Continuity of care. It matters. Not for every contact – but for many. Even the times when continuity isn’t essential, getting to see the same doc / patient can help relationships to build over time.
I’m going to have a look at the Emis continuity calculator and see if we can run this at out practice in Pendle.
We do not need any more research about the benefits of continuity of care. The evidence is clear; it is associated with improved preventive and chronic care services, patient and clinician satisfaction, lower hospital utilization, lower costs, and for elderly patients, lower mortality.
What we do need is better continuity of care. According to a recent BMA survey, enthusiasm for continuity of care exceeds that of any other aspect of general practice,
Continuity of care matters more to some patients than others, in particular those with long-term conditions, mental health problems, multimorbidity (several different conditions at the same time), during serious but hopefully shorter term conditions like cancer and during end of life care. Continuity of care makes care more person-centred because getting to know a patient as a person takes time. Continuity of care makes care more efficient because less time is spent repeating a medical history…
In the run up to the #compassionWL events this week I have been reading around the subject of compassion in health. Lots of material in this article that would lend itself to discussion points about the subject. Many GPs are now using social media platforms such as @resilient GP to cultivate methods of managing their stress & unCompassionate working conditions / working lives.
As the prospect of more GPs being added to the workforce is looking increasingly slim we need to consider what the GPs can STOP DOING so that we have more space for contemplation , compassion & care.
In 2001 Richard Smith, then editor of the British Medical Journal (BMJ) wrote an editorial titled, Why are doctors so unhappy? and found the source of their unhappiness in a bogus contract in which medicine promised too much and delivered too little to the mutual disappointment of doctors and patients.
In 2013 John Launer responded in an essay titled, Doctors as Victims in which he called for doctors to reflect on how powerless they felt despite being in possession of far more power than their patients.
Returning to the theme, and linking these two pieces together, Smith has responded with a much less sympathetic blog for the BMJ this week,
General practitioners have replaced farmers as the profession that complains the most.
I have no sympathy for them. I want them to stop being victims and become leaders, people who solve problems rather than complain about them and expect others…
Well presented discussion points – in glad I didn’t miss the reference to this article that was made in a tweet. Understanding the system which makes people take the decisions that they select is essential if society is to continue benefiting from a universal health care system. Patients are making Rational Decisions – they just aren’t always the ones the health managers would like them to take
Like many people who spout rhetoric about the NHS, I am guilty of indulging in the blame game. Some professionals and policy makers ‘blame’ patients for ‘inappropriate attendance’ at A&E and we have millions spent on campaigns to urge us to ‘choose wisely’ when thinking about heading that way (assuming that we do not make rational choices).
Likewise, I can blame professional for thoughtless and ineffective policies and practices. Or, I can point the finger at ‘the system’ for being professionally-centric. Note that the notion of blaming ‘the system’ is itself a neat trick that casts a blanket of blame over others, without requiring us to be more precise about where the problem lies. It is also a familiar tactic for the traditional patient movement through which we can maintain an ‘us and them’ attitude and an adversarial posture towards improvement.
Does your company or organisation need a #Digital makeover ? Wondering about how to quench the thirst for information and engagement within your sector. Contact john Popham & Helen Reynolds for more info
Well, we did it! The first Digital Makeover is complete. Helen Reynolds and myself are offering organisational Digital Makeovers in which we go in and try to reach every part of the company with some digital magic over the course of 2 days.
We had a great time working with some wonderful people at Yorkshire Coast Homes. The feedback was fantastic, the energy of the staff and board members we worked with was infectious, and it all carried us through the barrier of tiredness which hit us towards the end of the second day. We even managed to fit in a great Tweetup on the Monday evening, which allowed us to make further contact with some of the Scarborough digital community.
#Gamification, #Selfcare and Maintaining a Healthy Behavior Change
This post is about New Years Resolutions . How to phrase the goal so you are more likely to succeed. It includes a link from Dr Mike Evans about the reasons why New Year is a good time to make a change, and includes some useful websites and tech ideas that could help us succeed in maintaining those healthy behaviors we have in mind.
