Are We in Good Health? How Do We Measure the Status of Health?

 

Jennifer wrote in the comment column.

Dear Dr Lim,

You write very well. My friends and I always enjoy all those seldom written articles about the mysteries of life, about the the soul, and spirit combined with your highly qualified knowledge in medicine and science. One of them was your article on forest bathing and your article about the aura surrounding the human body which you said may be the living soul. You mentioned whether or not this aura emitted by the body and all living things may indicate vitality of the body and you discussed whether or not we can use this simple method to diagnose disease and our health. 

The reason I ask is, I go to the doctor or to a medical lab they offer to have my blood tests done every 6 months to ensure my health is perfect, and so far, all the results are normal. 

Despite what the doctor assured me, I still feel tired and lethargic, lose my appetite and feel depressed. I would like to seek your expert professional opinion whether these blood tests, body scans and examinations I periodically go to would be of any use since I just don't feel tip top. What if I go to the jungle for forest bathing or use Kirlian imaging instead. Would that help?

Thanking you in anticipation

Jennifer Lee

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Dear Jennifer

First, I have to thank you for your kind words. It is a pleasure for me to write to find it useful for appreciative people like your good self.

I am sorry to hear about your health problems despite going to your doctor for check-up and having all those lab and blood test periodically done by your doctor, you still do not feel well. 

Before I go to answer further, I have to straight away emphasize that doing all those blood tests and undergoing all those annual medical examinations and find them all normal does not mean you are healthy.

First, let me give you the official definition of health. WHO remains firmly committed to the principles set out in the preamble to the Constitution that:

 "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".

This straight away means that we cannot measure health by merely going to a doctor for medical examination and doing all those blood tests like most people do, with the doctor certifying you in good health when all your test results are normal. That is WRONG straight away.

When I was working at the Institute for Medical Research (IMR) we conducted nutrition and health surveys across the lengths and breadth of the country. Our medical team including myself of course, may have already examined at least 2.5 million people in the course of my 25 years work at IMR. 

Our health and medical team consisted not just medical doctors, but a large number of physicians and doctors, expert nutritionists, anthropologists, sociologists, biochemists, biostatisticians, psychiatrists, clinical psychologists, behavioural scientists, dental officers, nurses, medical laboratory technicians and other support staff.

 We spend weeks each time evaluating first their nutritional status as our priority as nutrition as singly, nutrition is most important indicator of health, followed by the normal results from a battery of other medical, and other health-related assessments. 

We did not just do some medical examinations and carry out some blood tests or urine examinations only like doctors from outside in private practice offer their patients, giving them the wrong impression they are in “perfect health” if they find all these blood tests normal. That's WRONG straight away. We need to look and measure the status of health holistically, not just look at the absence of disease.  

 Please once again, bear in mind the official definition of health spelt out clearly by the World Health Organization. All, including Nobel Prize winners in Medicine or in Physiology need to accept and respect this official defintion by WHO. Normal blood tests results does NOT mean one is in good health. Good health is far more than normal blood chemistry.    

Let me explain what are the physical types of examinations and tests normally done to assess the status of health. The most important is the nutritional status of an individual.

Let me explain this first, before I go to the medical examination and other tests since food and nutrition is solely the only ingredient we need to stay alive and healthy, not all those nutritional supplements or medicines we take. So let me explain how our very large team of health professionals carry out a nutrition survey first to assess the status of health before going to all those medical examinations and lab tests that you underwent, found them all normal and yet you complained you don’t feel well.

Health Assessment (First, Nutrition Status):

Our food intake, quantity, type of food consumed is going to determine the type of diseases we are going to get. We, health and medical professionals in our collective consensus, think food and health relationships are intertwined not just biochemical or radiological normality. Health status assessment or health surveys must also include nutrition assessment that include anthropometry, heights and weights, food consumption, social wellbeing and cultural patterns, mental health, housing, water supply, sanitation among others.

Let me explain that in some detail its importance, not just for one person or one patient, but for entire communities and populations.  

