Solving the Wellness Paradox in Different Healthcare Systems with Dr. Natalie Grinvalds

This paradox , as I view it , is the trust , interaction and communication gap that exists between exercise professionals and our medical community .

This podcast is all about closing off that gap by disseminating the latest , most evidence-based and most engaging information in the health sciences , and to do that in episode 136 , I'm delighted to welcome back Natalie Grinvalds . Natalie joined us way back in episode 88 , where we talked a little bit about behavior change strategies .

This conversation is going to be very different and I'm very excited for you to hear it , because we are going to talk about the difference in structure between the American healthcare system and the UK healthcare system .

As you're going to hear in this conversation , although Natalie grew up here in America and did a portion of her undergraduate and graduate work here in the States , she's now over in England and , as you'll learn in this conversation , the UK health system is a national health system .

They have a single payer the government and they have providers that work for the government , which is very different than our system over here in America that is very much privatized and definitely has a little bit more of a for-profit basis to it .

The goal of this conversation was really just to orient all of you , as our listeners , to how healthcare is delivered in other parts of the world , to better understand how we can insert exercise professionals into healthcare delivery .

Any information we'd like to share with you from today's episode can be found on the show notes page , that's by going to wellnessparadoxpodcom . Forward slash episode 136 . Please enjoy this conversation with Natalie Grinvald . I'm very excited to welcome back Natalie Grinvalds . Natalie , thank you so much for joining us again .

But we're going to dive into a slightly different discussion today , but before we get into that , can you just remind our audience a little bit of your background to provide some context for the discussion ?

I myself I was born a few months early struggled with a lot of health conditions and for that reason including asthma struggled to be physically active from a young age . I also witnessed one of my grandparents live with a stroke and she was paralyzed from that and we kind of took care of her from a young age .

So I saw how you know , the impact of losing your physical fitness . But also my grandfather developed Alzheimer's disease and kind of the how you lose your mental fitness and I always wondered from a young age if we could have done more to kind of improve their health , improve their quality of life .

So I think that kind of sparked my first interest really in health and well-being . Fast forward to doing my well . I was always a quite an active child . I did kind of ballet to a high standard , so I was always quite physically active .

But I started my undergraduate degree at Indiana University and was really interested in kind of psychology and how humans behave and I thought you know what I don't want to do a PhD , because in America you know you've got to have a PhD to do a psychology , to be a psychologist . When you're 18 , it's kind of hard to say that that's what you want to do .

So I ended up kind of studying nutrition and dietetics , became really interested in how we affect health on a broader scale and ended up moving into applied health sciences and public health .

Now we know with the American education system the degrees are quite broad and you can change your major multiple times , possibly due to the cost of an education and the fact that you can just keep paying for university .

And in the last phase of that degree and I think this is what really brought a lot of this together and brought my interest together was I did an internship in cardiac rehab at Indiana University and the first two phases of that rehab program were in acute setting in a hospital gym and in the second two phases those were in a local YMCA .

For the British listeners , a YMCA is very similar to a community based leisure center and I didn't realize later on you know you kind of think of these as medical fitness centers , we call them co-located models here in the UK that my whole research for my PhD would be on this topic .

I didn't know this at the time , so ended up kind of working in public health and then also as a program assistant in clinical epidemiology at the Ohio State University Sorry to bring up Ohio .

physical and mental health , and then you could embed workplace well-being programs within your department tailored to your department , and that kind of really sparked my interest in workplace well-being programs within your department tailored to your department , and that kind of really sparked my interest in workplace well-being .

Alongside this , I took some undergraduate courses in corporate well-being , workplace well-being at Ohio State .

So all of this sounds like and one of your guests recently mentioned being a jack of all trades and I think we're often kind of looked down at the idea of being a generalist , but actually it's a jack of many trades , like one of your colleagues pointed out , and they a generalist , but actually it's a jack of many trades , like one of your colleagues pointed

out , and they've all weaved together and I know you and I talk a lot about our values personally and professionally and I can look back now and see how these brought me closer in alignment with my values and also kind of the physical activity , the behavior change , the focus on long-term conditions , so yeah , so I did that kind of skipping a few steps .