Please watch the videos from the links and consider tweeting your New Years Resolution for 2015 with the #NewMe2015 hashtag.
If you know of other sites or ideas that you would like to share then please comment below.
“It all depends on what we do in the next few weeks,” said infectious disease expert Chikwe Ihekweazu, speaking on Ebola at TEDGlobal on Friday. What happens next: will the number of new Ebola cases grow or plateau? And how can the world know the right thing to do?
Reliable news about the outbreak has been hard to find, especially for people fighting the disease in their homes and villages, but also for the rest of us who want to know what’s going on and whether to worry. Which is why, this week, TED Senior Fellow alum Jon Gosier launched EbolaDeeply.org, a curated news feed that mixes journalism, experts and citizen reports to create a more informed global dialogue. We asked Gosier to tell us more:
There’s a lot of mistrust. There’s the belief that “all these people showed up, and then all our people started dying.”
What is EbolaDeeply, and what problem are you trying to solve?
As part of series of interviews with my consultant colleagues I have been chatting to Dr. Pro Mukherjee. Pro is an avid advocate of compassion in healthcare and shared with me a great example of how powerful re-framing your view of something can be.
“Compassion” is a word of the movement. But do we really understand its context in healthcare?
Good points from this blog by Consultant Kidney doctor. I suspect that it wouldn’t be possible for all admissions & discharges to have a telephone consultation with the patients relative or carer – wonder what it would take to put this idea into action ?
“My father was in hospital for 2 weeks and not once did I get to speak to a doctor”
“All it would have taken was a phone call, I kept asking day after day, but no-one bothered”
“We were watching Mum get sicker day by day and we knew she was dying but we couldn’t get anyone to talk to us about it. They kept changing drugs and trying new things but nothing was working. We knew she was going to die”
These are just a few quotes from recent complaints that I have read and demonstrate a very common theme – we are not very good at communication. There are many aspects to our failing in communication; with the patient themselves, between specialist teams or between primary and secondary care but it’s the communication with families and loved ones I wish to focus on in this blog.
Guest blog from Alastair Blair of The Potent Mix, who reflects on the Making a Virtue of the Virtual Shared Learning Seminar. The original blogpost is available here, and you can see Alastair and other speakers discuss the event in the below video.
In a well-ordered world, the Welsh (and English) Councils and other public bodies learn how to save money the same way the Scottish Councils have, and then adopt a portal similar to tellmescotland.
In the real world, it’s salutary to look at what has happened. Even in Scotland, although 80% of Councils have adopted some or all of the measures learned from their training by thePotentMix, a small number still have done nothing and are saving nothing as a consequence. There are still tens of thousands of pounds that can be saved, on top of the hundreds of thousands that have already been saved. Ironically, almost all…
Activating the #epatient inside us all , young or old , rich or poor is the only way that healthcare can be delivered on a nationwide scale in times of financial restraint. How can we sell the dream – the idea – of what could be achieved ?
How can we, as a society, as healthcare providers and as healthcare leaders, provide good care to vulnerable older adults? Consider this person:
Mrs. A is an 86 year old widow who lives in assisted living. She’s been diagnosed with diabetes, hypertension, atrial fibrillation, COPD, osteoarthritis in her back and knees, stage III chronic kidney disease, osteoporosis, depression, and urinary frequency. Her daughter Ruth lives about an hour away. She’s been worried about her mother’s mood and memory.
You don’t have to be a geriatrician – as I am — to find yourself taking care of someone like this. Many of us have an elderly relative whose multiplying health problems cause us to worry.
And worry we certainly should, because people like Mrs. A often struggle with health, and with healthcare.
To begin with, the ideal management of most of her chronic conditions requires…
Channel shift or Channel shove – I met Kate Bentham & the Shropshire team in September 2012 at a conference Shropshire was hosting. I was highly impressed with what their #localgov team was doing & had achieved. I came back to work with lots of ideas for how channel shift could help the NHS. Local government were ( and probably still are ) way ahead of NHS when it comes to patient engagement.