The assessment of nutritional status is the most critical component of overall health assessment, particularly at the population level. Nutrition directly influences the prevalence of various diseases and health conditions. Let us have an overview of how nutritional status and related factors are assessed in a population or community:

1. Anthropometry

Anthropometric measurements are fundamental in assessing nutritional status. They include:

• Height and Weight: Used to calculate Body Mass Index (BMI) to categorize underweight, normal weight, overweight, and obesity. Growth charts for children. 
• Mid-Upper Arm Circumference (MUAC): Particularly useful for assessing malnutrition in children and pregnant women.
• Skinfold Thickness: Measures body fat percentage.
• Waist and Hip Circumference: Assesses fat distribution and central obesity
• Body Composition: Fat percentage, muscle mass, bone density.
• Waist-Hip Ratio: Indicator of fat distribution and risk of metabolic syndrome.

2. Dietary Intake Assessment

Dietary Surveys and Questionnaires

• 24-Hour Recall: Participants report all foods and beverages consumed in the past 24 hours.
• Food Frequency Questionnaire (FFQ): Assesses habitual food intake over a specific period.
• Dietary Records: Participants record their food intake over several days.
• Household Consumption and Expenditure Surveys: Collect data on food purchases and consumption at the household level.

3. Biochemical Assessments

Laboratory tests that measure nutrient levels in the blood or urine can identify deficiencies or excesses:

• Blood Tests: Measure levels of vitamins, minerals, and other biomarkers (e.g., haemoglobin for iron status, serum vitamin D, plasma glucose).
• Urine Tests: Assess nutrient excretion and balance (e.g., iodine levels).

4. Clinical Assessments

Physical examination for signs of nutrient deficiencies or excesses:

• Signs of Malnutrition: E.g., oedema, hair changes, skin lesions.
• Micronutrient Deficiencies: E.g., pallor (iron deficiency), goitre (iodine deficiency), rickets (vitamin D deficiency).

5. Socioeconomic and Environmental Assessments

Understanding the context in which people live helps identify barriers to proper nutrition and health:

• Income and Employment Status: Correlates with food security and access to nutritious food.
• Education Level: Influences knowledge about nutrition and health.
• Housing Conditions: Assess the impact on health and nutrition (e.g., overcrowding, poor ventilation).
• Water Supply and Sanitation: Important for preventing water-borne diseases and ensuring proper hygiene.

6. Food Security Assessments

Measures the availability and access to sufficient, safe, and nutritious food:

• Household Food Insecurity Access Scale (HFIAS): Assesses perceptions and experiences of food insecurity.
• Coping Strategies Index (CSI): Evaluates how households cope with food shortages.

7. Cultural and Behavioural Assessments

Understanding cultural practices and dietary habits is crucial for effective nutritional interventions:

• Cultural Dietary Practices: Traditional foods, meal patterns, and dietary restrictions.
• Behavioural Factors: Knowledge, attitudes, and practices related to food and nutrition.

8. Mental Health and Social Wellbeing

The relationship between mental health, social wellbeing, and nutrition:

• Mental Health Assessments: Tools to measure stress, depression, and anxiety, which can affect eating behaviours.
• Social Wellbeing Surveys: Assess the impact of social support networks on nutritional status.

9. Program and Policy Evaluations

Assessing the impact of nutrition programs and policies:

• Program Reach and Efficacy: Evaluating the effectiveness of interventions like food aid programs, school feeding programs, and nutrition education.
• Policy Impact Assessments: Understanding how policies related to agriculture, trade, and health affect nutritional outcomes.

10. Environmental and Food Systems Assessments

Evaluating the broader food environment and systems:

• Food Availability and Prices: Assessing local food markets, availability of nutritious foods, and their affordability.
• Agricultural Practices: Evaluating the impact of agricultural methods on food quality and sustainability.

By incorporating these comprehensive methods, public health professionals can gain a holistic understanding of nutritional status and its determinants within a population. This approach ensures that interventions are well-targeted and effective in improving the overall health and wellbeing of the community.