I ended up going back to IU to do my master's in public health because I really thought at the time I needed to have a master's to do what I wanted to do , focusing on behavioral , social and community health .

So how does our behavior , how is our behavior impacted from the individual level to the systems level and kind of really focused throughout that degree on physical activity and behavior change . In the last part of that degree I had to do another internship anywhere in the world .

I had some colleagues in the UK that I met through Indiana University and really became interested in health inequalities and the UK's approach to health inequalities , particularly physical activity health inequalities . How does that differ from the US ?

What I was really fascinated by was a concept called the Glasgow effect , where in Glasgow there are very short geographical distances and postcodes but very extreme health inequalities . We're talking 10 , 13 years and these factors are not just down to individual behavior , they're down to socioeconomic and political inequalities in those areas .

And how do these affect people's health . So in Sheffield in the UK they have that similar pattern between about three miles distance . They often talk about it as being a specific bus journey where the inequality and the health outcomes change significantly . We're talking still a life expectancy difference of , I think , 10 plus years .

So I interned with a development organization in Sheffield , which used to be one of the most deprived areas of the UK , and I had an amazing mentor there and she really helped me to understand how they address inequality and health inequalities from the ground up , really working with people rather than doing interventions to them and looking at you know .

I remember one time she drove me around the area to show me , you know , here's where we've invested in businesses , here's where we've improved this park , and these things were particularly eye-opening to see how these affect people's health in addition to those individual level behaviors .

And I think that's one thing being in the UK that's been so eye-opening to see how these affect people's health in addition to those individual level behaviors . And I think that's one thing being in the UK that's been so eye-opening to me is that I don't own a car here . I can walk places .

I think the food environment is a bit more controlled so there's less additives that go into food . Healthy food might be a bit cheaper . So all these things affect people's health . So I'm really interested in all that and currently sorry , that's a lot Alongside . So I ended up coming to the UK .

I was going to stay for six months to do that internship and you know what I thought . I'm not done here . I still have more to learn . So I ended up , through some different colleagues , finding out about a job in workplace wellbeing at Sheffield Hallam .

They have one of the kind of the few workplace wellbeing programs in the UK or in Sheffield that's evidence-based it's been trialed with NHS staff which focuses on physiological testing and then using motivational interviewing and behavior change skills to help people change behavior . And I know we've talked about that before .

I really wanted to work in corporate well-being , but the market in the US is very different than the UK because , as we'll get into , employers in the UK are usually not paying insurance premiums for employees , so they're motivated more by okay , employee retention , improving productivity and workplace well-being programs are not as common .

Alongside working in this program , I found out about a PhD , ended up doing that , and I think that's where we connected before many years ago on kind of I was researching co-located models of combining NHS clinics with leisure centers or fitness centers to improve physical activity levels through healthcare .

Currently I'm a researcher in physical activity , looking specifically at people living with metastatic breast cancer on a one-year project with a private company and sort of developing a tool to help them improve their lifestyles through physical activity , nutrition and psychological support .

Now , one other thing I wanted to mention is I do some lecturing for public health nutrition on motivational interviewing , and I'm also an assessor for an embedded gym instructor qualification within the undergraduate sports science degree here at Sheffield Hallam .

I know you talk a lot about professionalization in the fitness industry and that's one thing that the UK is working on as well .

We have a body called the Chartered Institute for the Management of Sport and Physical Activity , or SIMSPA , and they recently assessed our program and it was one of the first kind of academic partners to meet these professional standards and we got the highest award that it can , that can be received .

So so that's something I'm really passionate about kind of increasing improving the standards for fitness professionals in the UK , and then , of course , that just kind of elevates them and raises their profile . So yeah , lots of different bits . Sorry , that's what you probably want . To cut some of that out .

You have definitely kind of used your values as a guide to figure out what's next in the journey and has gone through that journey from your undergraduate time to your graduate time and now you work over at the UK . You've spent some time on the more micro level .

You've spent some time on the macro level and I think that gives you a really interesting perspective . And the interesting part of your perspective that you're going to bring to this discussion is talking about the UK healthcare system . You already hit on a couple of things . I will say this I always love how you call them leisure centers in the UK .

