1. Is prevention the new treatment?
How we can change our approach to health?
Dr William Bird MRCGP MBE
17th July 2018

2. A quick word from my sponsor FiterixTM
Major effect on the faulty immune system reducing the pro-inflammatory markers of anti-TNF factor, C Reactive Protein and IL-6.
Increases antioxidants and reduces the oxidative stress from Krebb’s Cycle in each mitochondria as measured by reduction in 8-hydroxydeoxyguanosine (8-OHdG)
Prolongs the life of cells by stimulating Temelorase and lengthening the telomeres at the end of each Chromosome hence prolonging cell life.
Reduces blood pressure, visceral fat, obesity, fibrinogen, blood pressure, and HDL/LDL ratio and can reduce the atheroma in each coronary artery
Stimulation of Brain-Derived Neurotrophic Factor Increases repair of neurons in the brain and promotes neural generation and increases grey and white matter with enlarging the Hippocampus.

3. 3X FiterixTM

4. aka GFW (going for a walk)

5. A quick word about walking
Major effect on the faulty immune system reducing the pro-inflammatory markers of anti-TNF factor, C Reactive Protein and IL-6.
Increases antioxidants and reduces the oxidative stress from Krebb’s Cycle in each mitochondria as measured by reduction in 8-hydroxydeoxyguanosine (8-OHdG)
Prolongs the life of cells by stimulating Temelorase and lengthening the telomeres at the end of each Chromosome hence prolonging cell life.
Reduces fibrinogen, blood pressure, and HDL/LDL ratio and can reduce the atheroma in each coronary artery
Stimulation of Brain-Derived Neurotrophic Factor Increases repair of neurons in the brain and promotes neural degeneration and increases grey and white matter enlarging the Hippocampus

6. Our factory setting is to be in a sociable group, supportive environment and have a purpose
People
Place
Purpose
Sociable
Nature
Autonomy
Be Active, Give
Keep Learning
Connect
Take Notice

7. Fear and Chronic Stress
People
Place
Purpose
Loneliness
Hostile
Rejection
Fear and Chronic Stress

8. Loneliness and Stress The experience of loneliness is stressful.
Chronic stress, via its effects on the endocrine and immune systems, enhances risk of long term conditions, (similar risk as smoking 20 cigs a day for CVD)
Lonelier people experience more sleep disturbances and engage in less physical activity than less lonely people with increased pain, depression, fatigue and poor health.
Jaremka, L.M., Fagundes, C.P., Glaser, R., Bennett, J.M., Malarkey, W.B. and Kiecolt-Glaser, J.K., Loneliness predicts pain, depression, and fatigue: understanding the role of immune dysregulation. Psychoneuroendocrinology, 38(8), pp

9. Nature and Stress
The contribution of green space to health and wellbeing in deprived communities lies partly in an enhanced “sense of place belonging”, a reduced sense of social isolation and offering opportunities to manage or mitigate stress. A study of allotment gardening using salivary cortisol as a measure of stress, found that gardening led to greater stress reduction than a restful indoor task (e.g., reading)
Van Den Berg, A.E.; Custers, M.H. Gardening promotes neuroendocrine and affective restoration from stress. J. Health Psychol. 2011, 16, 3–11.
Ward Thompson, C., et al Mitigating stress and supporting health in deprived urban communities: The importance of green space and the social environment. International journal of environmental research and public health, 13(4), p.440.

10. How does nature benefit health?
More positive social interactions and
Less stressed, mindfulness and greater understanding
(c) More exercise,
(d) Better quality environment for health promotion (i.e. has lower levels of air pollution)
Hartig T., Mitchell R., De Vries S. and Frumkin H. (2014) Nature and health. Annual Review of Public Health 35, 207–228.