Even all these would not indicate the precise status of health even for very large populations let alone for an individual like yourself. In fact, it is very hard to define what is health, let alone measure and define optimal health. There is no single criterion that can be used to measure state of health, definitely not just using clinical examination, using blood tests or any other diagnostic measurement. No single assessment can be used. Health encompasses everything from physical, mental and social well-being and not just the absence of disease or infirmity.

Health is a multifaceted concept that goes beyond mere absence of disease, encompassing physical, mental, and social well-being. To capture this complexity, a holistic approach is necessary, utilizing various measures and assessments. We need to have an expanded and detailed look at how different dimensions of health are evaluated:

1. Physical Health (Second, The Medical Aspect)

Clinical and Laboratory Assessments

• Vital Signs: Blood pressure, heart rate, respiratory rate, and temperature.
• Laboratory Tests: Blood tests (e.g., CBC, metabolic panel), urine tests, lipid profiles, glucose levels.
• Imaging Studies: X-rays, MRIs, CT scans, ultrasounds.
• Physical Examination: General appearance, organ-specific examinations, functional tests (e.g., range of motion, strength tests).

2. Mental Health

Psychological Assessments

• Screening Tools: PHQ-9 for depression, GAD-7 for anxiety, MMSE for cognitive function.
• Behavioural Assessments: Observations and structured interviews to evaluate mood, behaviour, and mental state.
• Self-Reported Measures: Questionnaires assessing subjective well-being, stress levels, and emotional health.

3. Social Well-Being

Social Determinants of Health

• Socioeconomic Status: Income, employment, education level.
• Living Conditions: Housing quality, neighbourhood safety, access to amenities.
• Social Support Networks: Family, friends, community engagement.
• Cultural and Religious Practices: Impact on lifestyle, diet, and mental health.

4. Environmental and Community Health

Environmental Assessments

• Air and Water Quality: Monitoring pollutants and contaminants.
• Housing Conditions: Overcrowding, sanitation, ventilation.
• Access to Health Services: Availability and quality of healthcare facilities.

Community Health Surveys

• Community Needs Assessments: Identifying health needs and resources in the community.
• Health Behaviour Surveys: Data on smoking, alcohol consumption, physical activity, and dietary habits.

5. Health Behaviours

Lifestyle Assessments

• Physical Activity: Frequency, duration, and intensity of exercise.
• Diet and Nutrition: Eating habits, nutrient intake, food security.
• Substance Use: Smoking, alcohol, and drug use.

Preventive Health Practices

• Vaccination Coverage: Rates of immunization against preventable diseases.
• Screening Programs: Participation in regular health screenings (e.g., cancer, diabetes).

6. Quality of Life and Well-Being

Health-Related Quality of Life (HRQoL) Instruments

• SF-36: Measures physical and mental health constructs.
• EQ-5D: Assesses mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.

Well-Being Surveys

• Happiness and Satisfaction: Surveys assessing subjective well-being and life satisfaction.
• Stress and Coping: Measures of perceived stress and coping strategies.

7. Cultural and Behavioural Context

Cultural Assessments

• Dietary Habits: Traditional foods and cultural dietary restrictions.
• Health Beliefs and Practices: Impact of cultural beliefs on health behaviours and treatment adherence.

Behavioural Assessments

• Health Literacy: Understanding and use of health information.
• Health-Seeking Behaviour: Patterns of accessing and utilizing health services.

8. Policy and Program Impact

Health Policy Analysis

• Evaluation of Health Policies: Assessing the impact of policies on public health outcomes.
• Program Effectiveness: Analysis of public health programs and interventions.

Health status assessment is a comprehensive, multidimensional process. It involves evaluating various physical, mental, and social factors to obtain a holistic view of an individual's or community's health. By integrating these diverse assessments, we, as health professionals can design more effective interventions and policies, ultimately leading to improved health outcomes and quality of life.

