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The need to be productive with minimal exposure to Occupational Health risk has become an integral issue in the front burner within the International Labour Organisation and World Health Organisation. As much as this has raised so much concern, i am particularly worried over the lack of zeal and interest of most countries in paying attention to the global outcry and giving full participation in supporting a healthy and risk free work environment.

Come 28th April 2013, countries across the world will be pitching tents at different geographical locations to celebrate an ILO initiative called “World Day for Safety and Health at Work”. This program is celebrated every year on April 28 using different themes based on risk prevalence or disease trends as communicated by ILO. The theme for this year’s celebration is “The Prevention of Occupational Diseases”.

You will agree with me that this year’s theme could not have come in a better time than this taking into consideration the disregard that Occupational Diseases have suffered across many sectors of the world because of perhaps the desire to post huge profit with high compromise to the safety and health of employees or in some cases complete irresponsibility displayed by business owners and managers towards the Occupational Health plight of workers. Of late, there have been some controversies from different quarters on where to draw the line or balance the difference between working safely and working productively bearing the mind that profit is the primary reason why businesses exist.

In my opinion, in as much as every business goal is to remain profitable to the owners, we should also understand we can also remain profitable without necessarily killing and maiming people at the altar of profits. We remain even more profitable by embracing the concept of health and safety in our workplaces; it is more expensive to manage accidents than working safely. One cardinal regrets on the long term impact of the work we do on our overall health is that the eventual outcome of the effects of what we have been exposed to takes a long time to manifest and sometimes this is even after we have retired fully from work. He that works unsafely today should bear in mind there are deposits you have made which your health must draw from in time to come. Should we then continue in this manner? Will this guaranty a sustainable future? Should not we rather preserve the lives of these experienced and aged employees who are potential victims of Occupational diseases? Wouldn’t it have been better if they remain reservoir of knowledge and experience to the younger ones? Wouldn’t this contribute to Nation’s building? These and many more are questions begging for answers. Remember, the death of an elder is as good as a library burnt down, that is how history puts it.

I also feel effective organisational policies will help to forestall this ugly trends that impacts negatively on the lives of employees in their work places. But my big question is, are there enabling Occupational Health and Safety legislations in most countries to support the policies?  Perhaps the west that has reasonably good enabling legislations but why is Africa left out in this global movement that advocates sustainable development? Isn’t this an integral part of the MDG program?

If Africa is really the future global market as predicted by virtually all the renowned and respected Economists and Investment Analysts, shouldn’t Africa be at this point be at the forefront in advocating for global best practices knowing our environment, our workplaces have become the spotlight of most investors across many continents even as have been evident, Asia. This is again an indication that Africa is a reactive continent and perhaps this sums up the reason why we have not been able to embrace the concept of Occupational Health and Safety which hinges not on REACTIVE but PROACTIVE dispositions. We cannot pretend not to know the impact of these incoming investments on our environment and the health of the African people. There are a number of global economic alliances happening across Africa with the BRICS economic initiative comprising of Brazil, Russia, India, China and South Africa, there are also other happening between Nigeria and other countries. These are all investment machineries focusing on boosting trade in Africa and with Africans; good as it sounds we need to think the processes through and mitigate possible short and long term effects of these business environments for the good of all.

Let us quickly ask ourselves the following questions:

Is Occupational Health and Safety legislation process different from other bill passage processes?

If no, why the reluctance in passing this most wanted bill?

Every retired parent has a child that is gainfully employed somewhere and every child has a parent that works in some workplace, it is the way this Occupational Health and Safety issue connects us all. If we keep quiet because we have retired from active service what about our children who just got in? If we cannot speak out because we are still young and in school yet to join the labour workplace, what of our working parents? This issue concerns us all, keep not quiet but speak out where ever and whenever you have the opportunity. The safety of everyone should be everyone’s concern.

If each one can touch each one then everyone can touch every one, what a safe place the word will be. Let’s do what we can today, for the night cometh when no man can work.

Salus Populi Suprama Lex  “The safety of the people is the supreme law”.

Please read and leave a comment.

Ehi Iden







International Medical Assistance is a concept that was designed to ensure that health policy holders of any international health insurance companies are able to use their policy cards across the world with little or no difficulties. This was the idea and thinking of health insurance providers that gave room to International medical assistance program.

Though the concept strives and performed optimally well in some countries of the world but difficulties are still being faced in proper administration, non availability of standard healthcare facilities, poor access to very fast medicare at the time of critical need, these and many more are the issues still hindering the smooth and efficient administration of international medical assistance services across the world.

There is an urgent need to critically review processes in ensuring enrolees get good value for their money and the healthcare facilities are also rightly motivated and incentivised through timely clearance of all Guaranty of Payments (GOP) if in use and in some cases have serviceable credit lines. At the moment, the risk is currently being shifted to the enrolees who most times are not granted access to medicare either because their health insurers are not known in that part of the world they find themselves in and even in some cases they have no enough funds with them to pay off the medical bills which will be duly refunded anyway. When such cases occur, one begins to wonder if it would not have been better to have your funds to yourself and be self accountable for all health challenges and eventual outcomes within a fiscal year.

My questions are:

  • Are there ways to do these better than we are currently doing?
  • Can we collate all questions and challenges reported to a round table and identify better ways of improving on the existing services and processes?
  • Can we fully take up the risk, instead of virtually sharing it with the policy holders?
  • Are there international trade barriers that currently impede the smooth administration of international medical assistance? Can they be identified and reviewed?
  • The state it is now, can our products really win and sustain subscribers confidence? If no, then the time for review has come.
  • Are existing frauds within all levels of implementation stages also factors to be considered? If yes, can we profile the countries of high prevalence and work out ways round it?
  • Is there the urgent need to tag-on with the local health insurance companies in ensuring a face is attached to the management of subscribers in such country of treatment?

I have become rather worried over these issues of late mostly the ones i have seen in Lagos Nigeria under the international medical assistance platform. Maybe we should even define health insurance in the right context; it could just be the missing clue to fix this whole confusion.

Health insurance has been defined as the insurance against the risk of incurring medical expenses among individuals. Or

The insurance that compensates the insured for the expenses or loss incurred for medical reasons, as through illness or hospitalization.