11. Sense of Purpose and Stress
a greater sense of life purpose—the extent to which people report having meaning and direction in their life—predicted lower levels of chronic stress at a 10- year follow-up.
Individuals who reported having high levels of purpose strongly believe in the ability to influence their health
Zilioli, S., Slatcher, R.B., Ong, A.D. and Gruenewald, T.L., Purpose in life predicts allostatic load ten years later. Journal of psychosomatic research, 79(5), pp

12. Chronic
Stress
Inactivity
Poor diet
Obesity
Smoking

13. Inactivity and chronic stress
Chronic psychosocial stress, increases the risk of physical inactivity and contributes to the epidemic of disease.
Tsatsoulis, A. and Fountoulakis, S., The protective role of exercise on stress system dysregulation and comorbidities. Annals of the New York Academy of Sciences, 1083(1), pp

14. Chronic Stress Stress Hormones Chronic Inflammation Inactivity
Poor diet
Obesity
Smoking
Chronic Inflammation
Mitochondria as a key component of the stress response. Manoli et al. Trends in Endocrinology and Metabolism Vol 18 No

15. Inflammation: The cause of Causes
Diabetes
Diabetes
Cardiovascular
disease
Anxiety and
Depression
Chronic
Inflammation
Starts in children
as young as
6 years old
Cancers
Cancers
Obesity
Obesity
Arthritis
Arthritis
Dementia
Dementia

16. Inactivity causes inflammation1.
Increases
visceral fat 2.
Reduces anti-
inflammatories 3.
Damages
healthy cells

17. Inactivity: trilogy of inflammation1.
Increases
visceral fat 2.
Reduces anti-
inflammatories 3.
Damages
healthy cells

18. Reducing inflammation – fat
Variation in visceral fat
content in men with the
same waist circumference
Visceral fat = 0.5 L
Visceral fat = 1.1 L
Visceral fat = 1.2 L
Visceral fat = 1.3 L
Visceral fat = 1.7 L
Visceral fat = 1.8 L
Visceral fat = 4.2 L
Visceral fat = 4.3 L

19. Visceral fat reduction with exercise
Fat loss after 13 weeks of walking 60 mins a day and no weight loss
% Loss of Fat
Lee S et al. J Appl Physiol 2005;99:

20. Inactivity: trilogy of inflammation1.
Increases
visceral fat 2.
Reduces anti-
inflammatories 3.
Damages
healthy cells

21. Inside a healthy cell Mitochondria, healthy and active. Providing lots
of energy
Chromosomes
keep dividing
Immune
system is
switched off
until needed

22. Sedentary, high fat diet and stress
Oxidative Phosphorylation
Anti-
Oxidants
Reactive
Oxidative
Species
Mitochondrial DNA
Mitochondria

23. Physically active, low fat and not stressed
Oxidative Phosphorylation
Reactive
Oxidative
Species
Anti-
Oxidants
Mitochondrial DNA
Mitochondria

24. Telomeres get shorter
Epel, Elissa, et al. Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres.
Annals of the New York Academy of Sciences (2009): 34-53

25. Senescence: the end of the cell
Hezel, Aram F., Nabeel Bardeesy and
Richard S. Maser. ‘Telomere induced
senescence: end game signaling.’ Current
molecular medicine 5.2 (2005):

26. This causes
inflammation
Immune system
is constantly
switched on

27. We have a new disease that conventional medicine cannot treat
Chronic Inflammation

28. Inflammation: ‘the cause of causes’
Inflammation of metabolic system
Diabetes
Inflammation of Heart and arteries
Anxiety and Depression
Inflammation
of brain
Chronic
Inflammation
Starts in children
as young as
6 years old
Inflammation and faulty immunity
Cancers
Obesity
Inflammation of visceral fat
Inflammation of joints
Arthritis
Dementia
Inflammation
of brain

29. Social Prescribing Pathway of Ill Health People Place Purpose
Chronic stress
Poor health behaviours
Mitochondrial damage, telomere shortening,
and chronic inflammation
Cardiovascular disease, diabetes, cancer, depression

30. Is being Healthy everyone’s cup of tea
Policies that nudge individuals towards healthy lifestyles promote the welfare of those individuals, as judged by themselves.
Thaler R, Sunstein C (2008) Nudge: improving decisions about health, wealth, and happiness. Yale University Press, New Haven

31. Should Happiness be the goal
Happiness was famously analyzed by Aristotle as being the sole ultimate goal of human existence, meaning that he viewed it the only thing important in its own right, not merely as a means to an end.
Whereas money and technology and health, for example, are mere tools, i.e., useful solely as a means to some, further thing.
If good health is the sole ultimate goal then any minor imperfection creates anxiety and can become a focus of one’s life.

