Q: Under a heading of ‘hot topics of the day’ I know you have strong feelings and concerns about the current state of the nation’s healthcare service. Can you tell us what those concerns are?
A: Yes, my concern is about the dreadful crisis in general practice where people can’t get appointments with their doctor for up to two weeks. This worries me greatly. As a result of this, people are flocking to hospital A&E departments and overwhelming the resources that A&E has. This was all foreseeable many years ago when GPs decided to opt out of 24-hour cover, so now we have a situation where people can’t see a doctor, they’re going to A&E inappropriately. If they do see a doctor they have on average seven-and-a-half minutes, which is inadequate, and we now have the Care Quality Commission (CQC) threatening to go into GPs’ surgeries and close the ones that under-perform, and yet the CQC is run by people who have never been doctors themselves. So I do worry about my beloved NHS General Practice in which I grew up and have always been very passionate about.
Q: In your general view would you say that we are a healthier society today than when you started out as a GP?
A: The answer is yes and no. We are a healthier society in terms of turning the tide on the epidemic of heart disease, which was very bad news 20 or 30 years ago, we’re seeing less acute heart attacks, we see fewer people having amputations because of arterial disease—but of course it remains the No.1 killer. And I think younger people are suffering less from acute heart attacks, largely as a result of improving lifestyles, but also because of drugs like statins and early intervention when people are found to have coronary heart disease, The fact that stents can be put in within 90 minutes of someone’s first heart attack has made a huge difference. I think in terms of physical disease, we’re seeing less serious infection, we’re seeing fewer nasty cancers—and we can do more when we find them.
On the downside, I think we’re seeing more mental illness in society, with people who are under more varied kinds of stress: the world is uncertain, employment is uncertain, people have financial worries. And I think that we don’t really address those psychological anxieties and causes of depression very well, we’re very under-equipped in the health service to support people with minor to moderate mental health issues. So I think as a society as a whole, that’s a problem. One of my big worries for the future is the number of young people who don’t seem to be able to forge inter-personal relationships very easily, with an over-reliance on gaming and video games and friendships that are operated remotely from their bedrooms. That worries me for the future because I think this is one of the reasons we see less empathy in society—people not understanding that other people have feelings and not being in tune with the people around us.
Q: Would you say there is a better understanding today about what living a healthy lifestyle actually means?
A: Yes, absolutely. And I think it’s a bit like what we used to say about ‘the worried well’—some 15 years ago, when we started to operate the well-person clinics, it was only ‘the worried well’ that would come in and use them! The vast majority of people who most needed to use them didn’t. I think that’s true of lifestyle messages that have been very widely publicised in recent years—there’s lots of information about the importance of regular exercise and healthier eating, giving up smoking, and checking cholesterol and blood pressure. But I’m not sure the right people are heeding that advice. We’ve got an epidemic of obesity, which is storing up enormous problems for the future in terms of diabetes and heart disease—we’re seeing type-2 diabetes increasingly in children as a result of obesity. Not only is this potentially crippling in terms of costs to the National Health Service, it’s also crippling to the people themselves, who will develop metabolic syndromes, become ill, and probably die prematurely.
Q: Indeed, but it is not entirely up to the individual alone how we live a healthier lifestyle because, on the premise that we are what we eat, do you not think that food manufacturers and food retailers could do more to improve what they offer, for example, by reducing sugar and salt levels in their products?
A: Definitely. They could do vastly more. We’re inundated with visual messages of tempting food on TV, advertisements on radio, billboards— food surrounds us and has become an addiction for many people. The manufacturers themselves, as well as advertising, their products contain far too much salt and sugar because that’s the taste that people have acquired, and I don’t believe that voluntary regulation is enough. The salt content in food has come down very slightly, but only marginally, and the difference is not going to be significant. Sugar is exactly the same problem—the quantity of sugar calories people consume is enormous. In one glass of fruit juice, the amount of sugar is unnecessarily high. So, yes, the manufacturers need to do a great deal more, they make vast profits, and they can say that people have a choice but in actuality, the majority of people don’t understand nutritional labelling, they have busy lives, and they go for convenience foods, which means mostly processed foods, which is bad news.
Q: Returning to your earlier concerns for the younger generation, would you add the dangers of addiction to those concerns—both drug and alcohol abuse?
