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Why the RCGP was wrong to describe Covid-19 as a ‘lifestyle disease’

An RCGP virtual conference titled ‘Covid-19: A lifestyle disease and the vital role GPs have in beating it’ set medical Twitter ablaze over the weekend. The agenda included useful talks to help GPs with video consultations and how best to utilise community assets.

I have no doubt that the day was useful for the doctors attending, as well as for their patients. However, the controversy that arose was specifically around terming Covid-19 a ‘lifestyle disease’.

According to the PHE report from earlier this month, living in a deprived area doubled your chances of dying from the virus. Working as a security guard, taxi driver or being a ‘lower skilled worker’ (many of whom have been clapped and celebrated along with NHS workers during this pandemic) was also bad news. Belonging to an ethnic minority increased your risk of death between 10% and 50%.

These statistics might suggest why people took offence to the conference title, as most of the risk factors are non-modifiable. Ethnicity, sex and being poor are not lifestyle choices, and to suggest otherwise is offensive and disrespectful to those who have died from the disease.

The report also revealed that having diabetes or hypertension also increased your risk of dying. Most people don’t actively choose to be unhealthy – we know it’s a mix of environmental and genetic factors.

Of course, individual behaviour and lifestyle are important, and it would be irresponsible to deny their role in illness. However, by terming Covid-19 a ‘lifestyle disease’, we run the risk of shifting the locus of blame to lie within the patient, rather than seeing it as a complex interplay between constitutional, social, political, and economic factors.

We run the risk of shifting the locus of blame to lie within the patient

My point extends to a wider critique of lifestyle medicine, an emerging specialty which is generating an ever-increasing number of Instagram doctors who proselytise multi-pillar plans and dietary guides to keep you healthy and glowing through self-care. According to the British Society of Lifestyle Medicine, the specialty promotes ‘physical, emotional, environmental and social determinants of disease operat[ing] within a boundary of evidence-informed medicine’. This sounds a lot like holistic general practice to me.

I have no doubt that the speakers and chairs planned this event with the aim of helping patients. I know they’re as passionate about social determinants as they are about exercise and lifestyle. However, semantics matter and sometimes you don’t see the issue until it’s pointed out.

Tellingly, a college rep who was on the event’s steering committee wasn’t aware it was happening until the day itself, and said he would like an audit, endeavouring to find answers.

With over 43,500 dead in the UK already and counting, this was a poorly-titled event delivered to the profession, many of whom are at risk due to non-modifiable factors and not lifestyle choices.

Going forward, I do hope that event organisers take the time to consider marketing and the power of language, so the potency of their aims are not lost.

Dr Tehseen Khan is a GP in Hackney, east London