The statement common to the two definitions are “incurring medical expenses” and if health insurance must act in line with this definition, it means there must be that capacity and capability to absorb or manage the health risks of the subscribers within the period of the validity of their health policy. We need more people into this pool and the only way to make this happen is to ensure a high level of trust and confidence exists between the insured, the insurer and the treating facility. The interface must be strong, cordial and mutually of measurable benefit to all parties concerned.

There are a whole lot of distrust which currently exist amongst this circle of stakeholders which have greatly imparted negatively business relationships and quality of care delivery. We understand the huge fraudulent practices and gross dishonesty on the part of the subscribers also which has a huge cost effect on the finances of the international medical assistance company. Most of these false policy claims arise from falsification of medical bills, falsification of admission that never existed, claims of known costly treatment that were never done. There could not have been such claims if there was no connivance with a health facility or a treating Doctor that issued both the false medical report and the acclaimed medical bill which the policy holders always claim they have paid for with valid receipts to support such claims. This has created a level of distrust with the relationship chain; investigations and excessive scrutiny are now in place to verify claims even when they are genuine. Is this practice what we can do away with? Yes, we can.

We do not need to play in every market, let us play in markets where we can have a level of control for our products or where we can have responsible persons or organisations duly representing our interest in effectively managing our subscribers. The International Medical Assistance companies should defractionalise and close up the market with strong capacity building and development which makes them form a strong mass through a collection of several insurers having a cover under one umbrella and trading in that name in countries where they have no comparative advantage. This we see already happening among the International Assistance Group (IAG), other smaller companies registered under them use their names in countries where they have strong controls. This is all to the benefit of the subscriber.

We have had to investigate a number of cases, case-manage so many other cases and even sometimes we had to place a local Guaranty of Payments (GOPs) in place on personal recognition for the sake of the subscribing patients who needs medicare at such times. We still feel these are not all enough, there is the need to have a face to your international medical assistance policy having an in-country representative who will at all times be available to help sort you out. When this happens, we can have international health policies and travel to Ukraine, India, Bangladesh, Morocco, Australia, China, Venezuela, Sweden and of course Nigeria without having any difficulty in accessing quality medical care based on trust, equity and fair play on the part of all stakeholders within the wheels of best global practices.

There is also the need to understand infrastructural gap which still exist in most countries and there are times mails are sent about a patient sent to healthcare providers and they at the hospitals at that moment do not have a functional internet services, these and many more creates a number of breeches in trying to run a smooth and hitch-free processes.

One of the things our company has done of late is to be able to position properly for the International Medical Assistance companies in ensuring we cater for all requests sent to us seamlessly by closely interfacing properly with all notable hospitals across the country and riding on the wings of such relationships to ensure nothing is left to chance.

We have become very involved through our Medical team in:

  • Case management
  • Bills verification and negotiation
  • Admissions confirmation
  • Treatment review and confirmation
  • Case bookings
  • GOP placements
  • Third party hospitals management
  • Local and international medical evacuations

These have greatly become very crucial units within our growing SBUs. We will keep innovating changes and ensuring what ought to be done are rightly done to create requisite value for not just the patient alone but the healthcare facilities and ultimately the International Medical Assistance community.

We just wanted to share our market experience, opportunities and the daunting challenges. Kindly read through and leave a comment.

Ehi Iden







Let us ensure we do something in our places of work and homes today, no matter how small. Chemical use has become an integral part of our modern daily lives and we cannot dispute this fact. With the trend of development in divers areas, chemical usage will certainly be on the rise and we obviously may not be able to stop this but it is within out rights to adequately control the effects and levels of exposure. This is called chemical management processes.

Hearing the name “Chemical” your thoughts might be as erroneous as mine was years back thinking after all i do not use chemicals. You might be right but not in absolute.

If we have had cause to clean our toilets, mop our floors, wash our clothes and involved in any way in either domestic or industrial cleaning processes using any of the cleaning agents, we have had dealings with chemicals.

Have you had medications or fumigated your house of late, have you used any form of pesticides or insecticides owing to malaria endemicity within our region, then we have had contact with chemicals.

Chemicals are key to healthy living and modern convenience. They range from pesticides that improve the extent and quality of food production, to pharmaceuticals that cure illnesses, and cleaning products that help establish hygienic living conditions. Chemicals are also critical in many industrial processes for developing products important to global standards of living.

However, governments, employers and workers continue to struggle to address controlling exposure to these chemicals in the workplace, as well as limiting emissions to the environment”  International Labour Organisation.

Do you go through the roads where you are exposed to heavy vehicle fumes? That is another form of chemicals. Which ever way you look at it, chemicals have come to live with us and it is our responsibility to know the contents of the chemicals we are exposed to and the inherent health hazards. This will absolutely be the first step in safe guarding our kidneys and lungs which are the two major organs where chemical inhalation really hurts us as human beings.

By virtue of exposure to chemical inhalation in your work processes, you are by right expected to undergo medical evaluation test twice a year to look at the functionality of both your lungs and kidneys and possible damages that have been constituted due to your chemical exposure level. The medical evaluation processes include but not limited to:

  • Spirometry test
  • Electrolyte, Urea and Creatinine

These are very basic and periodic medical evaluation that focus mainly on the state of your lungs and the kidney. Upon completion of the evaluation, if there are spikes or indicators that warrant a further Physician’s review, we will gladly make this referral because early detection gives you a better disease management opportunity and increase our survival chances.

These are not obviously the only areas where chemicals hurt. What about people who daily work with chemicals as Industrial Chemist, others who apply them daily for general cleaning or blasting corroded pipes and rusty metals, we should also get concerned about these ones. The effects are not only on the internal organs but also on the skin surface and that is why you hear of skin burns, skin tissues and the likes of it.

Chemicals have high spilling potentials in our workplaces if processes are not well spelt out and managed. Chemical spill could lead to death of a group of people depending on the nature of chemical, quantity spilled, proximity to the chemical and duration of the chemical contact before medical help came their way.

Every chemical available for use, the user must be well informed of the chemical hazardous contents and every form of information that is available as it concerns the chemical. There is always an accompanying document to chemicals called Material Safety Data Sheet (MSDS) or Safe Handling of Chemical (SHOC) cards, these documents are made available within each chemical type to equip users with all the handling information necessary. We have realised that most people do not even read these documents, they get too familiar with the chemicals as working tools and they handle them without reading the accompanying chemical handling information and people get affected at different degrees.