A: Yes, it’s a huge worry. The price of alcohol per unit has never been cheaper than it is today and young people do have the ability to buy large amounts of alcohol, and they do. And whether they are university students or tradespeople—whichever walk of life—a lot of young people think the only thing to do at the weekend is to get totally inebriated. As a consequence of that we are seeing more liver disease in much younger people. Some of the liver units in NHS Trust hospitals are really concerned about the level of young people with alcoholic liver cirrhosis, and liver failure as a result of excessive alcohol consumption, and bingeing leads to all sorts of social problems—A&E departments are overwhelmed with people who are intoxicated, I think to the extent that about 75 percent of all admissions after 11pm are alcohol-related.
So alcohol and other recreational drugs, and substances that give a legal high, these are of great concern because it only takes someone who is relatively innocent and naïve in recreational drug use to take one tablet and it can have far-reaching, if not life-threatening consequences. I’m currently helping an organisation called the Angelus Foundation, which is run by Maryon Stewart, the author of a nutritional bible of a book. She lost her medial student daughter to a legal high when her drink was spiked. So these issues are generally very worrying in our society today.
Q: In your role as a well-known TV doctor, Hilary, would you say that a key part of that role is helping to get these messages across?
A: Very much so. We’ve covered the ‘legal high’ story. We regularly talk about the problems of alcohol abuse in all age groups, we talk about recreational drugs, too, but also we cover the whole spectrum of social issues that are medically related. So rather than just talking about a topic such as heart attacks per se, we will look at an overview of the causes and the lifestyle that people still aren’t adopting, the lack of exercise that people take, the fact that people aren’t aware of their blood pressure—the things that people could do more to change themselves today, that’s the approach I like to take. Taking responsibility for you own health has always got to be better than relying on the doctor to tell you what to do. And one of the things I said recently was that, yes, the doctors and nurses should show the way… we’ve got far too many overweight and obese nurses working in hospitals. Hospitals should be a place of healing and should be a healthy environment—whereas if we look at our hospitals, we have people coming outside to smoke, throwing their cigarette butts outside reception and we’ve got McDonald’s franchises on the ground floor of the hospitals. On the wards you’ve got windows you can’t open to get fresh air, you’ve got staff who look unhealthy. It’s hardly a place that’s conducive to healing and I think we should address that, and encourage staff in particular to be healthy and show a good example, and that’s something I’ve always tried to do myself.
Q: In your TV role, you must often find that when there is a breaking news story—often a sad news story, such as the recent death of the actor Robin Williams—this can help highlight an often-grim topic in a positive way in that it brings a renewed focus to a health problem which, in this case, is addiction and depression.
A: I think that when there is, for example, a celebrity death that’s related to certain conditions, people can often identify that with themselves. Robin Williams, a much loved and beloved soul in the celebrity world, and to hear that this comic genius who was mainly on a euphoric high from his artistry, the fact that he found it difficult to cope with the lows, or the moderate parts of his life, and had found solace in alcohol and drug addiction, people can connect with that. It demonstrates that these problems can affect everyone and anyone, and that even celebrities are not immune. So for my television work, it brings about a useful talking point. And then of course there’s the latest news that Robin Williams had Parkinson’s Disease and it may be that he was seeing his life deteriorate physically as well as mentally—he wasn’t getting the jobs he wanted—take this to the level of every man, every woman, and the problems are the same. So it’s a helpful talking point, you can celebrate his life and then tell people that there is help available and if they are suffering similar problems the sooner they get it the better.
Q: If we can look at the main theme of your publication, Live to 100 with Dr Hilary Jones, you may agree that a large part of increasing life expectancy is achievable by applying common sense. I’m wondering if you might have a five key priorities that would help achieve the objective of ‘Live to 100’?
A: I would say that my first priority is regular exercise. I’m a great believer in the importance of this. Our bodies are designewd to be exercised, not just our joints and our muscles, but our hearts, our circulation, our lungs, every organ of the body responds well to regular exercise. It controls our blood pressure, it reduces cholesterol, it strengthens bones. Exercise also has benefits for people with anxiety and depression, and it normalises weight (which is one of the big problems in our society), so, for me, enjoying exercise—preferably in the company of other people—is a great form of sociability. You see people going on these fun runs and bike rides, and there’s a great camaraderie, and people who have that regularly in their lives are much more likely to make friendships and be part of a happy environment. So, having exercise in all its forms is one of the major keys to living to a ripe old age.