Kate’s blog reminds us to think about explaining the reason why channel shift is needed & urges organisations to consider how channel shift affects the different segments of society.
Sometimes we all need to speak with a person.
For one reason or another I wasn’t blogging much at the time I attended the inaugural channel shift camp in November 2013, organised by the amazing Nick Hill and others at Public Sector Customer Service Forum so this is a very delayed post on that event and my thoughts generally about channel shift.
I get that there isn’t much money about in Local Government. I get that there isn’t the same level of staff resources. I get the reason for channel shifting. I’ve even seen the average cost per transaction for the various channels. And I don’t want to sound like a luddite about channel shift but what I’m not sure I really get is the aggressive, almost guerrilla style tactics deployed by some councils to shift their customers to another cheaper channel.
There seems very little evidence that councils have actually asked their public how they prefer to contact…
“Last year’s words belong to last year’s language. And next year’s words await another voice.” ~
A year is a long time in social media. The pace of change can for some feel overwhelming. That’s just one reason why Social Media Surgery Dundee has the potential to make a real difference, to help people sharpen their focus.
The surgeries, informal monthly gatherings at Dundee Central Library, can help support you on your journey of digital development. Yet I go along not just to share but to learn.
Last night I learnt, through speaking to Dylan from Humans of Dundee, there armed with his camera, that what I felt social surgeries actually offer was to help people find their voice. And I reminded myself that social media can make change happen. It can change lives. It’s certainly changed mine.
So you have a new iPad, and maybe you are wondering just what you could do with it to use the iPad to its full potential ? These are a few suggestions that I hope you will find useful. This article is primarily aimed at GPs who haven’t used iPads before or who are wondering about having a go with some of the different apps that can make life a bit easier – or more entertaining . Please email me or leave comments at the bottom of the page if you have any suggestions of what to add. The apps below are all ones that I use. I have had a variety of apps suggested to me via twitter friends that I am in the process of trying out. Search #GPiPad on twitter to see who their suggestions or click here for the search on google.
In 2013 East Lancs CCG applied to use some innovation funding to purchase iPads with Emis Mobile installed for the GPs working in Pendle. Its traditional for GPs to take a printed summary of the patients records with them when they go a home visit. The downside of this is that it can only offer a fraction of the information that the GPs are used to working with when they are at their regular computer in their GP Surgery. Emis Mobile on the iPad can allow the GP to view and edit aspects of the patients records using a mobile 3G connection whilst at the patients bedside. The Emis Mobile version of Emis Web is expected to develop over the next year to provide a more complete offering to the GP.
Apps Apps Apps – its all about Apps
First steps . Set up an apple ID if you don’t already have one. This is the account that you will use to purchase apps from the Apple App Store. The good news is that many apps will work on all devices, and many have free or basic versions that you can use to “try before you buy”. You will need to link your account to a credit card so that you can pay for apps that aren’t free. It is possible for several devices to use the apps that have been paid for with one account. – more info is available from the apple website – but if you do this – please make sure that the messaging features are set up properly on each device or everyone will see the same notifications etc. This also means that software you may already be using your own apple devices may also be used this NHS device without additional costs.
Just when I was feeling the Campaign for Free Wifi for Hospital Patients had stalled, there comes news of a major breakthrough. Prompted by Consultant Paediatrician, Sebastian Yuen, George Eliot Hospital in Nuneaton has introduced free wifi. This came about after Sebastian consulted with the family of one of his patients who made a specific request, and it was introduced as an NHS Change Day pledge.
Here is a great video about it. Please spread the word and tweet about this using the hashtags #NHSwifi and #NHSChangeDay. Thank you also to Teresa Chinn for the prompt
This guest blog from a patient advocate @MarkOneinFour sums up the benefits that social media use amongst public NHS workers & nicely illustrates the differences between the “official party line from the Comms Team and the less polished input from the “normal” staff. Social media & Comms Teams both have a role to play – they have different roles & contributions to the discussions about health & social care.
This is a transcript of Mark’s rather excellent presentation today.