Having been informed on the chemical inherent danger and handling processes, there is also the need for everyone who will get involved in the application of those chemicals to be fully protected with adequate personal protective equipment (PPE) which is expected to protect the user from the harmful effects of the chemicals. When we say PPE we do not mean any form of PPE, we are referring to requisite and adequate PPEs addressing the specific threats posed by the chemical types. Of late we have noticed in most companies and workplaces, people just go to safety shops to buy anything just because they were told PPE is a work pre-condition and the PPE they end up acquiring has no form of relevance with their risk exposure they intend to address, this is not safety.

Outside the chemical information and provision of PPEs, there is also the need for adequate training of the personnel that will daily use the chemicals. This is a very critical point in the entire chemical handling processes. That you used a similar chemical in another environment or project location does not mean the processes and application methods must remain the same even in the age to come. We must learn to submit ourselves to training and retraining even on the chemicals we feel we are so knowledgeable of, when you introduce any form of new chemicals there must be the need to retrain your people to adapt their skills to the new chemical type. When there is any form of change in the application processes, we must also undergo a retraining to ensure adaptation to the new processes.

What is our level of preparedness to chemical hazards response? There is a concept called Remedial Action Plan (RAP) which is put in place to remedy any form of release of threats or severity when there is a failure in our existing health and safety processes or management system. Example is having informed your employees on the hazardous nature of the chemical in use, you have made provisions for all the necessary PPEs and adequately trained them on the application processes and use of the chemical type and you still experience chemical spills into the eyes. You should also be proactive enough to make provision for eye wash within the workplace; the eye wash can be used to quickly irrigate the eyes to limit the harmful effects of the chemicals before having access to adequate medical attention. These and many more are some of the processes that can limit our chemical hazard exposure within our workplaces and safeguard lives in no little way.

In rounding off on this article i will also point out the prevalence of chemical hazards as a result of storage. We have also been to many workplaces where chemicals are stored in clinical cans and other form of storage materials without adequate labelling and sad to know this is also a huge contributor to domestic hazards. In my days in active clinical services, we have had instances where children were rushed into the hospitals as a result of chemical absorption; they drink kerosene, medical syrups in bottles and other forms of colourless chemicals stored in cans within the reach of children and mostly infants in our homes.

In some cases, chemicals are stored in cans without proper labelling and anyone could work with some wrong assumption that could lead to a very costly end. Even the temperature under which chemicals are stored should be a key condition to consider in the entire chemical hazard management processes. These requirements are all spelt out in the Material Safety Data Sheet and Safe Handling of Chemical documents and i think we should give these conditions due consideration in our continuous efforts in working with chemicals.

I wish every reader a happy World Health and Safety Day at Work 2014 and we are looking forward to doing something different God willing in 2015. If anyone must die, let it not be as a result of chemical hazard exposure. Stay safe.

You can also checkout what we are doing on Facebook in trying to change the world. Kindly follow us on www.facebook.com/changingtheworldnetwork, please like the page and join us on this global movement for social change.

Ehi Iden



It has become imperative that we discuss this issue surrounding mental health amongst Doctors and other healthcare workers. The sanity and mental wellbeing of a healthcare worker including the Doctor forms the bedrock of patient safety. It takes a safe and sane person to deliver safe healthcare and we have to give this attention also even as we navigate daily trying to find ways towards improving quality of care within our healthcare systems.

Within the last two weeks in Nigeria, we have had two very shocking incidents which have left everyone rattled and disturbed. The first case was that of a Medical Doctor named Emmanuel Ogah who stabbed his 62 years old mother to death in Lagos. As we were all still trying to come to terms with that incident, on the 19th of March 2017 another Medical Doctor identified as Dr Allwell Orji asked his driver to stop at the middle of third mainland bridge, came down from his car and jumped into the lagoon where he drowned to death before help could come his way. These two incidence happened within a space of one week bringing the loss suffered within the Medical profession to two in just one week.

This has got me thinking as an Occupational Health Consultant and a Patient Safety Advocate, I am battling so hard to balance this out and looking at how it further increases the risk exposure to the patients. These are both Doctors who were trained to care for patients, could they have been overworked? Are there issues surrounding their personal lives as families and other very personal issues responsible for these acts? Nigerians were not known to commit suicide, the suicide index in Nigeria has been very low and non-significant but we cannot boast of that any more, we are fast losing our resilience and copping capacity. Let’s take the issue of being overworked as an example, the population of Nigeria is 173.6 million people according to 2013 report and if we go by this report, Nigeria needs a minimum of 237,000 Medical Doctors to care for the population in line with the World Health Organisation (WHO) ratio of 1 Doctor to 600 people within a population group. But from all reports available within this context, there are only 35,000 Doctors actively working as Medical Doctors in Nigeria and this is just not a good enough ratio and there is no need Doctors will not be overworked. We are invariably having 1 Doctor to 4,960 people following the figures above. By this figure, we can almost conclude that workload may have just been a strong contributing factor to suicide or death amongst Doctors and healthcare workers in Nigeria. Though the Nigeria Medical College has trained more than this number of Doctors, a number of them have long delved into something else as music, sales and marketing, importation and other viable entrepreneurship ventures.

The question is, how does this impact on patient safety?

It is even sad that mental health was not included amongst the list of Occupational Health diseases or illness in International Labour Organisation list of occupational diseases until much later when the toll became so obvious. Psychosocial hazard has become a very huge issue within the healthcare work environment leading to burnout, fatigue, exhaustion, stress, tiredness and sleep deprivation amongst healthcare workers and these outcomes impact negatively on the safety and quality of care within treatment cycle. The need to keep the healthcare workers safe and mentally stable is a thing that needs our collective action and support, it takes a safe healthcare worker to deliver safe healthcare to patients.

We should be looking at the workload and duration of duty shifts within the healthcare sector which has long changed over the years, making workers to engage in longer hours per shift dealing with excess workload beyond their copping capacity. We all agree that in healthcare, we deal with lives and any mistake within the line of service delivery is always a costly one which innocent people pay for with their lives. Work overload is a critical issue surrounding daily patient harm in the hospital, it hurts the patient as a much as it hurts the healthcare workers. This load, if allowed to persist for too long, alters the mental wellbeing of the healthcare worker leading to cheap mistakes, irrational behaviour, lack of co-ordination and a total disrespect towards the right and dignity of patients. This is never in any one’s best interest.

