The Prevention Gap

The Road to Here

 

My passion for effective healthcare has evolved over years of meaningful experiences and relationships. At 17 years old I was diagnosed with fatty liver disease after years of unhealthy eating. I did not have a family doctor, and I was not referred to any other type of health care professional. The lack of support left me fearful about the implications of the diagnosis, and it was one of the reasons I later developed an eating disorder. Thankfully, I was able to get help from health care providers at this point, and with their work and support I successfully reversed the fatty liver disease, conquered the eating disorder, and achieved mental wellness. 

 

My family's experiences have led me here, too. Since my mom's diagnosis of ovarian cancer when I was 10 years old I have feared for my parents' mortality. My mom is now cancer-free; however, this fear still grows with each health complication, from high blood pressure and insulin resistance, to a life threatening pulmonary embolism that left doctors unsure of my father's chance of survival for days. In 2013 I provided CPR for my Nana, who passed away days later after years of coronary artery disease complications. In 2018 within the span of three months my family lost two loving men, one to a stroke and another to lung cancer. 

 

And my work within this community has hugely driven my desire for change. Childhood obesity rates have tripled in the last 30 years, increasing the risk of missed/abnormal menstrual cycles, type II diabetes and sleep apnea, on top of its impact on academics. I have worked with children whose education has suffered due to low self-esteem and self-efficacy as a result of being bullied, isolated, and the many other challenges that arise with childhood obesity. I have worked with so many people battling diseases - from cancer, to depression, to type II diabetes and all its complications - that I do not know how to narrow down their stories to share with you. 

 

Perhaps in part because of these experiences, I have always been sensitive and - at times painfully - empathetic. But I am also a doer; a practical person who knows that if a problem exists then a solution must be possible. Over the years I have learned not to suppress empathy or to hide my sensitivity, but to use these qualities to foster a passion for change. I know that when women combine their intelligence, determination and creativity with the qualities that have historically been frowned upon, they can implement far-reaching and necessary changes in their regional and global communities. 

 

Thus began my career in health and fitness. Since 2011 I have worked primarily with people who are sedentary and at an elevated risk for health complications. Much to the dismay of business advisers I consulted through a business development program, I want to work with people who hate exercising. This demographic is not highly profitable, but they are immeasurably rewarding. This demographic often requires after hours attention - text messages, phone calls and e-mails - for reassurance, emotional support and the motivation to just keep going. As far as TrainMeFit is concerned, this time is not billable. Our system has in many ways told this demographic that they are too much work; we want them to know they are worth the effort it takes. This demographic generally cannot afford private care or service up-sells, and they are often so busy taking care of others that they do not have time to find the resources their health needs. We work tirelessly with every type of body and personality to ensure member success. This has meant that TrainMeFit's growth has been slow but  organic, and the impact in our community has been meaningful and long lasting.

 

Some of our members are no longer on blood pressure medication. Our senior members are not afraid of falling anymore because they are strong and independent. Our female members are proud to be able to pull out their winter tires on their own each season. A man who could not support his own body weight is now able to walk around the block. Many members are no longer insulin resistant (pre-diabetic). Members who have had to undergo surgery recovered faster and with less pain than doctors expected on account of their fitness.

 

While growing a business has felt impossible at times, TrainMeFit has grown every year since 2011. In 2018 I decided to go back to school to complete my Bachelor's degree in Applied Science so that I can become a Registered Kinesiologist. This will broaden my scope of practice so that I can create a preventative health care centre and foster change for even more community members. 

 

But physical inactivity and preventable disease is not just a problem in my city - it is prevalent nationwide (at least). So once I complete my undergraduate education, and while I am growing my preventative health care centre, I plan to also be enrolled at McMaster University in their Master of Public Health Program. This will allow me to receive an education in health policy while continuing my research in preventative health strategies. Once complete, I will have conducted research on effective, implementable strategies for preventative health care, created a preventative health care model within my own business, and be qualified to take that model and research to the government to inform policy. 

 

The effects of physical inactivity are detrimental and vast; but most importantly, they are preventable.