That's just such an interesting term for us over here in America . But when Natalie talks about leisure centers she's talking about what we traditionally consider a fitness center here in America .

But our countries have two very different health care systems and audience might remember Joel Hungate who was recently on our podcast from Hancock Health that talked a little bit about some of the health healthcare dynamics that exist in our healthcare system here in America . America has a very unique healthcare system compared to the rest of the planet .

For the most part and I might be using that term unique in a very kind way I think our healthcare system has a lot of shortcomings to it . No healthcare system is perfect and , natalie , we'll talk a little bit about the UK system . It certainly has its limitations .

But to set you up to talk about the system over in the UK , I just want to provide a little context on our system in this country .

Our system is largely a privatized system , although the government does certainly play a role through the Centers for Medicare and Medicaid Services , and there are multiple different entities that provide care in America and there are multiple different entities that pay for care in America and quite often health insurance is tied to your employer and that actually has to

do with some things related to wage and labor controls way back around World War II that are beyond the scope of this discussion . But our health care system in America has evolved differently , in part because I think America has always had this capitalistic nature to what its ethos and the fact that it's always one of the private markets to drive innovation .

But there's also been some accidental things that have happened along the way , like employer-sponsored health insurance , which had many unintended consequences that I don't think anyone thought of at the time in the 50s and the 60s .

This is not a lesson on the American healthcare system broadly , but I think many of our listeners , I think we have more of a domestic audience than a national audience .

Sometimes I think my international audience is relegated to you and your friends over in the UK , which I appreciate , but we all who are listening to this , I think , understand the American healthcare system . I don't think we have a strong sense of what happens over in the UK .

So just for starters , before we actually get into the part of this that's relevant to us , the physical activity , just explain the healthcare system in the UK from a perspective of an American who probably doesn't realize a lot of the nuances of the differences .

You know there were a lot of changes around , it seems like , in health care systems around and after World War II it was created . The National Health Service , as they call it , the NHS , was created in 1948 after a lot of campaigning and years , by a woman at the time who believed that people experiencing poverty should not be solely responsible for themselves .

So at the time it was created by a newly elected labor government and the Minister of Health and I always mispronounce his first name , anurin Bevan and he was tasked with establishing this universal health care system . The main selling point , the main unique thing that your listeners will probably already be aware of , is that it is free at the point of use .

It's funded by taxation , general taxation , so it provides free , comprehensive care to every citizen and in the UK it's really a question . I think many people feel it's kind of a question of what kind of society do we want to be ? Healthcare is really considered a right , a human , universal right . It's not a privilege .

So we have general taxation and mandatory salary deductions to pay for the NHS . They support healthcare . A little bit goes to dental care , social services and public health initiatives . But we tend to pay for dental care and pay for mental health . Not mental health care , pay for eye care as well .

So you know I will point out there are pros and cons of this . I'm not here to be negative about either healthcare system . Like you mentioned , there's no perfect healthcare system , but they are very different and the populations are very different . So we're kind of comparing apples and oranges , but I think it's really helpful to learn lessons from both .

So , like I said , it's funded by direct income tax reductions . The government employs the majority of the healthcare staff and runs the operations for the hospitals . Since the government is really the only buyer , it's just called a single buyer system . You have multiple private sellers , so the cost for things like drugs and treatments are a bit lower .

Like I said , there's fees for prescriptions . We pay for our prescriptions . We pay for our dental care . We pay for our eye care . However , there are some caveats to that . For example , if you have hypothyroidism I think for life you don't have to pay for synthetic thyroid hormone .

If you have a condition like glaucoma , I don't believe you ever have to pay for an eye test or glasses again , but that could all be changing . So , again , like I said , it's considered a human rights issue . Now the structure . There's something , a body called the Department of Health and Social Care , which is a government body .

The funding flows then to NHS England , which allocates funding for NHS through what has been established in 2022 , what are called integrated care boards . So the Department of Health and Social Care is kind of responsible for overall health policy . Now , when we talk about the NHS , we got to where it was today , which I think is really important .

The NHS faced a period of austerity and austerity is a word you hear quite often on UK public policy and it's a period roughly from about 2010 to 2019 where government policies were focusing on reducing the national debt and one of the things hardest hit was health and social care .

