Carla Carlisle on the cost of bad health

I'm never sure how much responsibility we're supposed to take for our own health. I know all the obvious stuff-don't smoke, exercise more, cut down on red meat/sugar/cream/alcohol-and I'm relieved that the ‘eight glasses of water a day' command was dismissed this week by the British Medical Journal as an urban myth perpetuated by the producers of Volvic, Evian and Badoit-but I'm hazy about other things.

Every now and then, I feel I should do something more. Check my blood pressure. Have a blood test. I see my dentist every six months, and more often if I've chomped on a piece of shot, but my local surgery never calls me in for a check-up. Despite all the hoo-hah about preventative medicine, I don't seem to be on any list. I have to make an appointment and then confess to my GP that I have no aches or pains, no health ‘issues', that I'm one of the ‘worried well'.

I usually make these appointments after a trip to America. In the USA, everyone can produce their cholesterol levels-the good and the bad-blood pressure and blood types as fluently as their phone number and date of birth. I don't know a single American over the age of 40 who hasn't had a colonoscopy and my cousin Marguerite threatened to stop speaking to me until I'd had one. As I had no symptoms, this was done privately. Not pleasant, but all clear.

Another trigger for appointments are the emails I get regularly from a site called Harvard Medical School. I'm not sure it's the Harvard, because they seem rather pushy for a distinguished school of medicine. This morning's email offered three booklets: The Sensitive Gut (Digestive Problems That Can Disrupt a Normal Lifestyle), Better Bladder Control (It Impacts 32 Million Adults-Yet Most Suffer in Silence), and Low Back Pain (Does Back Pain Govern How You Live Your Life?). I never actually purchase, but nor do I click ‘unsubscribe'.

All the same, I feel like a burden on the State when I request a blood test. I sleep like a baby, I have no knee or hip pain (did I say that I had a bone-density test at my own expense a couple of years ago?) and my hay fever has diminished with age. I suggest to Dr Wallace checking cholesterol, liver, sugar levels, as she unwraps the fat NHS needle (are thinner ones more expensive?). I wonder if I should have fasted before the test, or if I should have asked for the result in writing so I could convert the results into Ameri-can readings. I say nothing.

Back in April, when looking for food writer Mark Bittman's recipe for butternut chowder, I found an article he'd written called How to Save a Trillion Dollars. Mr Bittman maintains that, although Congress is arguing over how to save $38 billion, it could actually save a trillion dollars if it prevented disease instead of treating it. The figures are terrifying: the cost of cardio-vascular disease-the leading cause of death in the USA and in most of the world-will triple by 2030, to more than $800 billion annually. A study of 30,000 men and women in 52 countries showed that at least 90% of heart disease is lifestyle related.

The next big bill is Type 2 diabetes, projected to cost $500 billion a year by 2020-‘A disease,' writes Mr Bittman, ‘that is almost entirely preventable. The more you change your diet and your lifestyle, the healthier you are.'

The NHS statistics on Type 2 are just as terrifying. Some £3.5 billion a year, £9.6 million a day, 10% of the NHS budget, is spent on Type 2 Diabetes, and rising.

The statistics are depressing. In fact, despair is the only symptom I can describe to my gp. Despair because a growing section of the world's population is eating itself into an early grave while sitting on a sofa watching another part of the population starving to death. There's no health in it. If you're one of the worried well, you can only get sick with worry.

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