 

The Problems

 

1. It is currently estimated that only 15% of Canadians achieve the recommended 150 minutes of physical activity per week. This is problematic for a variety of reasons, given a 2009 report indicating that the direct and indirect cost of physical inactivity is 6.8 billion dollars annually. Moreover, diseases preventable with physical inactivity include coronary artery disease, stroke, hypertension, colon cancer, breast cancer (women only), type 2 diabetes and osteoporosis. Two - thirds of all deaths each year are caused by preventable chronic diseases.
 

 

2. Implementing and maintaining a physical activity regime is difficult for the general population. A variety of barriers exist, including lack of time, lack of money, feelings of fatigue, low self-efficacy, low-self value, lack of support at home, lack of support from health care providers, lack of knowledge and fear of injury. 

 

3. Our current healthcare system is fragmented and reactive making it incapable of effectively addressing our physical inactivity problem. 

 

The Solutions

 

The solution is simple, and yet quite complex: we must increase physical activity among Canadians. Below I have outlined my proposed methods to do so.  

 

1. Create free, accessible, easy-to-understand education about the implications of and mechanisms behind hypertension, insulin resistance and type 2 diabetes; as well as how an individual can be overweight/obese and healthy. All education pieces will be tied to physical activity and will be accessible via online videos. A plan to develop a free app with engaging, reliable health content is also in development. 

 

Why this will work: the consequences of physical inactivity have been normalized in our society (i.e. the grave implications of chronic disease and unhealthy lifestyle behaviours have been minimized). Due to an overcrowded health care system, individuals are not receiving education about why physical activity is important, or how deeply common chronic diseases will impact their health. Giving people a better understanding of the implications of their daily choices may allow empower them to overcome common barriers to physical activity. 

 

2. Expanding upon my current business model, I will open a preventative health care centre for my community. Within this centre I will be able to test strategies for change and eventually create a detailed program outline that is translatable across a larger population. 

 

Why this will work: I will be able to construct appointments based on community members' needs since it is my facility (i.e. I can make changes to my program where needed without delay). Individuals will have access to education, strategies for change, health monitoring and methods of accountability, not to mention supportive, health-focused small group training. In acknowledgement of the complexity of health care and behaviour change, a team of registered dietitians, chiropractors, psychologists and fitness professionals will be available to the facility's clients. 

 

3. Upon completion of my Masters, research, and approximately five years of working with clients and professionals through my preventative health care facility I will move into government policy change. I will take my model to the government and work to implement it across our province and nation. 


Why this will work: our government is recognizing that our healthcare system will only survive if we put more resources into preventative care. My undergraduate and Masters degree will mean I have the education and data to support my suggestions. By this time my preventative health care facility will have allowed me to work closely with more community members to develop strategies that actually work; this means evidence for tangible changes and less fragmented care. 

 

The Plan of Action 

 

My plan to bring effective preventative health care to my community and then to my government has three components: education, research and business expansion. 

 

Completing my undergraduate degree in Applied Science and becoming a Registered Kinesiologist will provide me with the education I need to safely work with a large section of the population. Obtaining this broadened scope of practice is necessary for me to move forward with my plans. 

 

Upon graduating in 2020 I will apply to McMaster University's Master of Public Health program. This program will expose me to policy, preparing me to enter into government health policy. It also offers a thesis track, which means I can do more research on effective strategies for increasing physical activity. 

 

In my final year of university (fall 2019), I will complete undergraduate thesis research. Dr. Jamie Burr has agreed to supervise my work, which will look at the effect of education on adherence to a walking program. I will prescribe a light walking program to two groups of sedentary, middle-aged adults. Their walks will be recorded on their smartphones.  One group will receive education akin to what is currently offered through our healthcare system (ex. "you should exercise a few days a week", "high blood pressure increases the risk of heart attack"). The second group will have weekly access to online videos I create that simply explain the physiology behind common chronic disease risk factors (ex. hypertension or pre-diabetes), and how physical activity keeps the body healthy. I will follow up with the two groups after approximately four weeks to establish whether there is a difference in their exercise adherence.

 

The results of this study will fuel my graduate work, which will be of the same focus - exploring the efficacy of education on physical activity levels. It will take me approximately four years to complete my masters work, as I will be enrolled part-time to allow the flexibility to continue working and to support a business expansion.