So this has led to declining quality of care in specific areas , including main problems or long wait times for care , particularly mental health , and we can often be talking months or years at a time to see a psychologist and no longer being able to meet key waiting time targets .

Fewer people with long-term conditions such diabetes , cancer and depression are getting help , and breast cancer screening rates for women 50s through about age 70 have been falling and it's harder to see a GP or a general practitioner primary care provider . You know , within the same day you probably won't often all hear .

You know , okay , come your appointments in two weeks . You don't really have a lot of choice around your appointment times as well , especially for specialist providers , like if you get referred to an orthopedic doctor , you know they'll just give you an appointment time and then if you can't make it you need to call back . So there's some bureaucracies around that .

Now , one thing that really kind of made everything the UK . England was hit really hard with COVID . This created a huge backlog . Also , a lot of fitness centers , leisure centers , gyms went out of business . We'll talk about that later . So health services entered the pandemic with this already huge problem of a backlog , and then it made everything a lot worse .

Emergency care is probably one of the biggest problems you might hear about on the news in the US as well . Often people are being treated in corridors on beds . People with mental health problems that really shouldn't be seen in the community are spending weeks in the accident and emergency department because there's no services available in the community .

So yeah , so those are some problems that are currently going on .

Now there was a recent report I think I mentioned to you , commissioned by an independent investigation into the NHS , and it highlighted three major shifts that need to happen , to make improvements , and one is really now a lot of us that work in prevention , public health and physical activity have kind of been saying these things for years , but there seems like

there's a real commitment now to focusing on changing these things and these three big shifts .

Number one is moving from the hospital to community care , so recommending from moving from acute services to community health services and social care to reduce strain on hospitals , and that's where things like your version of the Medical fitness center or kind of co-located models can really play a role here .

Moving from analog to digital , so really emphasizing the need to digitize the entire NHS , because there are a lot of kind of bureaucratic systems in play , using the NHS app , and also focusing on digitizing the workforce and then moving from treating sickness to preventing it , so the kind of focus on treating sickness or preventing ill health is a big thing .

That was also a focus , kind of , of my PhD We've been talking about for years as fitness professionals as well , and we have a big role to play in that . So that's kind of what is happening currently .

There's a new budget and really , rather than focusing on more investment , it's focusing on where do we invest that money to be more efficient and help focus on health for the long term . There's also a big focus on health inequalities , particularly for long-term conditions , mental health and maternity .

So that's kind of where the UK healthcare system is right now , and another interesting fact is that I think in the US you spend almost double on healthcare expenditure per capita . The health outcomes aren't necessarily that different .

As many of you know , the wellness paradox is all about closing off the trust , interaction and communication gap between fitness professionals and the medical community , and no organization does that better than the Medical Fitness Association . They are the professional member association for the medical fitness industry .

This is the industry that integrates directly with healthcare in many facilities throughout the entire country . The MFA is your go-to source for all things medical fitness . They provide newsletters , webinars . They even have standards and guidelines for medical fitness facilities .

They do events around the entire country and , most importantly , they are one of the more engaging networks in the entire fitness industry . I personally have benefited from the network that I've developed through the Medical Fitness Association and I highly recommend that all of you that are interested in solving the wellness paradox engage with the MFA .

To find out more about the Medical Fitness Association , you can go to their website medicalfitnessorg . That's medicalfitnessorg . Now back to today's episode . Yeah , you nailed it there . We spend about somewhere between 18 and 20% of our GDP on health care .

Basically , one out of every $5 is spent on health care , and that's not just double what you're spending in the UK , that's double all the other industrialized nations on the planet . And , to your point , our health outcomes are nowhere near close to what a lot of the other industrialized nations are on the planet .

On every single metric , have it be mortality , morbidity , maternal mortality , we pay more in America and we actually get much less in America .

But I think the impact of physical inactivity on the population , on the economy , I think it's around like last I read , 1% in the UK , but I think it's like 20% , almost 19% in the US . You know , and you know , yes , we focus a lot on treatment of the healthcare system .

