Collaboration is key for the success of lifestyle medicine
Lifestyle4Health (L4H) is a member of the European Lifestyle Medicine Council (EMLC) since 2024. Here Rob Lawson (EMLC president) and Hanno Pijl (professor Diabetology, LUMC and cofounder of L4H) discuss the shared goals of ELMC and L4H, their expectations and the challenges and opportunities of lifestyle medicine.
How did the both of you get involved in lifestyle medicine?
“I’m an internist endocrinologist at the Leiden University Medical Center (LUMC) and I have been advocating the use of lifestyle in treatment, of in particular type 2 diabetes, for about 15 years”, Pijl says. “Six years ago, I teamed up with a principal scientist (Ben van Ommen) of TNO, the Dutch institute for applied science. We worked together to form the basis of L4H to advocate the use of lifestyle intervention in the treatment of not only diabetes, but in any chronic non-communicable disease. L4H started as a collaboration between the LUMC and TNO, but now is a platform with lots of members that are stakeholders in the introduction of lifestyle medicine in the Dutch healthcare system. This includes knowledge institutes, the industry, patient organisations and health funds. And now we move more towards population health as well, to preventive interventions”, Pijl explains.
Lawson: “I’m now retired from clinical medicine. I was a family doctor, and at retirement age, I set up a lifestyle medicine center. That later led to the founding of the British Society of Lifestyle Medicine (BSLM) in 2016, the ELMC in 2019, and the World Lifestyle Medicine Organization (WLMO) in 2022. My first experience with lifestyle medicine was in 1986 – before it was called lifestyle medicine – when I set up a lifestyle active management programme for people living with diabetes and chronic diseases. I’m delighted that, at long last, there are enough sensible people around who are realising that the drivers of non-communicable diseases are caused by humans. Especially in the beginning there was a lot of resistance against lifestyle medicine, and my own profession may have well been the biggest barrier. That has lessened in the course of time, and we have crossed over to an understanding that lifestyle medicine is a core addition to Medicine as we traditionally know it. In Britain we have got to the point where now lifestyle medicine is recognised as mainstream. For example, BSLM has worked with the Royal College of General Practitioners (RCGP) to produce a framework for GPs with extended roles in lifestyle medicine.”
What are the main objectives of ELMC?
“The aim of the EMLC is to change the direction of 21st century health, which is currently not in a good trajectory. The ELMC is a coalition of like-minded, non-profit, European country-based lifestyle medicine societies which promote evidence-informed approaches to prevention, management and even reversal of non-communicable diseases. We started in 2019 and now we have 25 country members, and we are still growing. The ELMC promotes advocacy, education and research into the field of lifestyle medicine by providing support and a networking platform for appropriately constituted national lifestyle medicine organisations. ELMC believes in shared decision-making, supported behavioural change and tackling upstream causes of lifestyle-related disease. Our vision is of a Europe with the best possible health outcomes for its diverse citizens”, Lawson says.
What are the benefits of the collaboration between ELMC and L4H?
“I think the introduction of lifestyle interventions in care for chronically ill people is something that is needed worldwide. In fact, we are fighting a social problem in healthcare. I believe that the European society should take measures to prevent disease and to also make the treatment of chronic non-communicable disorders easier for people. For that in particular, we need international collaboration. We need to know the people in other countries who try to implement social changes and effective lifestyle interventions in their healthcare systems. In that way we can learn from each other. Moreover, we should join forces to tell governments that they should take action. The more we push politicians, the more they will understand”, Pijl thinks.
“In order to really make a difference we have to work together. We have a real problem globally and this demands a joined up approach. The biggest benefit is amplification. Amplification of our voices enables us to make a noise in government circles in terms of advocacy and policy in Europe. Together we can be invincible”, Lawson states.
What are your expectations of L4H’s ELMC membership?
“My main expectation is to get to know people who have similar aims and to collaborate. And secondly, I hope we can learn from what other countries have established. For example, what Rob just said about the RCGP and the lifestyle programme they developed is very interesting to know. Hopefully we can establish a similar thing with the Dutch General Practitioner Organisation (Landelijke Huisartsen Vereniging, LHV)”, Pijl explains.