Hello! I’m Mark Brown. I mostly do mental health stuff. My work comes from my own experience of mental health difficulty. I don’t work for the NHS but I do spend lots of time effing about on twitter.
At a time when the NHS is experiencing it’s biggest challenges for at least a generation, I want to talk to you about the way in which social media can help to root the NHS in the fabric of communities. I want to talk to you about the ways…
For a while now the line between digital and boundaries have been blurring.
Job descriptions we used to have don’t hold up anymore. There used to be a dedicated customer services team but as Eddie Coates-Madden has said on many occasions we’re all now customer services now.
Why? Because once you start to use digital channels you open a door to anew world. It’s one where people can talk back to you, ask questions, be snarky, be nice and to ask why haven’t the bins gone out.
Customer services on Twitter really fascinates me. For the first 18 months using @walsallcouncil I was it. When I asked for Christmas Day dinner to be postponed for 10 minutes because we were going out gritting and I had to tweet it I kind of new I was probably in too deep.
There is a rather fascinating new Twitter that has sprung out…
As of last weekend the Self Care Plan for people with irritable bowel syndrome (IBS) is free access for those people with the condition and for those who might feel their symptoms are down to IBS, but are unsure and wish to know what to do next. Check it out here:
As the UK charity for people with IBS we felt it was important to have this information for everyone to access. I know of no other site that has information on symptoms, medical treatments, dietary treatments and psychological symptoms such as anxiety and depression that often follows this diagnosis, in one area and including tools that can help
such as the bowel relaxation recording. It also has information on alternative treatments and how useful these are for symptoms. It has been checked by the IBS Network team of advisors including gastroenterologists, psychotherapists and dietitians to ensure the information…
Doctor First Appointment system – A 21st century Solution?
“Accept the things you cannot change, and change the things you can” – Reinhold Niebuhr
No one can argue that current ‘demand’ in the NHS is high.
We can argue until the cows come home, as to why, or who/what is responsible for this ever increasing demand. But unless we think we can alter this demand in the immediate foreseeable future, maybe – just maybe – we should start thinking about how we can manage it.
What if it is time to adapt?
For more than 60 years now – long before the birth of the NHS – General Practitioners have been offering the same traditional style of service: Patient decides on need to see doctor. GP offers a time to be seen. GP sees patient. This has always been considered the gold standard, the very essence of the…
When was the last time you went out for some food? Was it to a restaurant , a take away or just a bakers? The chances are that you entered into a contract with the provider of the food about what you would consume in exchange for a particular amount of money. It’s a standard transaction for a modern economy.
A few weeks ago I had a fantastic Chinese banquet. Choosing the banquet option meant that we had a bigger selection of things to choose from and savour, but this came at the price of committing to buying a bigger quantity of food than we would have consumed with a traditional three course meal.
The NHS National Health Service in the United Kingdom is in a state of transition, and has been for several years. Budgets are being adjusted ( usually downwards ) which means that there is less money to pay for as many things as before. There are increasing pressures on the remaining staff, and increasing expectation from the consumers of health care about what they choi,d be receiving.
Going back to the food model. I’d like to suggest that hospitals and many aspects of Secondary Care are like the a la carte restaurant – dishes are served up with a pre arranged price tag, except in the health scenario the customer is blissfully unaware of the cost of the item or the experience they are receiving.
General Practice , or family medicine, in the UK has more in common with the “eat as much as you like buffet”. Providing you can get through the front door, you can fill your boots with as much health advice and medication as you wish. I have enjoyed some really great buffets in my time, and some not so great ones. You generally get what you pay for – your expectation of the quality of the food inside is influenced by the expected financial cost.
The blog is good ,links great & the podcast is worth listening to Steve Spangler Is the chap who came up with the idea of dropping a mint into a coke bottle to create a fountain. He trained as a science teacher , then started looking for other ways of making science fun & stimulating. He had approx 61 episodes on YouTube before the coke fountain experiment caught on and went viral.
Compassion in NHS is big news this week. The Francis report is out, and all branches of healthcare are considering its implications. This article discusses the fragility of compassion once the environment becomes stressful. When resources ( time, nurses, cleaning staff, etc ) are in short supply then group survival mechanisms kick in.