I know that's a focus on this conversation , the difference in healthcare system , but I think a lot of it , coming back to like my public health lens , is down to , you know , access to quality , accessible green spaces , parks , can we walk places , can we use public transport , kind of a lot of those system factors rather than focusing on kind of the individual .

But yeah , so that's kind of where it is now .

And then , thinking about my current work and we already kind of talked about the fact that people living with breast cancer and other chronic conditions and other health problems , there's not a lot of talk , not as much talk as we would like and not as much referral to lifestyle support services such as nutrition , psychological and physical activity within the healthcare

system . They tend to rely on charities to deliver those services .

The most fundamental difference between the two systems and this is another conversation that is very compelling to get into , but we definitely don't have time to get into this , I know In a nationalized healthcare system , the population writ large has essentially decided that healthcare is a fundamental human right . It is not a privilege .

That is a decision that many , many industrialized nations around the planet have made . We've not made that decision here , and the ethics and the morality of that are another conversation for another time . So that's the fundamental difference . The similarities that exist are care is constrained in both systems .

People have to wait longer than what they want to get the care that they're looking to get , and that wellness and prevention isn't really a significant emphasis in either system , although both systems talk about it being important .

In order to get things done In the NHS , you only really have one stakeholder to convince , but the bar for convincing that stakeholder is obviously going to be very high and very bureaucratic .

Yes , like we said , no one perfect system , but we talk a lot on the wellness paradox , about things we can do within the American health care system to integrate exercise professionals with health care and there's the barriers that our system imposes , and there also may be some things that maybe make it a little bit easier because it's a little less bureaucratic .

But let's really drill down on what our audience would be interested in knowing , which is what are some things that are done well in the UK system of healthcare with regard to physical activity and exercise that you wish we would adopt over here in America ?

How do we address the people that are the least active ? How do we reach them ? A lot of people don't see themselves as belonging in gym environments .

A lot of people don't see themselves , as you know , exercising in a traditional way , and I think as much as we talk about , you know , medical fitness centers and co-located centers , how can we reach those people in a different way ? And those are a couple of things I think I can highlight that the UK does well . One of them is exercise referral schemes .

I think you're probably quite aware of these . I know Amy does a lot of research in that area , but the UK and Scotland were kind of first in kind of developing these on such a level in the 1990s . That's when exercise referral schemes traditionally started , and I'm sure most of your listeners are aware .

But as they were originally developed , it was where a general practitioner , primary care provider , could make a referral or prescription to a patient they were seeing to go to a gym , fitness center , leisure center , community leisure center for a number of weeks to see a personal trainer or other exercise provider , usually 12 weeks long .

I think Scotland or Wales does 16 weeks , but that's kind of the standard and there's been lots of randomized control trials , other types of evaluations of these centers and there's a lot of kind of mixed results in terms of are they really effective , are they economically effective ? But a part of that is due to maybe we're not evaluating them appropriately .

Part of that is are clinicians actually referring people in the first place ? The second issue is uptake . So how many people are actually attending that first appointment and adherence ? How many people are staying for a whole duration of the time and participating and is that behavior maintained long-term , despite the challenges ?

The UK has , I think , over 600 different exercise referral schemes all around the country and because we are not worried about reimbursing that kind of prescription to physical activity through the healthcare system , we don't have to worry about co-pays deductibles , any of that . How do we code for this ? I think that probably creates less of a barrier .

Save some time because it's not monetized in the same way .

So , as I mentioned , exercise referral schemes were traditionally from GPs but these were like allied care , so physiotherapist , physical therapist , allied care , so physiotherapist , personal , uh , physical therapist translation diabetes nurses , podiatrists .

It's now been rolled out to neuros , neuromus , uh , sorry , um , musculus , other musculoskeletal conditions and neurological conditions and cancer , but it's so . People that would attend these clinics would get , I think , three months free or subsidized gym membership .

It's not the same , but if it's a community leisure center pretty much around the country they will do a very subsidized , significantly reduced . So maybe four pounds a session , three pounds a session , that's , like you know , four or five dollars , but that can still be a cost burden for some , for sure .

and it just makes the logistics so much easier . And I think that's probably a microcosm of what happens within the system as a whole .