The status of health in an individual is measured using a combination of subjective and objective assessments. These measurements provide a comprehensive view of an individual's physical, mental, and social well-being. Here’s a detailed overview of the methods and tools we used:

1. Medical History and Physical Examination

Medical History

• Personal Medical History: Information about past illnesses, surgeries, allergies, medications, and vaccinations.
• Family Medical History: Information about the health of close family members to identify genetic or hereditary conditions.
• Lifestyle Information: Details about diet, exercise, smoking, alcohol consumption, and other lifestyle factors.

Physical Examination

• Vital Signs: Measurements of temperature, pulse, respiration rate, and blood pressure.
• General Appearance: Observation of appearance, behaviour, and mobility.
• Organ System Examination: Detailed examination of various body systems such as cardiovascular, respiratory, gastrointestinal, musculoskeletal, neurological, and others.

2. Laboratory Tests

• Blood Tests: Including complete blood count (CBC), blood glucose, lipid profile, liver and kidney function tests, electrolyte levels, and specific markers for diseases (e.g., HbA1c for diabetes, troponins for heart conditions).
• Urine Tests: Including urinalysis for infection, kidney function, and metabolic conditions.
• Other Fluid Tests: Analysis of cerebrospinal fluid, saliva, or other bodily fluids for specific conditions.

3. Imaging Studies

• X-rays: Used to view bones and certain tissues.
• Ultrasound: Utilizes sound waves to visualize organs and blood flow.
• CT scans: Cross-sectional imaging for detailed views of internal structures.
• MRI: Provides detailed images of soft tissues, brain, and spinal cord.
• PET Scans: Used for detecting cancer, monitoring heart conditions, and examining brain function.

4. Functional Tests

• Cardiovascular Tests: Including ECG, stress tests, echocardiograms to assess heart function.
• Respiratory Tests: Spirometry, peak flow measurements to evaluate lung function.
• Neurological Tests: EEG, EMG, nerve conduction studies to assess brain and nerve function.
• Musculoskeletal Tests: Range of motion tests, strength tests, gait analysis.

5. Screening Tests

• Cancer Screening: Mammograms, colonoscopies, Pap smears, PSA tests.
• Infectious Disease Screening: HIV tests, hepatitis tests, tuberculosis tests.
• Chronic Disease Screening: Blood pressure screening, cholesterol screening, diabetes screening.

6. Mental Health Assessments

• Psychological Questionnaires: Tools like the PHQ-9 for depression, GAD-7 for anxiety.
• Cognitive Tests: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA).
• Behavioural Assessments: Observations and structured interviews to assess mental and emotional health.

7. Genetic and Genomic Testing

• Genetic Tests: To identify predispositions to certain hereditary conditions.
• Genomic Sequencing: Comprehensive analysis of an individual’s DNA for personalized medicine.

8. Health Risk Assessments

• Questionnaires and Surveys: Collecting data on lifestyle, environmental exposures, and family history.
• Risk Calculators: Tools that combine various data points to estimate the risk of developing certain conditions (e.g., Framingham Risk Score for heart disease).

9. Self-Reported Measures

• Health-Related Quality of Life (HRQoL) Instruments: Questionnaires such as the SF-36 or EQ-5D that measure perceived health and well-being.
• Symptom Diaries: Logs kept by individuals to track symptoms, triggers, and patterns over time.

10. Wearable and Remote Monitoring Devices

• Fitness Trackers: Devices that monitor activity levels, heart rate, sleep patterns.
• Remote Health Monitoring: Blood pressure cuffs, glucose monitors, and other devices that transmit data to healthcare providers.

By integrating these various methods and tools, healthcare providers can obtain a holistic view of an individual's health status, identify potential health issues early, and tailor interventions to promote optimal health outcomes.

Normally we are more interested in looking at the health status of the entire health status of very large communities, not just one individual. Assessing the health status of a large population or community involves different approaches than individual health assessments. Public health professionals use a variety of methods and tools to gather data, analyse health trends, and identify health needs at the population level. Let me show you some key strategies we normally use.