There are many Doctors, Nurses and others who love their jobs and keep giving all they have, giving mutual support to other Nurses who they perceive to be overwhelmed with work, this sometimes lead to collective burnout within a team leading to patient harm. Such healthcare workers are seen as trusted by everyone and tagged “MR FIX IT” because of the willingness he always shown to help or assist. The worker becomes a victim of patients continuous demand, he does not say NO but always there to help, overtime he becomes emotionally overdrawn and this can also lead to patient harm.

Mental health amongst Doctors and healthcare workers should at this point be taken so seriously owing to the new and emerging conditions and disruptive behaviour noticeable amongst healthcare workers. The two Doctors whose cases were sited at the beginning of this write-up are supposed to be managing patients trusted in their care, any Doctor that thinks suicidal for whatsoever reason is a risk within the hospital environment no matter the department or unit he works from. I really think this is where we must be looking deeply into Human Resources management in healthcare environment, this is not a function assigned to a new comer but a role played by a very experienced professional with a strong analytical background in Human Psychology. We cannot rule out the fact that these two Doctors never displayed such violent or suicidal behaviour that would have attracted the attention of co-workers or even the Human Resources Managers who would be expected to have an audience with such an employee with obvious suggestive indicators. We need to start engaging our colleagues, we need to start setting up Employees Assistance Programs (EAP), we need to start looking beyond work and also start getting quick and smart peeps into what happens in the home of our employees. Are there issues? Are there smart ways we can help out? This should be the thinking, it will save both the patient entrusted into the care of such employees and the employees themselves and maintaining good reputation of the healthcare facility.

We must understand that healthcare workers are human beings just like us all, they are not super men, and they are fallible like every one of us. We need to start re-humanise our workplaces, let’s start reviewing the workloads, timelines and deadlines, let’s once again treat these people the way we would want them to treat our patients. Let’s bring dignity of labour back to healthcare, let’s again work like one big family where we all continuously watch each other’s backs, let’s rebuild the lost confidence while having the patient at the centre of these thoughts.

Losing more Doctors and seeing others behind bars due to homicide and seeing others incapacitated and almost invalid when we know the work pressure and work environment contributed to these conditions and states is not a plus to us all, we can change it.

It just takes a SANE Doctor to offer a SAFE healthcare.

Ehi Iden







In our studies and work with several organisations we have identified with the global efforts on the statement that chronic disease and lifestyle-related health issues are on the rise globally, raising potentially disruptive implications for workforce planning and development. In order to effectively plan for sustainable work forces, employers with global reach are now compelled to refine business strategies with employee well-being in mind.

As economy of different countries and organisations are affected by the new global economic hardship, more pressure has been placed on executives and organisations like never before to uphold their organisations through sustainable innovations and strategies. This expectation is worsening the level of health outcomes of organisations through stress, burnouts, sleep deprivation, increased blood pressure, poor heart health, very critical timelines, leading to overwhelming mental and bodily task and overall health risks. These collective health issues, if allowed to prolong will make us all end up with chronic diseases in the long term. Retirement years are becoming characterised with so much illnesses which are outcomes of our behaviour and lifestyles during our active work age.

Smart companies across the world are enacting innovative health and wellness programs to stimulate improved employee health in such critical time as this. Motivated by a desire to positively impact their employees’ health and well-being, as well as driven by defined business goals and redefine their work cultures.

Achieving business success is not only predicated on entirely business strategies and processes, the health and wellness of the work population cannot also be overemphasised. The question is how integral is a healthy population to our overall business success?

What is healthy population: This is the healthy outcomes of a group of individuals, including the distribution of such outcomes within a group. Though there are existing health plans (health Insurance) in most organisations, but the urgent need to move from focusing on curative healthcare approach within the workplace and moving to preventive health underpinned in health and wellness programs is of urgent importance. The need for organisations to focus on social ecological models within the workplace and consider environmental cues that influence our overall health and wellness has become expedient.

There are two major critical factors that have become key influencers of continuous presence on chronic disease in our workplaces. The two major factors are:

  • Dietary pattern or style
  • Physical inactivity

Dietary pattern: What we eat becomes who we end up becoming. Our dietary pattern and eating habit has grossly changed in the past two decades and the need to revert the trend has become a global anticipation. Most organisations have common food sources and the need to tie the food types into our wellness and health programs is also of overall importance.

Eating behaviour amongst us has also gone very bad. Binge eating and disordered eating have characterised eating pattern amongst us all and this is fuelling our body sizes and body weight accumulation. It will interest us to know that body weight and body fat composition are pointers to our collective health risks. Psychology of eating states that people eat for different reasons; these talk about hunger, appetite and satiety. We should eat not because we have appetite for food but because we are truly hungry. Eating because we have presence of food all around us is stimulated by appetite and this is one underlying cause of increased body weight.

There is the concept of energy balance which we must all apply in ensuring a healthy life style and body weight. Energy intake over energy expenditure is what energy balance represents. If you must eat much, be sure you have enough physical activities to expend the amount of food taken in. This will keep you healthy.

Physical inactivity: Physical activity is not same as physical exercise, this is unintentional or unplanned physical activities we get involved in. The World Health Organisation (WHO) defines physical activity as any bodily movement produced by skeletal muscle and require energy expenditure. Physical inactivity has become a huge confounder of chronic diseases not only among a working population but a collective global concern. As technology improves, mechanization of the workplaces increases and this fuels sedentary lifestyle amongst workers. The guideline for healthy living says, sitting in a position for one hour and above at a single stretch is unsafe and unhealthy to us all. Studies have revealed that sitting time is associated with increased risk of obesity, heart disease, diabetes, high blood pressure and other disease states.

Most smart organisations in their attempt to improve healthy life style have adopted the policy of having a central printer system which is kept far from everyone’s seat. This means everyone will have to deliberately move from his or her seat to pick documented sent for printing. This means unintentional muscles activity has become part of the workplace engineering processes. This should be encouraged and emulated in workplace health and well-being designs.

Lack of physical inactivity has made obesity and overweight become prevalent in workplaces, people are sliding our of healthy body weight range while some are even getting into morbid obesity stage.

What is healthy body weight?

This is calculated using weight in kg divided height in metre square. Below is Body Mass Index (BMI) categories based on increased risk.