So , despite the specific centers that I focused on , despite trying to create a building that was salutogenic in its design , that had a single point of reception for both the NHS receptionist and those that work at the fitness the leisure center , they had two different . They were from two different organizations . Their systems didn't talk to each other .

So , from a patient perspective , when you walk in , it looks like I'm going to the same desk . I should be able to go to that clinical appointment and then immediately go to a fitness class or meet with personal trainer , but the timing of the appointments , the systems don't talk to each other .

There's still and we go back to this many times a lot of mistrust and people feel they have different responsibilities between the healthcare professionals and the exercise professionals working in those centers . But a lot of challenges are reduced , I think , because it is within the NHS .

The barriers are still there , but to your point I think , the barriers are just a little bit lower .

It could be a prescription to go to like a dance class in the community for somebody suffering from low mood that wants to be more active . There's also terms called green prescribing . So , you know , can we , instead of maybe someone's not a gym person , can we prescribe physical activity in a park ?

There's something called park run which is very popular in the UK and Europe where every Saturday morning parks all around the country there are 5Ks that are run and anybody can join . Some of them are now condition specific , which I discovered through my research on cancer . There's like 5K your Way for cancer .

People are encouraged to walk , they're encouraged to do whatever they want . So I think it's about also making those options accessible .

Maybe some people don't belong in a gym , but what we found by what I found in my research is that by putting the clinics with the gym , for people that maybe don't feel like they belong in a gym environment , going to their clinic , going in through a leisure center or a gym , just helps normalize that physical activity .

You know , even if they don't attend the first time , they see other people being active , maybe with long-term condition , maybe a little bit like them , but they can aspire to that . So it helps normalize that physical activity .

So those kind of in those co-located models they're also kind of , I've heard , called active wellbeing centers are really kind of there's been a big push through some non-governmental bodies , really kind of there's been a big push through some non-governmental bodies such as UK Active .

The Royal Society for Public Health has also recently made a big call for the use of fitness professionals to fill the role of public health . So yeah , those are some things I think that do make it a little easier . And the prevention focus . I think the UK again has always had more of this kind of prevention focus and health inequalities focus .

They're making their money by doing more from a service perspective . Our payers are making their money by trying to pay less for services to be performed . There's this really fundamental tension that exists between payers and providers here that just simply doesn't exist in a national health system .

But again , I feel like we can drill down to such a great extent and maybe that's a third conversation at some point . But before we wrap this up , I want to flip the question for you . I asked you earlier what are things that are being done in the UK healthcare system that you wish were done in the American healthcare system Now reversed ?

What are things that are happening in the American healthcare system with regard to physical activity and exercise that you wish the UK system would adopt ?

A couple of those are at university fitness centers , a couple of them are at private gyms and whenever I meet Americans or I'm evaluating it through the lens in America , it's like gyms , leisure . You know , whenever I meet Americans or I'm evaluating it through the lens in America , it's like gyms , leisure centers and sport are kind of on a different level here .

I think there's not as much . Probably comes down to it looking at from a university gym perspective , I don't think there's as much because students pay a lot less in tuition fees . There's not as much invested in collegiate sport . So sometimes I do miss that aspect .

Now that's kind of going back to the other things around the healthcare system that I wish that we would adopt . So , as I mentioned , I started out in dietetics in my undergraduate degree . Dietitians in the UK there's not a lot of role for , there's not as much scope for kind of a proactive role and that's not .

I know we're focusing mostly on physical activity . But that's not just for dieticians , that goes for other allied healthcare professionals as well .

So I think more roles and more use of allied healthcare professionals and then increased focus on as much as I talk about public health , I think we do have to focus on the individual and kind of that lifestyle medicine and lifestyle approach .

I am a certified health education specialist which your American listeners will know is kind of a recognized credential for health promotion , health education , and in the UK I think we're kind of lagging behind on kind of the role of like health promotion , health coaching , that kind of lifestyle focused approach .

Yes , I've done it for the workplace wellbeing program I've worked out , but again , because we're not tied to reimbursements for insurance premiums , I think you know there might be less of a kind of role of these professions .

And then standardization and professionalization kind of of different credentials , such as fitness professionals we're working on it , but maybe not quite as advanced . And then easier access to mental health care . One thing I think , maybe popular culture . In the US there's a lot less stigma around receiving , you know , treatment for mental health and I think .

