By Meleni Aldridge, executive coordinator and Rob Verkerk PhD, founder, executive & scientific director

All of us at ANH are frequently reminded that communication really is an artform – every week, on a Wednesday! Taking complex problems and pieces of information and communicating them in simple, accessible, but meaningful ways to a large, diverse, audience is an ongoing work in progress.

But talking about our Blueprint for Health System Sustainability has taken the communication challenge to a whole new level. Whilst it may seem a little dry or personally irrelevant because of the language used, it actually speaks to the core of each one of us because it’s about creating optimal, vibrant health and preventing disease. It’s a journey that both Rob and I have been on for many years, and we’re so incredibly excited by its potential to transform the way we all view, approach and manage our health.

Download the Blueprint

We know our communications to date haven’t really focused on the relevance for individuals, so here goes…

But first a short video teaser:

What it isn’t

First off, the health system outlined in the Blueprint doesn’t replace your doctor, the NHS (if you're in the UK) or other primary healthcare facilities. It’s not a healthcare system, which is another way of referring to conventional medical, primary, care. And it’s not just focused on symptom or disease management. It also doesn’t define health in terms of disease labels like type 2 diabetes, heart disease or cancer. And lastly, it doesn’t assume that because you’ve been diagnosed with a disease you will always have that disease and possibly even be defined by it.

What it is

Said most simply, it’s a blueprint for health creation.

Without our health we have a poorer quality of life and are unable to do the things we love, with the people we love, to the level we’d like to. Without health it’s easy to feel like the walls of our lives narrow and reduce our choices. But health can be both complex and misunderstood depending on where you're standing. It means more than the absence of symptoms or the lack of disease. To us at ANH, it’s about reaching optimal health, feeling vibrant, enthusiastic, motivated, able to exercise a range of lifestyle choices and to bounce back from health challenges with a degree of resilience.

We also understand that we have different genetics, environments, upbringing and experience – our own personal ‘ecosystem’ is unique to us. Therefore, our needs are varied and diverse, as are our health requirements. One size most definitely doesn’t fit all. We also like to engage in different therapies and seek support from a diverse range of health professionals that might not be your GP. Unlike the current conventional model, our future health system also needs to be sustainable if it’s to be truly effective and stand the test of time.

The 'blueprint' maps out a community-based, participatory, collaborative health system that is built on ecological and sustainability principles. It puts you - as a citizen, not a patient - in the driving seat of your health. Once large numbers of us become empowered as health creators we can influence the health care systems that provide goods and services to us from the bottom up. As well as that, the blueprint uniquely unites citizens and health-related professionals from all modalities (also referred to as therapies) with one common health language.

>> PARTICIPATORY – puts you in the driving seat

>> COLLABORATIVE – communication using a common language

How?

At the individual level, the Blueprint model optimises performance across 12 domains of health. We call this the Ecological Terrain (see figure below) — achieving balance across all domains is required to harmonise your 'ecosystem'.

Using this approach, each of us gets to understand how we are going on our respective health creation journey by monitoring our performance across these 12 domains of health. When we look for guidance from our chosen health, fitness or lifestyle professionals, these professionals are able to understand the same language. The professionals, by understanding function across the same 12 domains of our personal ‘ecological terrain’, can in turn help us to perform better over time.

By not being prescriptive about the types of modalities (therapies) that an individual should select, by being inclusive of any that the individual chooses to select, and because it is impossible – for any individual – to accurately know which of multiple factors that influence health are the most important (e.g. diet, lifestyle, sleep quality, response to stress, selected interventions, social connection, life purpose, connection to nature, etc), people will self-select systems that are appropriate to them. Think of it as a natural system that over time self-selects the combination of factors that contribute to the best health outcomes. Most of us have an inkling of what we need when we're ailing, but we're so used to being dictated to when it comes to our health, that we often put our own knowing aside.

A 'natural selection' system

In terms of monitoring, this also allows for Comparative Effectiveness Research (CER) to take place – where overall outcomes related to different health ‘ecosystems’ can be compared. Call it a form of natural selection that selects for effective combinations of factors. What’s more, it’s exactly how nature works and makes its own biological and ecological selections.

Moving on to the second tier of the model, the Hallmarks of Sustainability, when the individual selects healthcare systems (notably delivery systems for healthcare goods and services) they should select those systems that meet the criteria proposed in the 10 hallmarks of sustainability (below). This process facilitates bottom-up selection pressure for systems that both create health and are more sustainable. Plus, it puts us all (instead of big corporates) back in the driving seat again and allows citizens to drive the change that has to happen if we’re to take ourselves and our planet back from the brink of disaster.

Creating change from the bottom up

The blueprint concept is not about being prescriptive (or dictatorial) about specific therapies (modalities). It’s about being as upstream as possible, which means looking to prevent health challenges earlier on in your life or looking at the cause of your problem(s) to prevent them worsening or returning. It also means having a unified model for assessing health across multiple domains and then allowing natural selection to take its course. At the moment, health is still widely seen in a very reductionist (limited) context. People routinely argue over the primary determinants of health – is it for example diet, the relative amounts of macronutrients, the fats, the salt, the sugars – or is it the amount of activity we take, how we cope with stress or lack of life purpose, etc. that are the primary determinants of health?

In conventional medicine there is an obsession over the role of drugs, whether positive or negative, this often eclipses the extraordinary work the body does in its effort to try to establish some kind of equilibrium – while simultaneously coping with the assault/toxicity of the drug itself. It’s of course so much more complex than that – and we should never pretend to know all the answers. However, what is beginning to emerge is that there are certain common associations. For example, healthy behaviours are often associated with each other, as are unhealthy ones.

The blueprint’s evaluation approach will ultimately allow different associations of behaviours to be compared and then selected. This process allows 'healthy ecosystems' to be self-selected over time – and there is an ever increasing amount of data to suggest that healthy ecosystems, such as those found in blue zone communities, that are harmonious with our evolutionary backgrounds work. If the data prove this right, then we may well expect better outcomes among those who work with nature, rather than against it.

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