Remember – January New year New me? How’s that worked out? So many new years running and exercise resolutions have already ended because of a niggling injury. Unfortunately running-related injuries are much more common amongst new runners than the experienced ones, they survived their induction period and graduated to 10k races and marathons (Videbaek et al., 2015). But the types of injuries experienced by runners and “keep fit” enthusiasts tend not to be acutely life threatening, and so the Irish public health system – the HSE – is not overly concerned with their treatment. They don’t fit the “sick care” model. If runners want timely treatment they are forced to interact with the private system. This can be expensive and many may not be in a financial position to prioritise their injuries. In simple terms we, the service user, pay to skip queues, or languish on a waiting list for months on end.
The reality is that the health system in Ireland is based on a reactive model; it is a “sick care” structure. Our system waits for one to become sick before providing appropriate reactive treatment and action. This design is not intended to help stop the onset of disease but instead to diagnose and treat illness once it has developed. Hence, the healthcare system is designed around an acute care concept, where the focus is to fix rather than prevent urgent issues. It is for this reason that the HSE describes elderly patients as “bedblockers”. Often this patient population have no immediate or pressing medical needs and so don’t fit into the “sick care” model. In a proactive health system these elderly, vulnerable patients would be identified even prior to admission to these acute hospital settings and the appropriate measures for their discharge established, thereby preventing the creation of these hostile relations between the HSE and the service user, which unfortunately is all too common.
The health system in Ireland is broken. It hasn’t coped with what Minister for health Simon Harris described as an unforeseeable and unpredictable increase in demand for beds in the last 3 – 4 weeks. This is in spite of the fact that the problem was highlighted in early December 2016 by reports from the HSE’s very own department – the Health Protection Surveillance Centre – which urged high-risk groups to seek urgent vaccinations as the numbers of flu cases were increasing. But in fairness to Mr Harris and the HSE who could have known that vulnerable populations might contract influenza or winter-related illness this winter…….. Was it so unpredictable? There was a significant deterioration in emergency department overcrowding in November and December which culminated in the entirely unsurprising record of 612 patients on trolleys at the turn of the New Year.
But what has this got to do with running, because this is a column about all things “running”. Runners are healthy people, because consistent exercise prevents premature death, cardiovascular disease, ischemic stroke, type 2 diabetes, some colon and breast cancers, and even depression (Carlson et al., 2015). It is so powerful at maintaining and improving health that it can add not only years to life but quality to those years. It can produce transformational changes in fitness levels, mental, social, emotional health and wellbeing (Murray et al., 2016). Increasing levels of activity in the Irish population could ultimately result in annual saving of between €67.5 – 135 million. A British study reported that non adherence to exercise guidelines was directly responsible for an approximated cost to the British National Health Service of at least £1.06 billion (Allender et al., 2007).
But while the failures of the HSE in the management of small injuries may be easily dismissed when weighted against the current trolley crisis, it is still indicative of its lack of foresight and planning. It may in fact be one of the main weaknesses of the failing HSE as the injured runners of today revert back to the couch and risk becoming the “bedblockers” of the future.
Allender S, Foster C, Scarborough P & Rayner M. (2007). The burden of physical activity-related ill health in the UK. J Epidemiol Community Health 61, 344-348.
Carlson SA, Fulton JE, Pratt M, Yang Z & Adams EK. (2015). Inadequate physical activity and health care expenditures in the United States. Prog Cardiovasc Dis 57, 315-323.
Murray A, Calderwood C, O’Connor N & Mutrie N. (2016). Scotland’s progress in putting policy about physical activity into practice. Br J Sports Med 50, 320-321.
Videbaek S, Bueno AM, Nielsen RO & Rasmussen S. (2015). Incidence of Running-Related Injuries Per 1000 h of running in Different Types of Runners: A Systematic Review and Meta-Analysis. Sports Med 45, 1017-1026.