As much as I focus on physical activity , I try to get the people I work with , you know , on a physical personal training or a fitness space , to think about the whole concepts of their lives . I think we can't ignore the impact of mental health . But I still think I said just curiosity .

Are there any things that you would like to adopt from the US healthcare system ? And I think the majority of them . They love the NHS , but they're , you know , in agreement that they would be willing to pay a little bit if that meant that they could see someone sooner and face to face . So I'm not .

You know , there are some incredible people that work for the NHS and they work tirelessly during the pandemic , but there are definitely issues with it , just like there are with the American health care system .

We've said multiple times during this conversation there is no universally perfect healthcare system and I really hope that our audience , as they're listening to this discussion , just has their eyes a little bit more widely open to how healthcare is practiced across the globe , because a lot of what is being done in the UK , to varying degrees , exists in most of the

other industrialized nations on the planet where they have a single-payer universal healthcare system that's covered by taxes .

That's different than it is here in America , and I really enjoyed how you wove us through the history of the NHS , talked about its pros and its cons , and you have a great perspective of being someone who is worked in and adjacent to the American healthcare system .

You've worked in and adjacent to the UK healthcare system , so you have a really good perspective on both and we'll link up to some comments , to some information on the show notes page for people to check out a little bit more so they understand the UK system .

There was that really good paper that you sent me a while back that talks about some of the reforms that the NHS has undergone . I think that would be very instructive for our audience to listen to . The NHS is undergoing I think that would be very instructive for our audience to listen to .

But we get so stuck in our American bubble that quite often we don't look outside of it to understand opportunities and challenges that exist throughout the globe in health care .

And I don't think we can really solve for the wellness paradox by understanding what we're doing here in America , because there are so many great opportunities to learn from people like you and the work that's going on in another country . So thank you so much for all of that great information .

For me , one of the things I was very interested about the UK was Sheffield was one of the first cities to have a physical activity strategy and now you know you're doing that in the States . You're working on creating co-located or medical fitness centers .

So you know again , and I think in both countries it comes down to , there are people that are real champions of the cause and they're individuals that want to make a difference , but we need the support and the power of the backing of you know society as well .

That will be in a new special issue of the American College of Sports Medicine , which is called Exercise , Sport and Movement . And then , if you want to follow me on , I have an Instagram which kind of combines together my skills and focuses on some of the classes and things I'm teaching which I can link to as well .

For the most part , it does really provide that interesting different perspective and again , the whole goal of this conversation is to just kind of widen the aperture of what we can understand about the way health care is delivered across the planet .

Before I let you out of here , I'm going to ask you the same question I asked you last time , because I know we grow and we evolve over time and we learn , and your answer may be the same , it might be different .

Either one is fine , but I consider the wellness paradox to be the gap in trust , communication and interaction between exercise professionals and our medical community . In your view , what is the single most piece of advice , single most important piece of advice you can give our audience as to how they can close off that gap ?

And then you know , kind of my grounding and motivational interviewing and behavior change , communication and just being a person , and I think it's really about probably the same answer I've given before is developing that trust on an individual level , taking time to listen to each other , build rapport and really understand each other's job roles , each other's remit , each

other's professional boundaries and also , you know , taking time to understand oh okay , this fitness professional actually has quite a significant amount of experience and understanding of this particular health condition .

Understanding what we've done in terms of experience , education and then , like I said , taking time to understand our commonalities and our goals of wanting to improve the health of that individual or the health of the population . We're on the same team here . Why are we being so protective of what we're doing or unwilling to work together ?

And that's one thing I think I don't understand is that kind of protectionist attitude of what we're doing . We all should be on the same team .

But you know , adding to that now , my answer before on a systems level , I think , improving the quality standards for education of fitness professionals and then , you know , also further recognition for their role through policy , because I think that helps elevate the status of them in the eyes of the public as well .

That's been going to wellnessparadoxpodcom forward slash episode 136 . Please be on the lookout for our next episode when it drops in two weeks , and don't forget to subscribe through your favorite podcast platform . Until we chat again next time , please be well .