 

For the past two years TrainMeFIt has operated out of our garage studio (my parents were kind enough to let my husband and I renovate their garage). After years of renting limited hours from a local space, we decided to move the business into a home studio in 2016 to save money for expansion. We are finally ready to make the move and are in the process of obtaining a loan through the Canadian Small Business Financing Program. We have been searching for a space for months, as our membership and target demographic cannot afford a large fee increase. Finding a space that will support the business while keeping services accessible has been a challenge, but we will find one. 

 

Once we obtain a bigger business space I can begin to re-brand and set up a preventative health care centre. My husband will run health-focused small group training in the space, while I will offer counselling, education, support, accountability and plans of action to a sedentary population. We have maintained a dedicated membership base since 2011, and I know we will only continue to further our reach with this expansion.

 

The Toptal Scholarship

 

Since I returned to university I am training and managing operations on a more limited schedule due to my full-time schooling. I have one more year of undergraduate studies to pay for before I begin making payments for graduate studies. Managing these expenses while working fewer hours and trying to financially support a business expansion can be stressful. Receiving the Toptal scholarship would relieve a large portion of the financial burden, allowing TrainMeFit to put everything we can (both physically and financially) into our expansion to a preventative health care centre. 

 

When I was 22 and completing my diploma in fitness and health, I met a female chiropractor in my community. She was treating me for a back injury, and her ability to educate me on anatomy, physiology and reasons for her rehabilitation prescriptions was inspiring. I asked if I could complete my internship with her and I have been working at her clinic in one way or another for the past eight years. She has taught me how to use kindness, empathy and integrity to build a business. She has taught me that when people are educated they are more likely to adhere to a plan. She has guided me through business decisions, the choice to return to school, and has always stressed the importance of continued growth and learning. She now has two babies and is turning her love of children into a new career path by completing her Masters of Pediatrics, which is another testament to how women can add value and strength to their communities. 

 

Dr. Melanie Abbott-Cambridge taught me the value of a mentor. As I enter into new areas - research, graduate studies, and a business expansion - I know how valuable a mentor's input will be to my success. Specifically, I would like a mentor to help with any of the following: 

 

- website development

- app development

- re-branding

- marketing 

- connections to health professionals in policy and/or preventative health      care work 

 

Impact on Regional and (Eventually) National Health 

 

When I create and implement a preventative health care model that increases the number of physically active individuals in the general population, I will be able to improve the health of my immediate community. When I am able to take my education, research, and proven body of work to the government I will implement national, effective programs and tools that will increase the physical activity of Canadians. 

 

It has been estimated that if 10 per cent of Canadians moved from physically inactive to active, there would be a reduction of $2.6 billion dollars in health care costs related to hypertension, diabetes, heart disease, and cancer over 25 years. If Canadians were more physically active and living longer, healthier lives it is reported that gross domestic product would increase by $7.5 billion by 2040, cumulatively. ​

 

It has also been estimated that being physically active (i.e. achieving 150 minutes of physical activity per week) can reduce a person's risk of developing type II diabetes by 43 per cent, hypertension by 26 per cent, and osteoporosis by 36 per cent. Statistics Canada estimated that a person can extend life expectancy by 3.8 years by avoiding a sedentary lifestyle. 

 

The implications of physical inactivity are far-reaching. Our healthcare system is struggling to support the number of Canadians with chronic disease. Physical inactivity negatively impacts our economy by decreasing days worked, increasing missed days, increasing the number of workers on disability, and decreasing our overall gross domestic product. Physical inactivity hurts our families. 

 

I am sensitive and - at times painfully - empathetic. I am heartbroken by the stories our community members share, from children struggling in school, to parents suddenly dying of heart attacks, to families crippled by a primary earner unable to work due to preventable injuries or illnesses.

 

But I am also a doer; a practical person who knows that if a problem exists a solution must be possible. I am driven by the needs of my community and the excitement of knowing that I am capable of creating the education, resources and policies that we desperately need. The Toptal scholarship will ensure I receive the financial and technical support I need to lift my community, first regionally, then nationally. 

Lindsay M Branton

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