1. Population Surveys

Health Surveys

• National Health Interview Survey (NHIS): Collects data on a broad range of health topics through personal household interviews.
• Behavioural Risk Factor Surveillance System (BRFSS): A telephone survey collecting data on health-related risk behaviours, chronic health conditions, and use of preventive services.
• Demographic and Health Surveys (DHS): Collects data on health, nutrition, and population trends in various countries.

2. Census Data

• National Census: Provides comprehensive demographic information, including age, sex, race, and socioeconomic status, which are essential for health assessments.
• Specialized Health Censuses: Periodically conducted to gather specific health-related information on large populations.

3. Vital Statistics

• Birth and Death Records: Collect data on birth rates, death rates, causes of death, and life expectancy.
• Marriage and Divorce Records: Provide insight into social determinants of health.

4. Disease Surveillance Systems

• Notifiable Disease Reporting: Mandatory reporting of certain infectious diseases and conditions to public health authorities.
• Syndromic Surveillance: Real-time data collection and analysis to detect and respond to potential outbreaks based on symptom patterns.

5. Health Care Utilization Data

• Hospital Discharge Data: Information on reasons for hospitalizations, lengths of stay, and outcomes.
• Electronic Health Records (EHR): Aggregated data from health care providers on diagnoses, treatments, and outcomes.

6. Environmental and Social Determinants

• Air and Water Quality Monitoring: Data on environmental factors that impact health.
• Housing and Urban Development Data: Information on living conditions, infrastructure, and access to health services.

7. Community Health Assessments (CHAs)

• Community Surveys: Collect data on health needs, behaviours, and perceptions from community members.
• Focus Groups and Interviews: Qualitative methods to gather detailed insights from specific groups within the community.
• Health Needs Assessments (HNA): Systematic process to identify and address the health needs of a community.

8. Health Indicators and Indices

• Health Indicators: Standardized measures such as infant mortality rate, prevalence of chronic diseases, and vaccination coverage.
• Indices: Composite measures like the Human Development Index (HDI) and the Health Adjusted Life Expectancy (HALE).

9. Geospatial Analysis

• GIS Mapping: Geographic Information Systems to visualize spatial patterns of health problems and resources.
• Hotspot Analysis: Identifying areas with high concentrations of health issues or risk factors.

10. Policy and Program Data

• Evaluation of Health Programs: Data on the reach, effectiveness, and impact of public health programs.
• Policy Analysis: Assessing the health impacts of existing and proposed policies.

11. Health Informatics and Big Data

• Data Mining: Analysing large datasets to identify patterns and trends in health data.
• Predictive Analytics: Using statistical models to forecast health trends and outcomes.

12. Behavioural and Social Research

• Psychosocial Assessments: Studies on the impact of social factors on health, such as stress, social support, and community cohesion.
• Behavioural Studies: Research on health behaviours, such as smoking, diet, and physical activity.

13. Participatory Approaches

• Community-Based Participatory Research (CBPR): Involving community members in the research process to ensure relevance and accuracy of findings.
• Public Health Campaigns and Feedback: Engaging the community in health promotion and collecting feedback to refine strategies.

By employing these methods, public health professionals like medical doctors and nutritionists can efficiently assess and monitor the health status of large populations or communities, identify key health issues, and implement targeted interventions to improve public health outcomes.

Unfortunately most doctors are not trained in all these areas. It is hardly likely that they know all these areas of health, let alone do them to assess the health of a patient.

Their work is mainly taking medical history, do a clinical examination, request for lab tests, radiological examinations and writing out a prescription. 