< 18 = Underweight

18.5 – 24.9 = Normal Weight

20.5 – 29.9 = Overweight

30 – 34.9 = Class 1 obesity

35 – 39.3 = Class 2 obesity

>40 and above = Class 3 obesity (morbid obesity)

Prevalence of obesity and overweight in adult population globally

Adult men: 34% are overweight and obese

Adult women: 35% are overweight and obese

Adult men in obesity above 30 BMI: 10%

Adult women in obesity above 30 BMI: 14%

We will be leaving this discussion here but if you can follow us in the next edition, we will be looking at sleep, stress and health risks.

You can reach us using ehi@ohsm.com.ng


As a child growing up in a fairly remote village, I followed my mum a couple of times to the local maternity centre at the delivery of my younger ones for routine child immunization. One thing I noticed which I clearly remember till date is mothers giving their babies Paracetamol syrup prior to their baby’s immunization. I watched with so much curiosity with many questions in my mind but I was too little and naive to voice say these things out yet I lived with them for years.

When I started my career in 1997 in the hospital, I saw it happen again and I asked a Matron colleague of mine who took time to explain to me. It was then I realised, mothers actually give this medication prior to immunization to prevent their babies from having high temperature. I was so amazed when I imagined the level of awareness and poor educational levels of those women I saw in the village. What these mothers were involved in can be relatively seen as a preventive health approach to health (proactively preventing increased body temperature in infants). It simply means taking proactive actions to prevent possible ill health, sickness or disease before it comes.

What those mothers understood even in that poorly informed level is that their babies can avoid the pain of suffering from high body temperature if they are given paracetamol prior to vaccination. My question is why couldn’t the mothers leave the babies to just take the vaccines without necessarily giving them those medications? Even the Mothers need peace of mind. When their children suffer from increased body temperature, the mothers also suffer discomfort.

This was just to build a foundation on what this column will be focused on within the time or period we have at our disposal. Preventive health is indeed the new frontier in healthcare delivery; it is the new world order in both saving healthcare cost and achieving improved healthcare outcomes. We grew up to meet our healthcare professionals enjoying the conventional curative clinical care, the business the health professionals had with patients was just to listen to patients’ complains, examine their physical clinical presentations and either recommend them for further laboratory investigation or outright drug prescription.

In modern day healthcare services, the complexion of healthcare delivery has greatly changed even the treatment pattern. The focus now is overall wellness, wholeness of body, mind and soul. This is where interaction and patient engagement has placed patients at the centre of quality healthcare delivery team. The rule is, we do not want you to be sick before you come to your healthcare professionals, even when you have questions, go to them and seek medical clarifications.

There used to be a level of reserved disposition among practitioners towards patients, but this has long changed because we must talk with our patients, answer their questions and clarify bothering medical issues they may have in their mind.

The role of the healthcare professionals have transcended beyond just caregiving but to health education, health awareness and health promotion. The patient needs to get informed, the patient needs to know what to do to maintain good health, he needs to know the food type suitable to maintaining good health and possible ways to modify life style in the midst of available health risk exposure.

Preventive health has been recommended as the most cost effective form of healthcare delivery. Let’s look at Hepatitis B which is a viral disease that has a violent effect on the liver, you will agree with me that it is easier, safer and most cost effective for us to get an early screening and take the vaccination if we come out negative. The highest cost you may get this screening and the three course vaccination will be between N5, 000.00 – N7, 500.00, but the average cost of having a six-month treatment outside the pre-treatment test falls within the neighbourhood of N500, 000.00 – N750, 000.00. There is no guaranty that the virus will be totally out within this six months, you might need about a year, two years, 6 years or longer therapy to totally get rid of this viral infection.  What this tells us is that the cost of immunising yourself against Hepatitis B virus is just 1% of the cost of having a six-month therapy.

In any balances you may weigh this from; it makes a whole lot of economic sense to embrace Preventive health in our overall quest to maintaining an improved and quality life style. Curative Medicine is still very much in practice and in use but we need to free spaces in our healthcare facilities through Preventive Health approaches to allow those who really need those clinical environments access to curative care as recommended.

Organisations, families, governments and health insurers are financially bleeding in their health funds because of the sole reason of waiting till we get really sick before we seek medical help. This is wrong; we need to seek Medical help in form of Medical advice even when we are not sick. We need to have thorough engagement will our healthcare providers, if they are not talking to us or providing answers to our questions they cannot be the kind of healthcare providers we really need.

The most important approach to healthcare delivery in 21st century is “Caregiver-Patient Engagement”. This has another twist is preventing medical errors and ensuring patients safety.

We will be looking at most of these issues in details as time permits us subsequently. Stay glued to us here, we will surely be back.

Ehi Iden




It is most shocking that life expectancy in Nigeria according to 2011 report is 52 years, it is the 17th lowest in the world and i am really afraid because this is going to go even worse the way things are currently in Nigeria. I would rather think this report should have been of great concern to the Government of Nigeria mostly the Ministries of Health at both State and Federal levels; nothing has been significantly done to the best of my knowledge to improve on this statistics starting with health education and enlightenment on lifestyle improvement.

It would interest you to know that even our neighbouring countries like Ghana stands at 62 years while Niger Republic stands at 55 years life expectancy. We have countries like United States of America at 78 years, United Kingdom at 80 years while Switzerland and Hong Kong topping the list with 83 years life expectancy.

Seeing some countries healthier than others is based on 3 predominant factors namely:

  • Access to and quality of healthcare (health equity and health equality)
  • Difference in lifestyle
  • Difference in environment

When we consider the environmental factor, you will realise no individual exists in isolation but within a certain environment which greatly frame our lifestyles on both short and long term. Our roads were built without walkways, estates are built without play grounds and most recently schools are approved without consideration for sports and recreational infrastructures but the question is how did we get here? I still remember my primary school and secondary school days where you have more than enough sports infrastructures in schools, we found these very useful and you never can imagined how much those things contributed to the school child’s overall development most importantly mental health. We had inter school competitions, principals’ cup football tournament, inter house sports competitions and many other activities which added fun to learning and created activities that aided the school child exercise. It is so sad, how it has turned out these days. Do you know children are beginning to be hypertensive even at school age? This is a new development that has become so disturbing in global health perspective. How can this trend be corrected? What needs to be done? Can we roll back the years? It is indeed really sad.

