Health of Nova Scotians hast to improve

Dear fellow Nova Scotians, we need to talk. I’m worried about us and the direction that things have been going. We need to change.

I’m a family doctor in Windsor. Before the pandemic, my colleagues and I had been steadily waging a war against multiple epidemics of chronic disease. For example, 2013 data from Statistics Canada shows Nova Scotians have higher rates of lung disease (COPD) (4.8 per cent), diabetes (7.6 per cent) and mental illness (10.3 per cent) compared to national rates (4.3 per cent COPD, 6.6 per cent diabetes, 7.6 per cent mental illness). The Canadian Community Health Survey reports that our rates of smoking (17.9 per cent) and heavy drinking (20.8 per cent) are also higher than national averages (16.0 per cent smoking, 19.3 per cent heavy drinking).

Since the pandemic, I’ve noticed in my practice through virtual and in-person appointments that we are struggling: mentally, physically and financially. Many of us went into the initial two-week lockdown with an attitude of spring break, eating and drinking more because of the unique and seemingly temporary situation we found ourselves in. Once regular habits are broken, it’s hard to get back on track.

While it’s too soon to have statistics on the changes in our health status, I’m alarmed by the trends that I’m seeing in my patients. As the bloodwork starts to roll in, I’m seeing increases in cholesterol and diabetes markers from previous patient baselines and higher blood pressure readings in previously well-controlled patients. More patients are complaining of weight gain, identifying stress eating and lack of exercise as the change in their lifestyle.

Mental health concerns are also at an all-time high, in addition to high rates of burnout particularly in those juggling work and child care. The threat of COVID-19 is an ongoing and valid health concern. However, I’m also alarmed by the effects our COVID lifestyle will have in the years to come: the current 40-year-old who has a heart attack at age 50, the patient with previously controlled diabetes who needs an amputation in 2032, the cancers and strokes that would not have otherwise developed.

Many people in this province were already struggling before the pandemic, and the current situation has only made things harder. One in four Nova Scotia children live in poverty. The 2018 Canadian Community Health Survey reported that 15.4 per cent of Nova Scotia households were food insecure – the highest rate outside the territories. Further, our disparity in internet access in rural regions has made education, employment and health access more challenging for many.

Our shared trauma in this province in 2020 extends beyond COVID-19 concerns. There is sadness, anger, stress and grief. None of these feelings are helpful in maintaining and creating healthy lifestyle choices. So, what is to be done?

First, start with self-compassion. A deviation from healthy behaviours is often viewed as a failure. Feelings of shame, guilt and worthlessness make it harder to make a fresh start. Understand that your actions are separate from your true worth. Would you judge your friend who lived through a trauma and ate/drank/smoked more than usual as a way of coping? Probably not. Try extending yourself the same grace.

Next, develop goals and a plan to achieve them. What does health and wellness look like for you? What are three small steps you could implement now? They need not be extreme – we know that the biggest transformations come from the accumulation of small changes over time. Habit formation studies have shown the key elements for a successful plan.

Be specific: Identify the habit and how you’ll carry it out; the more details the better.

Problem solve early to address barriers. For example, organize workout clothes and choose an activity the night before.

Be attainable: Choose something you’re willing and feel able to do over something you think you should do.

Be accountable: Tell others about your habit, set timers and reminders and review your adherence regularly.

Habit pair: Marry your new habit to an existing habit to help cue your new behaviour.

Finally, get help. Nova Scotia Health has an array of community-based resources promoting wellness, rather than simply addressing disease; visit www.healthyns.ca to learn more. Mental health access is easier with on-line tools. Doctors Nova Scotia will be publishing a blog listing the programs, resources and websites my patients and I have found helpful; watch for it at: www.yourdoctors.ca/blog. Many resources are available through local libraries.

We are in this for the long haul. If you’ve been neglecting your lifestyle priorities, consider how you can change course. It’s been inspiring to see our collective support for one another in so many veins, including musical tributes, food donations and random acts of kindness. We are kinder to one another than we used to be. My wish is that we end up healthier and happier, too.

Dr. Amanda MacDonald,

CCFP, family physician

Windsor Collaborative Practice