Although doctors are trained in medical history taking, clinical examinations, lab tests, and radiological examinations, the comprehensive approach to health assessment includes many facets beyond clinical practice.  A more comprehensive and structured way in which this holistic knowledge could be integrated into medical education and practice should be these:

Enhancing Medical Training

1. Curriculum Development
• Public Health and Epidemiology: Incorporate more extensive training on the social determinants of health, population health assessments, and epidemiological methods.
• Nutrition: Include courses on nutritional science, dietary assessments, and the impact of nutrition on health and disease.
• Mental Health: Enhance training on psychological assessment tools, mental health conditions, and their interplay with physical health.
• Environmental Health: Teach the impact of environmental factors on health, including air and water quality, housing conditions, and community health.
2. Interdisciplinary Learning
• Collaboration with Public Health Experts: Encourage joint courses and projects with public health schools to foster a multidisciplinary approach.
• Social Work and Community Health: Partner with social work programs to understand the social and economic factors affecting health.
3. Practical Skills Development
• Community Rotations: Integrate community health rotations where medical students work with public health professionals, nutritionists, and social workers.
• Health Behaviour Change: Train in motivational interviewing and other techniques to promote healthy behaviours.

Continuing Medical Education (CME)

1. Workshops and Seminars
• Regular workshops on the latest research in nutrition, mental health, and social determinants of health.
• Seminars on the application of health informatics and big data in clinical practice.
2. Online Courses and Webinars
• Nutrition and Lifestyle Medicine: Online modules covering dietary assessments, lifestyle interventions, and the role of nutrition in chronic disease management.
• Mental Health Integration: Webinars on integrating mental health assessments into routine practice.

Integrating Holistic Health Assessment into Clinical Practice

1. Multidisciplinary Teams
• Collaborative Care Models: Develop multidisciplinary teams including dietitians, mental health professionals, social workers, and environmental health experts.
• Case Conferences: Regularly scheduled meetings to discuss complex cases from a holistic perspective.
2. Patient Education and Empowerment
• Health Literacy: Develop educational materials and programs to improve patients' understanding of their health and the factors affecting it.
• Community Outreach: Engage in community health initiatives to educate the public about nutrition, mental health, and preventive care.
3. Utilizing Technology
• Electronic Health Records (EHR): Incorporate comprehensive health data, including social and environmental factors, into EHRs for better patient management.
• Telemedicine: Use telehealth to provide access to multidisciplinary care, especially in underserved areas.

Research and Evidence-Based Practice

1. Health Outcomes Research
• Conduct research on the impact of integrated health assessments on patient outcomes.
• Publish findings to advocate for a broader approach to health in medical practice.
2. Quality Improvement
• Implement quality improvement projects that incorporate holistic health assessments into clinical practice.
• Measure the impact of these projects on patient health outcomes and satisfaction.

Policy Advocacy

1. Health Policy Engagement
• Advocate for policies that support comprehensive health assessments, such as better funding for public health programs and multidisciplinary care.
• Engage with policymakers to highlight the importance of addressing social determinants of health.
2. Professional Organizations
• Work within professional medical organizations to promote the integration of holistic health assessment into medical standards and guidelines.

By integrating these comprehensive health assessments into medical education and practice, healthcare providers can offer more effective, personalized, and preventive care. This approach not only improves individual patient outcomes but also enhances the health of entire communities. As the understanding of health continues to evolve, ongoing education and adaptation in medical practice are essential.

 Some medical schools do teach social and preventive medicine, not all. Some medical schools I know do not teach psychological medicine, psychiatry and mental health or nutrition which is exceedingly important as one of the major root causes of chronic lifestyle diseases so prevalent in modern societies. I think doctors should emphasize more on preventive medicine than trying to 'cure' a disease, especially chronic lifestyle and non-communicable diseases

Emphasizing preventive medicine, particularly for chronic lifestyle and non-communicable diseases, is crucial for improving overall health outcomes and reducing healthcare costs. Some strategies to enhance the focus on preventive medicine in medical education and practice I think should be these:

Enhancing Medical Education

1. Integrating Preventive Medicine into the Curriculum
• Core Courses: Ensure that all medical schools include comprehensive courses on preventive medicine, social and preventive medicine, nutrition, mental health, and behavioural sciences.
• Interdisciplinary Courses: Develop courses that integrate concepts from public health, nutrition, psychology, and social sciences.
2. Clinical Rotations and Experiences
• Community Health: Provide rotations in community health settings where students can engage in preventive care practices.
• Primary Care: Emphasize the role of primary care physicians in preventive health during clinical training.
3. Case-Based Learning
• Use case studies that highlight preventive approaches to managing chronic diseases.
• Discuss successful public health interventions and their impact on disease prevention.