“It is hugely important to create networks and getting people together who have a particular interest, because lifestyle medicine has a very wide scope. And we need to provide evidence for lifestyle medicine, that requires more research. At ELMC level we’ve set up two task groups, one focussing on policy and the other on research. The policy group looks into health economics, education and advocacy. To get minds from across Europe involved in this work gives us a broader perspective. L4H is a valued partner that can help us with that”, Lawson adds.
What are the goals and themes ELMC and L4H are looking to explore (together)?
“We just defined a new strategic plan for L4H. We mainly focused on health care until now, but we move a little bit more towards prevention. We have two things we want to focus on for the next couple of years. On the one hand, on social change in collaboration with municipalities. We choose for local because we are reluctant to work on a country level yet, as that is often more complex. So we try to work with municipalities to see whether we can implement changes in different city areas to promote health. Besides that, we focus on the work environment. We will try to work with industry, with businesses to improve the work environment of their employees to promote health. We hope that via these two routes we can contribute on a social level. And of course we will keep on working in the area of health care, to implement lifestyle interventions and finance lifestyle interventions in Dutch health care”, Pijl states.
“These initiatives of L4H fits to what we aim for. Obviously, at council level, we have to think at both government and regional level. And ultimately, if we don’t pay attention to social, environmental and economic determinants of health, we’re only firefighting. So Hanno is right, making social changes is hugely important. Our living environment, including the work environment are important. Well-being at work is something that, at world level, we’re bringing into the focus of employers and corporates. We attended a meeting with the World Trade Organization in Geneva in September, and got a very good reception. But as a Council, we have yet to get a strategic plan in place. We’re currently simply gathering people together, working through the policy and research areas and to get some sort of European cohesion, for example via the Alicante Accord”, Lawson explains.
What are the biggest challenges for lifestyle medicine?
“Lifestyle medicine is not a protected term, anybody can use it. So we have to set standards, maintain them and make sure that accreditation takes place. I think it’s really good that you are getting local government, municipalities involved in The Netherlands. In Scotland we haven’t been able to get local government to participate. Our financial situation is pretty difficult, I don’t see that money being channelled into the third sector or community assets to support the kind of local interventions and changes that we need. So I’ll be fascinated to know how you go about it, Hanno. And how it succeeds, because we need to replicate successes”, Lawson stresses.
“We still have a lot of work to do, and the signs are certainly not only positive. It is going to be difficult, in particular because the financial situation of Holland is getting worse as well. We just heard that our new government will completely shut down all money for preventive health. It would be interesting to find out whether prevention is something that other governments are investing in, and what they mean by prevention, because prevention means different things to different governments”, Pijl says.
“I agree. One of the worries I have is that people see prevention as an alternative for early intervention. I think screening healthy people isn’t something that actually is worth the money. If you’re going to screen, screen people who are at risk. Concentrate your efforts. One of the problems that we have in the medical community is iatrogenic disease. We are actually contributing to the problem through overtreatment and overdiagnosis. We do have a battle, but I’m more positive than I was 10 years ago. I think that if we don’t invest in lifestyle medicine and change the direction our health is going, our children and grandchildren are going to suffer. I don’t want that to be our legacy”, Lawson emphasizes.
Collaboration on different levels
“It might sound strange, but I think it would be useful to join forces with climate activists and scientists. A healthy climate will improve our health and the measures that we have to take to improve our climate, are the same to get ourselves healthy. Joining forces would amplify our voice”, Pijl thinks.
“Climate change has a very negative impact on human health. And therefore, we have to pay attention to that as well. So I agree with you. Collaboration is the most important step, between parties interested in lifestyle medicine and beyond. Our citizens deserve to live in an environment where they can live in optimal health. So let’s keep working away, together. There is a lot of uncertainty around. But the one certainty is that lifestyle medicine can make a big difference to people’s lives”, Lawson concludes.