A child is supposed to clock 60 minutes exercise time daily, it may not be at a stretch but all his activities for the day put together. The society and environment we have found ourselves has not helped in any positive way, children are most times been restricted to just the parents’ apartment and sometimes the compound which ultimately takes away from them the opportunity to clock requisite exercise expected of them daily. They eat without the opportunity to burn out the energy and this leads to heavy storage of unutilised calories in their systems which they must pay for later in their life time. Even adults are the worse victims in the excess calories storage; we need to know that every individual is the driver of his or her own health conditions.

We are living in an age where everything about and around us have become mechanised, we are a mechanised people living in a mechanised society in a mechanised age. No one walks anymore, there is huge vehicular movement on our roads, everyone wants to drive to even the nearest locations or shops, gone are those days where people walk to run errands or walk to visit friends.

There was a recent study done in U.S.A and U.K which looks at categories of people who run their errands using their personal cars, chartered taxis, public transportation, bike/walk as means of movement. What was most shocking in this discovery is the percentage number of people amongst the group assessed in the category of walk/bike. 32.3% of the adult group assessed in U.K. walk or use bikes to run errands or sort out issues but shockingly only 6.3 % of the adult group assessed in the U.S. walk or use bikes to run errands or sort out issues. This may be a very useful contributor to the difference in life expectancy in both U.K and U.S.A as already highlighted above.

Let’s learn to walk again and go back to our bicycles, these are cultural lifestyles that are fast eroding. Our fathers used these means and they yielded good results for them, why has it become so alienated in many countries of the world and mostly the continent of Africa? Walk for life is a healthy lifestyle code, let’s adopt it.

Have you heard of a concept called “Energy Balance”? It is simply talking about the amount of energy intake over the amount of energy expenditure. If you took in all that energy, you should be ready to also expend it proportionately so you can live healthily. Ensure you take in as much calories as you have the capacity to expend, if we are not able to get this right then we run into health trouble.

In most families’ pantry and shopping list today, how many of fresh foods as fresh vegetables, fresh fish, fibre rich foods, green foods do we really find? Everyone has gone into the collective chase of canned food high in salt and this is not helping anyone’s health. Because of work and career demand, we have all become so dependent on “MRE” (Meals Ready to Eat) they are basically found in cans. You need to know these foods have preservatives, high salt content which has high potential to induce hypertension. Let’s do more of fresh foods, fruits, fish instead of red meat, low cholesterol oil, less of sugar, less of canned and preserved food, less of fries and the likes, we will just be on a new trip for better health. Non communicable diseases are becoming a huge global concern, diseases like cancer, hypertension, diabetes, high blood pressure, stoke and other cardiovascular diseases traceable to sudden deaths are very preventable when a healthy lifestyle is adopted.

I have realised, we cannot solely blame our inability to live a healthy life on other people or government policies, living a healthy life is a deliberate choice we must make as individuals and it takes a whole lot more than being disciplined to make it happen but most importantly knowing that you are responsible for what happens to you and that you can control things within your capacity as it has to do with your health.

A word, they say is enough for the wise, the ball is in your court. Living a healthy life is a human right, compromising this is not in your best interest. Do not add to the statistics, stay alive.

Thanks for taking out time to read this.






As you may already have known, one of the key factors that fuels overweight and obesity is poor dietary pattern. Poor diet is not only centred on poor nutrient value but also our eating habits and eating behaviour.

A number of reasons such as physiological, biological, psychological and even cultural reasons are behind what determines our choice of food and will to eat. There are two main drivers that influence what we eat, how we eat and stopping us from eating, those drivers are, hunger and appetite.

Hunger: This is the biological, physiological phenomenon that drives us to get food. This happens when our brain receives information and tells us to find food. We must understand that hunger is not specific any food will do.

Appetite: This is the psychological desire to consume specific foods. It is aroused by environmental cues such as smell, taste, touch and sight. Even when you are not hungry, you have desire to eat specific foods because the environmental triggers are encouraging you to eat. This is where personal discipline and will for self-control and restrain come in.


Hunger and Eating: The sight of food and the smell of food make us hungry. The smell of food and the different kinds of food we put in our stomach secrets different kinds of acids that most times elicit faster digestive response, elicit growling and the hunger hormone elicits insulin. This just gets you ready to eat and makes you hungry. Eating is only a response action is such conditions.


We will quickly look at a study done by some Psychologists who placed rats in a cage and placed Chow (doglike meal made of soya) and tastes pretty bad but had all the ingredients the rat needed. The rats carefully ate as much as they needed and nothing more, they ate exactly what was needed to live and stopped. Another study was done placing same rats in a cage with supermarket meals as sausages, cheese, chocolates, condensed sweetened milk and many more. The rats did eat, eat and got fat. This study tells us, we do not just eat when we are hungry; we eat because of the presence of lots of food around us and even very good food afterwards.

It is important to realise we do not stop eating food when we are actually full, what we must do is to learn how much food makes us full and eat that amount of food  and stop when we think we should. Always try to remember what you ate in your last meal; it will make you eat less in your current meal.

There are other factors that influence our decisions to eat, these includes:

Emotions: People react differently to emotions; some people eat more when they are bored or upset while some take a break in such moments. Mood-dependent eating.

Medications: Certain medications we are on can impact our hunger and appetite for food. Some medications can make you feel hungry while others can get you irritated even at the smell or sight of food. Specific examples are pregnancy and chemotherapy.

Satiety: This is a feeling of fullness. Foods in larger volume of carbohydrates make us feel full too quickly while foods high in protein also keep us full for longer hours. Liquids do not induce satiety as much as solids. Similar amount of sugar beverage drink may not induce satiety for the same amount of calories.

Involuntary conditions: This is a certain level of state or condition that does not allow people to have access to food. Examples are poverty, draught and war. It is difficult to find people that have weight in excess under such conditions.

Social cultural influences: People of different faith follow different dietary patter leading to different health outcomes. Certain region promote vegetarian diet, there are period of times when certain kinds of food are not eaten or certain times when specific foods must be eaten.

All these factors as highlighted affect eating habits and decisions as well as having a great influence on our body weight and health.


Different food can provide different nutrients but same nutrients can also be found in different kinds of food. We all require the same nutrients but this can vary based on gender, age, life cycle (e.g. pregnant women need some specific nutrients in food more at this stage, pre-menopausal women need more iron than post-menopausal women). Men at some level of activities need more calories than women, so foods heavy in calories are appropriate at such times within their life’s cycle.