Continuing Medical Education (CME)

1. Preventive Medicine Workshops
• Regular workshops focusing on the latest research and practices in preventive medicine.
• Topics could include lifestyle modification, nutritional counselling, mental health integration, and screening recommendations.
2. Online Learning
• Online courses on preventive medicine topics that can be accessed by healthcare professionals worldwide.
• Webinars and virtual conferences on emerging trends in preventive health.

Practice-Based Strategies

1. Preventive Health Screenings
• Implement routine screening programs for early detection of chronic diseases (e.g., diabetes, hypertension, cancer).
• Utilize risk assessment tools to identify individuals at high risk for chronic diseases.
2. Lifestyle Medicine
• Incorporate lifestyle medicine into routine practice, focusing on diet, exercise, sleep, stress management, and substance use reduction.
• Provide personalized health coaching and follow-up to support behaviour change.
3. Patient Education and Empowerment
• Develop educational materials and programs to empower patients to take control of their health.
• Use motivational interviewing techniques to engage patients in discussions about their lifestyle choices.
4. Community Engagement
• Participate in community health initiatives and outreach programs to promote preventive health.
• Collaborate with local organizations to address social determinants of health.

Policy and System-Level Changes

1. Health Policy Advocacy
• Advocate for policies that support preventive health measures, such as funding for public health programs, incentives for preventive care, and regulations to reduce risk factors (e.g., tobacco control, healthy food policies).
• Engage in policymaking processes to ensure that preventive medicine is a priority in healthcare systems.
2. Healthcare System Reforms
• Promote models of care that prioritize prevention, such as patient-centred medical homes and accountable care organizations.
• Implement payment structures that reward preventive care and health outcomes rather than volume of services.

Research and Evidence-Based Practice

1. Research on Preventive Interventions
• Conduct and support research on the effectiveness of various preventive interventions.
• Publish findings and disseminate best practices for preventive health.
2. Data-Driven Approaches
• Use data analytics to identify trends and target preventive measures more effectively.
• Monitor health outcomes to evaluate the impact of preventive strategies.

Collaboration and Interdisciplinary Approaches

1. Multidisciplinary Teams
• Form multidisciplinary teams that include dietitians, psychologists, social workers, and other specialists to provide comprehensive preventive care.
• Hold regular team meetings to coordinate care and share insights.
2. Partnerships with Public Health
• Collaborate with public health departments and organizations to align clinical practices with public health initiatives.
• Participate in community health assessments and program planning.

By prioritizing preventive medicine, the healthcare system can shift from a reactive, disease-focused model to a proactive, health-promoting one. This approach not only improves individual health outcomes but also addresses the root causes of many chronic diseases, ultimately leading to healthier communities. Integrating these strategies into medical education, practice, policy, and research is essential for creating a sustainable and effective healthcare system.

I think we need to understand the importance of a holistic approach to health and the critical role of preventive medicine. Empowering both the doctors and patients with comprehensive knowledge and strategies is key to achieving better health outcomes.

Did your doctor you consulted do all these examinations and studies for you? If your doctor does not know all these, but merely does some history taking, clinical examination and sends your blood and urine to the laboratory for testing and tells you everything is normal and declares you in “perfect health” I am truly very sorry for you and for him also.

No wonder you still feel unwell, tired and lethargic and irritated despite your doctor declaring you in “good health”.  

You should check out your health status with a team of other health professionals not just with the medical doctor in all these areas I mentioned above, not the “diagnosis” of one doctor 

Neither can we measure the status of health using some blood test results like you did. No wonder you still feel unwell despite all your blood tests results showing normal. Just keep the official definition of health prescribed by WHO all the time, not the medicine prescribed by your doctor for "good health"  

I am truly very sorry for both of you. Doctors need to constantly learn too.