My second key priority is healthy eating. Some people tend to think this means eating boring food, but of course it doesn’t, there are so many different ways of preparing and enjoying healthy food, and it means having smaller plates and smaller portions of better quality food without ever feeling stuffed. Fresh fruit, veg, plenty of fish—the Mediterranean diet or the Japanese peasant diet, it’s all the same: low in fat, not too much starch, high in protein, packed full of nutrients, and if you look at people who live on that type of diet, they do tend to come from a population that lives well into their 90s and hundreds.
My third key priority would be to be happy at work. I think happiness is under-rated. A lot of people find themselves in jobs in which they feel trapped, they don’t really enjoy their job or the people they work with and they’re only doing it for the money. When you talk to people who are passionate about the jobs they do, the energy just emanates from them and you can see how driven they are—they’re pleased to get up in the morning, they’re creative, they love their work which forms a very important part of their life. Although it’s not always possible to change mid-stream, I’ve met many inspirational people who were stuck, they took the courageous step of moving sideways to do what they really wanted to do even if it meant a pay cut, and really flourished.
So, happiness and work, as well as of course in your private life, is so important to your good health. In the past, we’ve measured the immune system improving when people are happy and it’s noted that optimists live longer than pessimists because, perhaps, the immune system is healthier in happy, optimistic people. Happiness is an important thing to try to find.
Q: You’re saying that our good health is affected by how we feel about our lives?
A: Yes, I think it is. And people who’s glass is always half full do seem to do better than people who see their glass as being half empty; I do see healthier people, who belong to the optimistic group.
For my fourth key priority that I believe will extend our life expectancy is avoiding the things that we know are going to be detrimental to our longevity. I would include smoking, addictions of any kind, excess of anything. I’m not a kill-joy by any means, I’m not the sort of doctor who judges people and says ‘you must not do this’. I think a little bit of whatever you like now and then does no harm, enjoy life, but that doesn’t mean it’s a good idea to do it every day. Avoiding smoking is the single most important thing you can do in order to stay healthy for the future. And then, of course, avoiding the dietary things we know are bad for us: too much salt and sugar, and even avoiding medicinal drugs that we don’t really need—I would much rather people got their weight down and restored their blood pressure to normal by natural means rather than taking medication for it. I would prefer to prescribe someone a good holiday than give them a tablet for their stress!
My fifth and final priority would be for much better health education for kids. It saddened me greatly when we sold off so many playing fields and banned competitive sports for kids and tried to pretend that everyone’s a winner, when everyone knows that can’t be. I’d like to see people encouraged to know what it’s like to feel fit and healthy at a young age—that’s absolutely key. When young people never know what it’s like to have a fit body, they never will. Start them early and get them to experience how wonderful it feels to be healthy and fit, then I think people stay with it. People who enjoy sports tend to look after themselves much better than those who have never been healthy, and that has to start in school. I’d like more people doing sports in school, after school, and at weekends, this should be one of the country’s priorities.
Q: If we can conclude on the theme of prevention, I’m wondering if you think there is any value in people trying to discover if their families have a history of certain genetic disorders or diseases. Can this information be helpful when it comes to prevention or diagnoses?
A: We hear more about the study of the human genome and that in the future we might be able to give just a blood sample and then doctors would be able to tell us what diseases we are likely to become more prone to, but I think we are currently some way off that yet. I think it will be far more complex than that because there won’t be just one gene that codes for a certain disease, there will probably be hundreds, and some of them are inhibiting the others. So I think it will be some time before we can rely on that. It’s much more important to be able to talk to a doctor with the knowledge of our parents’ predispositions and our genetic traits. I’ve had so many occasions where I’ve had men who have come to see me with prostate cancer and they weren’t aware, until they developed it, that their own father had died of prostate cancer at a young age, because their father didn’t want to talk about it. So I think for a man to find out if his father had prostate cancer or a stroke or heart attack at a young age, is vital, and for women, whether their mother or aunts or sisters had breast cancer at a younger age—family medical history is important as it gives doctors a clue as to what to look for and how to advise people about preventative medicine. So, yes, this is something we should be aware of, if we can, and then, of course, the continuation of the human genome study will add to that information in the future.