  • Carbohydrate
  • Lipids (fats and oils)
  • Protein
  • Vitamins
  • Minerals
  • Water

Carbohydrates, Lipids and Protein are also known and classified as Macronutrients. They provide energy and calories in our diet.

Vitamins and Minerals are also known and classified as Micronutrients. The body needs them mostly in small amounts.

Vitamins, minerals and water assist in regulating our body functions. They do not provide calories but critical in deriving energy from the food that we eat.


Sodium: This is one mineral that we eat much of on virtually every meal. This comes from salt and also added to processed food, high consumption of it is associated with high blood pressure and hypertension. Cautionary clause recommended! Discourage the use of table salt and use less salt in cooking your meals.

Water: This is very essential for life. Daily adequate consumption is essential for health, water is also nutrient. Not only does water provide support for our metabolism needs, it is also helpful in getting rid of the substance we produce when metabolism is completed. In excreting waste water plays a critical role, we need more of water is saying the least.


  • Adult men – About 3 – 5 litres daily
  • Adult women – About 2.7 litres daily

This can come from beverages and foods. The need for water also depends on:

  • Body size
  • Health status
  • Physical activity level
  • Climatic condition

Sources of Water

  • Water
  • Beverage
  • Fruits and vegetables
  • Food cooked with water e.g. soups


What do you consider before thinking of food to eat? Some people think of:

  • Convenient food that is nutritious
  • Price
  • Taste
  • Nutrition


Nutrient claims: Those defined by terms such as low calories, fat free, no added salt etc. You must read the claims in each meal pack to be rightly healthy guided on food choice.

Health claims: Statement like “prevents heart disease”, claims that link food to disease state are a must-look-out-for in making healthy food choices.

Structure: These are function claims – all claims are regulated by FDA, NAFDAC etc. You must be sure of who regulates such products before trusting their claims.

As we round off on this, we encourage everyone to always look out for menu bar in any canned or packed food before purchase; this is a display of the nutrient content in percentage quantity per serve. We most times do not look out for this and we end up stocking our pantry with food high in calories than our bodies really need.

Though we are not there yet, but in most countries you have a right to ask for the calorie content per serve in each meal you want in restaurants. But let’s remember the sight and the smell of food compel us to eat but we must also understand it is within our will to apply restraint as a personal cautionary clause. It is in our overall best interest.

We will be looking at physical fitness in out next discussion but before them we hope you do something with the little information we made available here. For further reading, kindly use the links provided below.

The new American Dietary Guideline 2015 – 2020


10 tips for a great plate


Healthy eating habits



Ehi Iden



We will be starting our series of Preventive Health Intervention publications whose sole aim is to equip readers with reasonable and useful preventive health information, capable of positively influencing personal behaviour leading to improved health outcomes within and between population groups. This will be a foundational teaching of the entire series.

What is health? We all at some point misunderstood health as being the absence of disease but the World Health Organisation (WHO) in its 1948 constitution defined health as “a state of complete physical, mental and social well-being and not mere the absence of disease or infirmity”. This definition looks at health in totality and the outcomes capable of influencing our decisions, productivity, actions and the overarching effect on our personal health.

Every workplace, every neighbourhood, every settlement, schools and assemblage of people could be seen a population group and it is important to know the healthy population within these groups.

Healthy Population is the health outcomes of a group of individuals, including the distribution of such outcome within the group. When we have more of unhealthy work population, the work distribution term to place more pressure on the healthy population in trying to meet collective goals and this could also throw more people from the health population bracket into the unhealthy population pool. This is the reason why creating health programs and wellness initiatives towards maintaining healthy population have become the new global frontier.

Naturally, people are able to act or take hold of their health concerns within the level of health information at their disposal, this is necessary in reducing man-hour-loss through hospital visits, illness related absenteeism or even most recently presenteeism (physically present at work and not able to produce optimally). This further validates the need to build and develop within capacity in the area of health information and education.


This is referred to as the need to encourage physical and social environment that promotes health. We cannot isolate this exclusively to the work environment but also includes where we were born, where we live, what we eat, where we learn, where we worship and the effects they have on our functionality and quality of life. As already established in many studies, chronic diseases are fuelled by two factors spanning from these:

Non Modifiable Risk Factor: This is as a result of the inherited gene that each person has by virtue of parental traits. We see people having Type 1 Diabetes even if they fall within the healthy body size category, the Diabetes they have is hereditary and not as a result of their actions or social behaviour. This is the reason why people with diabetic parents are always advised to be mindful of their dietary pattern and social behaviour as alcohol use and frequently check their glucose level to know how well they are doing in this regard.

According to the study on nature-nurture debate on obesity for instance, it was reported that a child with non-obese parents stands 10% chance of being obese, a child with one obese parent stands 40% chance of being obese and a child with both obese parents has an 80% chance of being obese. This is just to illustrate how much parental genes can influence non modifiable health risk in their offspring.

Modifiable Risk Factors: These are all factors within our control and when modified, we just live a more functional and healthy life. Example is people with Type 2 Diabetes, this is the diabetic disease condition that comes not because of genetic factor but as a result of our life style which includes poor dietary pattern leading to overweight and obesity. Obesity is a confounder of diabetes and other cardiovascular diseases which can be controlled by life style modification such as healthy eating, physical activity and informed social behavioural choices capable of restoring functional health. We will leave this for now because there is a complete teaching coming on this issue in the weeks ahead.

It is obvious we all want to be healthy and active but at the centre of this desire is our personal actions which we are only able to take with the right information at our disposal and the level of our personal discipline. We cannot be eating high carbohydrate food at 10.00 pm or midnight with the assumption that it will not have effects on our body weight and overall health functionality. You can be thought all you need to know as it concerns your personal health but taking action is your responsibility. In trying to play your role in this cycle of change, you must have motivation within supported by commitment which Darl Bem propounded in his 1972 “Change Talk Theory”. The 4 types of change talk are represented in the D-A-R-N acronym.

D – Desire to change: There should be that “WILL”. Example, “I will”, “I want to”, “I am longing to run upstairs once I stop smoking”. This is all about desire; it is at the beginning of personal commitment to functional health.

A – Ability to change: This is the expression of that change “ABILITY”. Example, “I am thinking I really should be able to stop smoking because I remember when I was trying to lose weight a few years ago, I worked on it. I thought a lot about it, then I decided finally how to proceed and I actually maintained that. So stopping smoking; I should be able to do that”. Talking about ability to change builds your internal positive reinforcement and motivation.

