January 13, 2021
By Arjan Toor, CEO, Cigna Europe
COVID-19 has impacted us in ways no one could ever have predicted and the whole health of individuals has suffered as a result.
Our physical and mental wellness contributes to our whole health and how we’re feeling, but there’s more to it than that. In the late 1940s, the World Health Organisation (WHO) defined health as a “state of complete physical, mental and social well-being and not merely the absence of disease or other physical ailments”.
With regard to COVID-19, it is clear that both our direct and indirect environments have important roles to play. In our direct environment, stressors such as financial worries, maintaining a work-life balance, caring for children or elderly parents, and fewer social interactions, can affect resilience and can impact our whole health. In our indirect environment, these stressors include the broader impact of COVID-19, including societal, cultural and political issues.
As we navigate the current pandemic, we will continue to face challenging times and uncertainties. Being unable to control what happens in our direct and indirect environments is likely to cause us to become stressed, less resilient and make us feel like we’re unable to cope. But by recognising these stressors and focusing on ways to improve our coping mechanisms, while striving for healthier living, our resilience and whole health will improve in the long term.
Has ‘flattening the curve’ flattened our whole health?
The approach many governments around the world have taken to the pandemic is to ‘flatten the curve’ (curbing the rate of infections) in order to bring the R number (reproduction rate) down to below one. Nationwide lockdowns, limiting the number of times you can leave your home each day, a ban on all in-person social gatherings and the closure of schools and universities are some of the most intense actions we’ve seen taken.
As effective as those measures have been in fighting the virus, they had consequences for our basic social and economic rights. The pandemic has dramatically exposed economic inequalities, especially in countries with limited social protection systems, and in all countries, it is the most vulnerable members of society who are living with the true impact of crisis.
The physical side effects
Arguably, one of the most harmful responses to COVID-19 has been to make it harder for people to live healthy and active lives. Closures of parks, outdoor spaces, gyms, and a ban on all amateur outdoor sporting events have led to a 13% decrease in physical activity across all age groups. It’s no secret that regular exercise brings with it a number of physical benefits – maintaining a healthy weight, increased energy levels, better sleep quality and a potential increase in a person’s life expectancy – but it’s often the mental health benefits of exercising that motivates most people to keep active. People who exercise regularly experience a reduction in stress, improved memory retention and a boost to their overall mood and sense of wellbeing.
The mental side effects
The social isolation many of us have experienced during the pandemic has had profound psychological and social effects. Alcohol has become a coping mechanism for many. In Belgium, sales of alcohol in supermarkets have increased by 10 to 15 percent and in the UK, alcohol sales outpaced the rise in sales of groceries, by a 22% jump. While some of these increases can be attributed to bars and restaurants closing during lockdown and people spending more time at home, they can also be due to an increase in worrying.
Economic adversity, alcoholism and isolation are behind the rise in suicides as a result of COVID-19. Around 55% of adults report that their mental health has suffered due to worry and stress during the pandemic. Limited access to mental health services mean people who were developing or had existing mental health concerns haven’t been able to access care in the usual way. The wellbeing of this group continues to be a major concern.
Domestic violence has increased worldwide and has been described by the UN as a "shadow pandemic" alongside COVID-19. It’s thought that cases of domestic violence increased by 20% during the peak of the pandemic because of more people being trapped at home with their abuser.
The lack of person-to-person interaction may have helped flatten the curve, but it seems that isolation and quarantine are negatively impacting our whole health.
Prevention is better than cure
As a severely infectious disease, COVID-19 will have lasting effects on the whole health of individuals, especially as care systems work through the backlog of treatments and services put on hold during the pandemic. But what if more was done to highlight the connection between maintaining a reasonable level of physical and mental wellness and the ability to fight off diseases?
It is estimated that chronic diseases cost EU economies €115 billion or 0.8% of GDP annually. Up to 80% of healthcare budgets across the EU are spent on treating chronic diseases. Reducing the burden of chronic diseases such as diabetes, cardiovascular disease, cancer and mental disorders is a priority of EU Member States and at the EU Policy level, since they affect 8 out of 10 people aged over 65 in Europe. Investing in health promotion and ill-health prevention seems like a win-win situation to help to relieve this burden for healthcare systems across Europe, but only 3% of health care budgets are spent on this.