32. The Benefits of Happiness
happiness produces greater cooperation, energy, motivation, and creativity.
Similarly, positive feelings are associated with a stronger immune system and fewer cardiovascular problems,
whereas anxiety and depression are associated with poorer health behaviours and problematical physiological indicators such as chronic inflammation.
Diener, Ed, and Louis Tay. "A scientific review of the remarkable benefits of happiness for successful and healthy living." Happiness (2017): 90.

33. Meet
Bob

34. Let’s get Bob active

35. We can
give him
NHS
treatment

36. ‘Bob, why
don’t you
get off the
bus a stop
early?’

37. ‘Bob, you
really should
take the stairs
instead of
the lift’

38. ‘Bob, why
don’t you try
Betty’s keep fit
class on a
Tuesday?’

39. ‘Bob, have
you tried
cycling to
the shops?’

40. Or we can link him with a group of supporters who walk 2 miles to Anfield

41. and to
Bob, that is
not exercise
or health

42. Physical Activity is now hidden behind
a much greater experience for Bob
It is invisible to him
It is a ‘means to an end’ not the end itself
‘The end’ is now getting to Anfield
And finding this greater value for each person
will help create the industrial scale required

44. Green Gym Vs Aerobics
V Reynolds 1999 OCHRAD
11/12/2018

45. Exercise on Referral The focus has moved physical activity
from a venue based strategy ...
Exercise on Referral

46. Social Prescription … to a community based activity where
activity happens everywhere
Social Prescription

47. Social Movement But to get real scale we need to
get lots of people becoming
activity leaders themselves
Social Movement

48. Two Models of Social Prescription

51. Changes
Beat the Street Stranraer (N= 167)

53. Days of moderate activity before after and at 6 months after BTS
The number of people active for 5 days or more moved from 48%-61% 6 months later
The number of people who are inactive (<2 days a week 11% to 6% 6 months later
12,974 people took part over 7 weeks in February 2017

54. Return on Investment for MK Beat the Street using NICE model

55. Stressful events Resilience Stress Hormones Chronic Stress
Healthy pregnancy
Caring supportive childhood
Strong social networks
Feeling safe and secure
Connection to Nature
Sense of purpose
Sense of control
Genetics and epigenetics
Stress Hormones
Catecholamines
Glucocorticoids
Chronic Stress
Alcohol Drugs Smoking
Inactivity
Poor Diet
Diabetes
Dementia
Depression
Cardiovascular Disease
Fatigue
Arthritis
Inflammatory Bowel Disease
Chronic Inflammation
Mitochondria Damage
Telomere Shortening
Visceral fat and obesity
Unhealthy gut microbia

56. Stressful events Resilience Chronic Inflammation Chronic Stress
Healthy pregnancy
Caring supportive childhood
Strong social networks
Feeling safe and secure
Connection to Nature
Sense of purpose
Sense of control
Genetics and epigenetics
Chronic Stress
Stress Hormones
Catecholamines
Glucocorticoids
Satisfaction
Happiness
Active Lifestyle
Healthy Diet
Diabetes
Dementia
Depression
Cardiovascular Disease
Fatigue
Arthritis
Inflammatory Bowel Disease
Chronic Inflammation
Mitochondria Damage
Telomere Shortening
Visceral fat and obesity
Unhealthy gut microbia

57. Summary We live in a stressful environment
Isolation disconnection to nature and lack of purpose create chronic stress.
Chronic stress causes poor health behaviour and leads to Chronic Inflammation (CI)
CI is the “cause of causes” of most long term conditions
Health, diet, activity should be means to the end which is Happiness
Increasing SP should move to a social movement through digital platforms and Insight

58. What can we do to increase resilience…
What can we do to increase resilience….Who do we work with to change things?
Resilience
Healthy pregnancy
Caring supportive childhood
Strong social networks
Feeling safe and secure
Connection to Nature
Sense of purpose
Sense of control
Genetics and epigenetics

59. Building Active Communities