R – Reasons to change: What drives or motivate us towards taking an action is the perceived benefit. We ultimately want to live healthy lives; we must create a mental picture of the overall benefits. Example, “I am worried that smoking is going to make my health worse. I am still young, I love to smoke with my colleagues but I know that chances are I am not going to feel this way the rest of my life. Maybe I should stop smoking to make sure I am as healthy as possible”. The need to be healthy is the reason for the change.

N – Need to change: Until you identify that “NEED” to do something differently, you cannot experience that change. Example, “I have been noticing recently, since I smoke I have troubles running up the stairs, I feel I am more breathless and I cough more, I really need to do something about this”. This is the need to change.

The D-A-R-N Change acronym tells us the role of our personal responsibility in activating the cycle of change towards a positive health outcome which we all crave for. The need to develop personal health plans and setting goals, every goal you achieve no matter how little, be excited about it, appreciate yourself and motivate yourself towards the next goal.

We will continue from here in our next series but before we draw the curtain, we need you to rate your personal health and wellness in a scale of 1 – 10 (1 being the least and 10 being the highest). This is for your personal use, so be honest as much as you can.

How do you rate your personal health and wellness in terms of:

  • Presence or absence of disease
  • Emotional Health
  • Social wellbeing
  • Intellectual health
  • Spiritual wellbeing
  • Physical health
  • Environmental

We will be looking at healthy food and eating behaviour possibly in our next publication.


Theme: Know hepatitis – Act now

Viral hepatitis – a group of infectious diseases known as hepatitis A, B, C, D, and E – affects hundreds of millions of people worldwide, causing acute and chronic liver disease and killing close to 1.4 million people every year, mostly from hepatitis B and C. It is estimated that only 5% of people with chronic hepatitis know of their infection, and less than 1% have access to treatment.

On World Hepatitis Day, 28 July 2016, WHO calls on policy-makers, health workers and the public to “Know hepatitis – Act now”.

The Organization urges them to inform themselves about the infection, take positive action to know their status by getting tested, and finally seek treatment to reduce needless deaths from this preventable and treatable infection.

Activities will take place around the world to improve public knowledge of the risk of hepatitis, and enhance access to hepatitis testing and treatment services.

Know hepatitis – Are you at risk?

Viral hepatitis affects 400 million people globally and, given the size of the epidemic, anyone and everyone can be at risk. It is estimated that in Nigeria, 20 million people are infected while 2 million people die of the consequence.

Know hepatitis – Get tested

An estimated 95% of people with hepatitis are unaware of their infection. Hepatitis tests are complex and can be costly, with poor laboratory capacity in many countries.

Know hepatitis – Demand treatment

Globally, lack of awareness and poor access to hepatitis treatment services mean that most people who need treatment do not receive it.

Over 90% of people with hepatitis C can be completely cured of the virus within 3–6 months. Appropriate treatment of hepatitis B and C can prevent the development of the major life-threatening complications of chronic liver disease: cirrhosis and liver cancer.

Let’s look at Hepatitis B

This is about the most common Hepatitis virus amongst us. Studies have shown that 15% – 25% of people with Hepatitis B will die without treatment. So it is important we”

  • Get educated
  • Get tested
  • Join the fight against Hepatitis B


What is Hepatitis B?

Hepatitis B is caused by a virus that attacks the liver and causes liver inflammation. The virus spreads through contact with infected blood or bodily fluid, it can be transmitted through:

  • Mother to unborn child
  • Unprotected sex
  • Injection or drug use

What are the symptoms?

  • Nausea
  • Vomiting
  • Fatigue
  • Abdominal pain

However, you may be among the about 30% of people who do not have symptoms when they are infected.

Who is at risk?

  • People with multiple sex partners
  • Injection and drug users
  • Healthcare and public safety workers
  • People who live in same household with some who has Hepatitis B

Types of Infection

Acute: Short term, less than 6 months

Chronic: Long term, more than 6 months and it is mostly a life-long condition and requires a long tern treatment to prevent more damage to the liver. Treatment is important because the damage to the liver could cause serious liver problem called cirrhosis.

Cirrhosis of the liver is the destruction of normal liver tissues, harm and scars left behind will prevent blood from flowing through the liver. Cirrhosis certainly sets a stage for liver cancer. Chronic Hepatitis B is the leading cause of liver cancer worldwide.

Screening and Vaccination

Hepatitis B is a preventable disease, the first step in this direction is to undergo screening and when you are found negative, you quickly commence the vaccine which comes in three-course, 0, 1 and 6.


When you turn out non negative to Hepatitis B, the Doctor may order more test to check the state of your liver. It is important you see your Doctor often to check the state of your liver to know if treatment is necessary and to see how well your treatment is working.

Your Doctor may use a variety of test s to check the liver and monitor the amount of virus in your blood. Some of such tests are:

  • HBV DNA test: The Doctor may use this to monitor the amount of virus in your blood and also to measure your viral load.
  • The ALT: This looks at active liver inflammation.
  • Liver Biopsy: This is when the Doctor takes a sample of your liver tissue. This test is used to check the level of damage or liver inflammation.

The Doctor at this point decides what is right for you. If you have high viral load, the Doctor now decides which medication is needed.

High Viral Load

This is a sign of liver damage or you are at risk of liver damage. You may not feel sick but it is important you get treated if the Doctor recommends so. The earlier you treat a disease, the more likely you stay healthy longer. Why there is not cure for chronic Hepatitis B, there are two types of treatment to help:

Antiviral drug: These are to prevent the virus from growing and reproducing in your body.

Interferon: This helps strengthen your body against the virus.

Whether you are taking medication or not, there are things you must do to keep the liver healthy. These include:

Eating right: Eating healthy meals

Rest: Getting enough sleep

Avoid things that may harm your liver such as alcohol, drugs and some herbal medications.

See your Doctor every 6 – 12 months; it is also a part of taking care of yourself. It is only through the Doctor that you can know how the virus is affecting and detect liver cancer.

One of the several things you can do is to learn more about the disease and how to stop the spread of the virus.

This material is a part of publications of Action for Preventive Health Concerns, a Not-For-Profit Social Venture of OHSM



www.yourliveryourhealth.com    You can reach us using ehi@ohsm.com.ng