Around 91% of COVID-19 deaths occur in people with pre-existing health conditions such as heart disease, high blood pressure and weakened immune systems. 56% of people with high blood pressure and 20% of people with heart failure who are admitted to hospital as a result of COVD-19 require mechanical ventilation. A future-proof response to COVID-19 needs to be focused on deferring the onset of chronic illnesses and keeping resilience levels high. Healthy eating, exercising regularly and reducing alcohol consumption are all things that can help build a healthy immune system and fight off viruses and infections.
Government interventions to date have been based on the tactic of survival until there is a vaccine. As such, governments have not taken the opportunity to create a whole health approach to health. It is now time for them to act as a matter of urgency by investing more in health promotion and ill-health prevention to help encourage people to remain healthy, and as a measure to tackle COVID-19 head on.
COVID-19 has significantly damaged the global economy. Job retention schemes have been absolutely necessary to minimise the damage to the labour market and to protect livelihoods, and government spending across Europe and many parts of the world has been eye-watering. It is estimated that up to 55% of the private workforce in France, 45% in Italy and 25% in Germany were furloughed. The furlough schemes across Europe were only possible thanks to a staggering €100 billion loan from the European Union. This solid investment and urgent response to prop up the economy should be replicated across every measure to combat the global pandemic, specifically across health promotion and prevention.
Most of 2020 has been focused on lockdowns, social distancing measures, hand washing and face coverings to help prevent the spread of COVID-19. These are all valid approaches, but action needs to be taken that will help us build structural resilience to deal with the virus in the longer term. Improved prevention polices can foster a change of mentality and better equip people to use their whole health to build resilience against the physical and mental effects of infection.
A renewed focus on whole health
While governments may need to adapt their approach to COVID-19, employers also have a role to play. By taking a holistic approach to whole health through the creation of a robust wellness strategy, ‘human-centred’ employers can establish a culture of health within their business. Focussing on recognising and supporting mental health is fundamental to ensuring a healthy, engaged and productive workforce.
Employers can set the scene for their employees to take ownership of their whole health, but the crucial first step to rebuilding whole health and resilience begins with looking after our own physical and emotional wellbeing by exercising, healthy eating and goal setting.
But it doesn’t end there. Peter Mills and Inge Schrever, doctors responsible for the Cigna Europe medical team explain: “It’s important for everyone to take a moment to pause and reflect on the direct and indirect environments that we’re faced with and identify the issues that are impacting their own whole health and resilience. By taking a moment to reflect, we begin to understand that resilience is not just the ability to bounce back, it is also the capacity to adapt to changing and challenging circumstances out of our direct control. Resilience is a skill we are able to learn but it also needs constant nurturing. Often the same external factors that impact our whole health also impact our capacity to build and maintain it.”
If COVID-19 has taught us anything, it is how important it is to remain in a good state of health, with a decent level of resilience to stay mentally sustained. Employers have the opportunity to lead from the top by demonstrating good behaviours, such as:
- Encouraging employees to take time away from their screen for an hour at lunchtime to go for a walk
- Highlight the importance of airing homes, even in the cold: circulating fresh air is not only invigorating, it is an excellent measure against COVID-19
- Reminding employees that it’s okay, and even recommended, to schedule time to chat with a colleague. In the virtual offices we’re not able to have face-to-face interactions and conversations over a coffee or at the watercooler, so we need to be more deliberate about having social talks. They are important. A quick check-in, to catch-up and share experiences, both positive and negative really can make a difference.
Being mindful of our whole health and taking positive steps to nurture it helps make us more resilient. Future pandemics and global health crises are undoubtedly unavoidable, and while maintaining a healthy lifestyle won’t guarantee immunity from illnesses, the improvement to our overall health and wellness will only be a positive move in helping against the risk of infection – while maintaining our physical and mental strength will allow us to more rapidly maximise our capacity to rebuild our lives and states, as the opportunities emerge.