As Systemic Therapy thinkers we seek to understand the individual in relationship with others and within a given system rather than looking at him in isolation. We believe that the person is part of a system and therefore his beliefs, attitudes and behaviour are shaped by that environment. Thus the system or environment is the source oft the problem as well as the solution. Which reminds me of the nature versus nurture debate, where the argument is whether human behaviour is determined by the environment or by a person’s genes. If it is both, how much can be attributed to the environment and how much to genetics?

Currently the world is grappling with the scourge of the Coronavirus. It poses a  threat to our health and lives and being a novel disease, there is limited information regarding the virus. Therefore it has taken long to control or contain it. In order to remain safe we have had to change our behaviours and lifestyles by adhering to the Coronavirus protocols. A friend once asked me if ever we will go back to our old ways should the virus disappear. I doubt it. Most of our new behaviours have crystallised. 

With regard to the Coronavirus, health experts say that people over 60years of age and those with underlying medical conditions such as diabetes, heart disease, respiratory diseases, hypertension  or  obesity are at greater risk of developing severe illness if infected. The above metioned conditions also fall under what are called Non-communicable diseases (NCDs).

NCDs, What Are They?

Experts say that NCDs are diseases that are not transmissible directly from one person to another. Most of them are not infectious. Also known as Chronic diseases, they are of long duration and slow progression. According to the World Health Organisation (WHO), the four main types of NCDs are cardiovascular diseases like heart attacks and strokes; chronic respiratory diseases; cancer and diabetes.

Risk factors related to NCDs have to do with a person’s background; lifestyle and environment. They also include age, gender, genetics, exposure to air pollution and the sun. Added to that are behaviours such as smoking, alcohol consumption, unhealthy diet, physical inactivity which can lead to hypertension and obesity

The Double Jeopardy

Dealing with the burden of NCDs contributes to the achievement of the global Sustainable Development Goals (SDGs). The SDG number 3 focuses on “Good Health and Well-Being”. According to WHO, 71% of global deaths are due to NCDs. The combination of NCDs and communicable diseases like HIV/AIDS, TB presents a double burden to the sufferer as well as health systems. The target for the SDG 3 is to reduce premature deaths (before 70 years of age) from NCDs through prevention and treatment by one-third by the year 2030.

Currently the Coronavirus  has already taken almost a million lives. It is an infectious and therefore communicable disease. While we are taking the necessary precautions to protect ourselves we still have no control over the virus. What we do have control over is lessening the severity of the virus should we be infected through prevention of NCDs. According to experts 80% of NCDs are preventable. For example, obesity on its own predisposes one to several chronic conditions. Evidence also indicates that almost 25-30% of all cancer related deaths are due to smoking  while 30-35%are linked to diet.

Experts also claim that 5-10% of most chronic diseases can be attributed to genetics, while the remainng 90-95% have their roots on the environment and lifestyle.

What can we do to prevent NCDs?

We need to adopt healthier lifestyles and this calls for changes in some of our behaviours. And yet, change can be so difficult and we try as much as we can to resist it. We are afraid to lose that which we used to and also that we might not be able to adapt to new ways.

“ The comfort zone is a psychological state in which one feels familiar, safe, at ease, and secure. You never change your life until you step out of your comfort zone; change begins at the end of your comfort zone.” 

(Roy. T. Bennet)

Stages Of  Behavioral Change

Researchers of Alcoholism, Carlo C. DiClemente and J.O Prochaska  came up with a six stage model that can be used to motivate change.

Precontemplation: Individuals are not even thinking about changing their behavior/ problem. They may not perceive themselves as having a problem and when it is pointed it out to them, they think it is an exaggeration. The individual is in this stage because they are either reluctant to change,  or rebellious in that they resist what they are being told to do. They may also have resigned by giving up hope of the possibility of change. They also tend to rationalise, by way of having all the answers, and plenty of reasons why they don’t see themselves as having a problem.

When I was a child I had an uncle who was an alcoholic. He loved drinking what he called the “strong stuff”, that is whiskey or brandy. When extremely drunk the man would grab the bottle and start reading aloud everything related to the label. He would then go on to extol the virtues of the stuff. As he rocked from side to side, backwards and forwards and with slurred speech he would teach us how to pronounce the names. Fortunately he recovered from alcoholism otherwise I shudder to think how he would have pronounced stuff like Glenfiddich or Cognac!

Contemplation: Individuals are willing to consider the possibility of change. Somehow they are sitting on the fence and not so sure. At this stage the individual wants to learn about their problem and how to deal with it but this does not mean they have made a decision to change. They are prepared consider the pros and cons and to look back at their  previous attempts and failures. Growing up as an African child, I remember that behaviour change was just a slap away or it only took your mother to give you “the eye”. You did not have the luxury of contemplation!

Preparation to action/Determination: This marks the decision to change.  After doing a cost-benefit analysis the result comes out in favour of change. There is concerted effort to stop the problematic behaviour. This stage calls for coming up with a realistic plan which also anticipates the pitfalls and the solutions.

Action: The plan is put into action. At this stage one has to inform significant others or relevant support systems of their commitment. The advantages of doing so are that you become accountable and you also get moral support. However one needs to choose well because some significant others might be resistant to the changes you want to make.

When I started exercising, results began to show through weight loss and some people close to me were not happy. They pointed out that my weight loss would make outsiders think that I was sick or experiencing some serious problems. If you stop taking alcohol, your drinking partners may say that you have suddenly become a boring person. Let me say that your reasons and the resolve to action are what matter most when the push comes to shove. We do not be live for other people.

“You can lie down for people to walk on you and they will still complain that you’re not flat enough. Live your life.”

Maintenance: The individual is able to maintain their changed behaviour. When the new behaviour continues without external stimulation then it has become self sustaining. The action stage normally takes three to six months. Experience has taught me that you need to be very patient and persistent because results do not show overnight. I have seen some people giving up just when they are about to cross over. If you are able to sustain the change over many years, and there is little chance of reverting to old patterns, then that stage of successful change is called maintenance. 

“The 21/90 rule states that it takes 21 days to make a habit and 90 days to make it a permanent lifestyle change”

Relapse/Termination: With chronic diseases like alcoholism, there is a possibility of relapse. A crisis situation or event can trigger a relapse because someone will be looking for ways to cope. Relapse prevention skills are needed as well as knowing where to get support. Termination is the ultimate goal where one has confidence that they can cope without fear of relapse.

Healthy Lifestyle Essentials

Lifestyle medicine is a therapeutic way of living that treats and prevents lifestyle related diseases.

• Good Nutrition: It means that your body gets all the nutrients, vitamins and minerals it needs in order to work at its best. Eating plenty of fruit, vegetables and whole grains while cutting down on processed, fatty and junk foods makes good nutrition.
• Physical activity: A sedentary lifestyle will accelerate physical decay. For example too much sitting whether when working, driving or watching TV and too much sleeping can be detrimental to health. Exercising and/or even doing some household chores are recommended. Physical activity promotes blood circulation and produces essential chemicals that can revitalise body tissues. It also enhances the immune system as well as improving brain function and mental health.
• Environmental and Personal Hygiene: Simple hand washing is important and even more so in this Coronavirus era. One should also avoid use of or excessive exposure to tobacco, toxic substances and drugs. Moderation is better especially when stopping completely is difficult like in the case of alcohol. Good dental hygiene should also be valued.
• Good relationships: Being able to take care of the self or self love, having healthy relationships with other people and a strong connection with the Creator, all have a way of boosting your overall health.

Please bear in mind that any change in the right direction no matter how small is progress. They say, small changes eventually add up to huge results. Be gentle on yourself and all the best!