to be shifted on strengthening the well-being resources of people and piggy-backing risk reduction (20). Fear has not been a good seller, as seen in tobacco warnings on cigarette packages or in HIV-prevention but was more effective when combined with psychological advises (16, 17, 22, 23). Maltreatment and distress and the protective role of social support should be considered (12, 16). Currently there is an emerging mainstream desiring “healthy and purposeful” lifestyle. Medicine might be well advised to align with these motives (13).

Prevention and health promotion are needed as a further – if not essential – pillar in order to bring medical competence to the general public (6, 8). Furthermore, prevention should and must be included and shaped in the programme of medical faculties (8). In order to meet these challenges, preventive measures must also be promoted by university teaching hospitals but must be incorporated long-term by all healthcare providers. This means, the hospital of the future will have to care about sustainability which means their effect for the related population and communities.

Doctors have to Learn to Think and Talk differently

Naturally, when clinicians consider prevention, they focus on the individual, how to prevent or moderate progression in this particular individual patient. The concept of risk factors is particularly important for doctors to categorise the patient‘s health problems and to design therapies. However, several of them such as age and sex are not even modifiable by the individuum. Thus, our risk communication with the patient needs to be revisited (22, 23). The patient is the centre of the preventive action, the patient takes decisions and responsibility, doctors in turn should consider themselves as the expert adviser (19). This requires other communication skills like motivational interviewing a behaviourally-informed, very brief, physician-delivered opportunistic intervention is acceptable to patients and an effective way to reduce population mean weight (1).

Until now, most doctors do not regularly counsel patients on lifestyle (10, 14). They regard this as too complicated, too time-consuming, and not being financially rewarding. However, such interaction might be feasible, as no one expects doctors to coach exercise therapy nor to design training programs. Doctors can motivate patients and refer to physical activity, nutrition and stress reduction specialists or to community-based programs (3, 6, 21). The Exercise-is-Medicine Initiative or the FYSS book in Sweden are good examples of such network initiatives (3, 6, 14).

Theses

1. Prevention is the sustainability concept of health development. In highly developed health care systems, prevention, has a cross-disease effect and thus clearly saves resources. Thus, life-style changes, such as appropriate physical activity, nutrition and stress reduction measures, lead to a reduction in the risk of contracting a large number of diseases.

2. In order to achieve health goals, they should be set in writing, appropriate policies should be designed and their implementation monitored. Inequalities in access to health resources need to be carefully monitored.

3. To achieve long-term positive effects of prevention and to develop appropriate measures, participatory processes as a bottom-up approach are useful.

4. Policies should facilitate interaction and communication of different stakeholders. This should lead to an improved implementation of prevention and health promotion through accumulated competence.

5. Medical faculties have to adjust their teachings for medical students to focus not only on diseases but on prevention and public health. Hospitals should adopt sustainability goals of health interventions for their policies.

6. An interdisciplinary approach enables optimal delivery. Interdisciplinary cooperation of medical doctors with many health care professions as nurses, physiotherapists and sport therapists as well as community resources, fitness centres and sports clubs is necessary.

7. Impact on the environment: Moving around by bicycle or changing one‘s diet could contribute significantly to reducing CO2 emissions. So, what is good for human health is also good for the planet.

Health is present in all policy areas. It is desirable that governments and executive agencies have access to high-quality evidence to guide their policies toward prevention.
As far as research and also the evaluation of prevention in all policy areas are concerned, we are dependent on findings from other countries around the world. To meet this demand, the overall volume of targeted research funding must be geared to the requirements of the prevention agenda.

In summary, prevention and health policies are necessary within medicine, science, politics and society in order to advance health promotion, to improve the well-being of individuals and to maintain and promote functionality in the long term. For all those involved, prevention represents the fundamentally right as well as the strategically smart thing to do.

■ Steinacker JM , Matits L, Wendt J, Fischer JE, Sniehotta F