Coaches need to coax better health outcomes

Everyone has been part of a flippant conversation about life expectancy. It ends with the inevitable shrug and acknowledgement that when it happens it happens. In reality though, most of us set our own date, by making daily diet and lifestyle choices with life-long consequences.

Apart from the quarter of us who succumb to injuries, accidents, mental afflictions or rare diseases, it’s the way we eat and exercise that determines the quality and duration of our lives.

So given that almost all of us can afford to eat well and stay fit, it’s important to understand why so many of us exchange great health for inactivity and unhealthy food.

Behavioural experts remind us that short term pleasures trump delayed gratification. The best example is the rush experienced with smoking. There is no greater predictor of bad health than cigarettes.

Talk to any person struggling with their health and they will single out motivation as the key. Australia’s fee-for-service system delivers over eight GP visits and nine prescriptions per Australian per year.

But even that is failing to motivate enough of us to lose the girth, the kilos, unclog our arteries and control our blood pressure.

We also know that around nine million Australians don’t fully comprehend health advice, medical information and discussions with clinicians. Mainstream health providers have so far struggled to get messages through to those with low levels of health literacy.

Ultimately, the State hospital systems pick up the tab for bad health choices and the poor understanding which underpins it. They battle both the moral hazard that health expenses are ultimately paid by others and the adverse selection which leaves the sickest patients in the public system.

Economists are a dry lot; often joking that it is not when you die but how that matters. Dying quick and cheap saves the system, while slow debilitating conditions requiring intensive support throw our health budgets into overdrive.

Private health insurers know this too. They are in the business of finding ways to intervene in this cycle of decline. They know that beating bad health is equally about living longer and dying cheaper. Keeping your mobility and avoiding hideously expensive cardiac operations are good examples.

Short of financially punishing bad health choices with larger gaps, higher fees or fines, health planners are desperate to develop new carrots to drive healthy behaviour however they can.

Now, insurers and State governments are hiring third parties to do the extra coaching.

Connecting Care supports those most likely to end in hospital with positive behaviour change. That includes education, guidance and support to reinforce the health recommendations so often ignored as we walk home from the doctors.

Telephonic health coaching - literally phone based training - is one way to tailor the health message to individual levels of health literacy. That builds a fuller understanding of the health message, and alerts patients to what they can do to change outcomes. It also delivers these things at a much lower economic and time cost than face to face consultations.

NSW Health announced this week the contracting of one such firm to phone coach around 36,000 people with chronic and complex needs. These are the people with serious conditions who without urgent intervention are highly likely to end up back in hospital.

Brief but frequent interventions are one way to head off unhealthy practices between hospital visits and to identify problems early. Those in this first phone coaching group include patients with diabetes, high blood pressure, heart and lung disease.

We all talk up health promotion, but few in the business know what reliably works. Government-sponsored TV ads are politically popular but cost millions without any guarantee they alter behaviour. Agrawal and Duhachek identified defensive processing as one reason why.

In the April 2010 Journal of Marketing Research, they reported that ads led to defensive processing where individuals assessed their personal circumstances as better than those portrayed in the ads. Put simply, we view our own personal greatness as a buffer from potential negative consequence, whether it’s drink-driving, smoking or eating junk food.

Clearly, we need a more intensive approach which connects ill-health to actions. Health coaching can be evaluated, by examining comparable groups which aren’t coached. Early results published in the Population Health Management magazine found health coached groups were 20% less likely to be admitted to hospitals.

Health coaches cost less than doctors and they can reach more people more often using phone and computerised interventions. More detailed studies will tease out which sub-groups respond best to counselling and why.

As free agents, we should all be able to make our own lifestyle choices. We don’t need Government screaming at us about what we eat or how little we exercise. But the will of responsible people to invest in expensive remedies for people who consciously elect to be unhealthy is not unlimited.

The price of bad lifestyle is deferred but it is always ultimately paid in full. Part of the challenge for government is to better align cause and effect. Only by paying the true price of unhealthy lifestyle now will individuals decide the price isn’t worth it.

Personal health coaches aren’t cheap but against a backdrop of exponentially increasing healthcare costs, the potential money and lives saved could be dramatic.