It’s the old nature vs nurture debate, and it had its routes in the biological evolution of societies and culture. Tribes of people & staff develop ways of differentiating themselves from the people who are not in their tribe. This is done through words (jargon & abbreviations), appearance (uniforms), and rules or regulations which may not be obvious to the uninitiated.
Worthwhile Project in East Lancashire offering people a fresh start Green Dreams Project in Nelson
I have been looking at the new look website for this popular resource today. Please take a look at their site and consider if there is anyone you know who may benefit from their help.
Sue Hogg works with patients at Reedyford Health Care in Nelson. She has supported patients with finding voluntary work in a local community centre, getting in touch with Inspire for alcohol issues, securing emergency food parcels and being introduced to social groups. Sue has also worked with patients who want to live a healthier lifestyle, eating more healthily and doing more physical activity, including those with long term health conditions. She has been able to provide information about job search support, eco- therapy placements and benefits advice, working with partner organisations. Many patients are experiencing mental health problems, including stress, depression and anxiety, low self- esteem and confidence, and bereavement.
What do you want from your local services online ? What are you expecting to see when you look at your local councils website, or try to check out out your doctors surgery website for information about flu vaccine clinics ? Does your local council have a Facebook , twitter, YouTube or website presence?
The digital futures Shropshire conference is taking place on Monday, and I a shall be attending. I am interested in learning more about how to encourage people to use online services or information. What makes a website a hit or a miss? In this age of austerity I believe organisations have a responsibility to be making sure that they are making the best possible use of resources. This means spending some time considering who is actually using the information that is being provided digitally ? Who is looking at their web pages ? Which groups are missing out on this and what could be done to help change the current status quo ?
Internet has a massive potential for helping information spread about society, communities and special interest groups. As a GP I have an interest in helping people to find and use “quality” websites. I’m a big fan of the concept of getting the information out of the reservoirs and flowing down the pipes to the people that want it. I’m interested in using some of the tips and tricks that social marketing can offer to help to nudge people into a more informed position. What can we learn from those who work in the marketing industry? What examples of social media marketing can you spot at your breakfast table ? On the cereal packets?
Remote monitoring in COPD ; how much & how often ?
As a GP associated with the East Lancs COPD Telehealth Project I have been considering what evidence there currently is for the model of Telehealth which is being proposed.
I was asked to join this project in spring 2012. The choice of providers & type of teleheath technology had already been agreed. The aim was to explore how the technology could be used in East Lancashire COPD patients, and shed some light on how much impact this could have on the patients experience of COPD and what impact it had on the healthcare workload.
We are planning on using remote monitoring technology to enable remote recording of the patients blood pressure, pulse oximetry and temperature. These readings are taken by the patient ONCE a day and sent to a remote monitoring hub which effectively aims to spot significant changes and decides if the patient needs to have contact with a clinical team member.
Patients will be selected on the basis of those at high risk of needing a medical admission in the following year using the Blackpool NHS Predictive Risk Tool. This tool is being incorporated into the GP patient record systems of practices which signup to working with the project.
“I have a heart condition and have to get my Coumadin (#warfarin)checked regularly,” said Kaiser Permanente patient Richard Miller, 76, of Vallejo, Calif. “I get an alert that I have new test results, and they email me if I need to change my dosage. I also go to the encyclopedia to tell me what my lab results mean, and I can make and change appointments.”
The above paragraph illustrates the potential of mobile health applications to revolutionise the way we interact with our healthcare providers. Wouldn’t it be great if an email could be generated to let the patient know when their blood result is back and has been auctioned by their clinical team? Think of the savings in time and reduction in risk. Emailing the results means that the doctor knows that the result has been received ( could incorporate a read receipt system).
It would be fantastic If we could offer this in the UK. What are your views on this ? Please click on the speech bubble to leave a comment & share the link on your preferred social media. Thanks. @stuartberry1 websites for kaiser permeate blog& apps
The 999 demand over recent weeks has been very high, it continues to rise and shows no sign of easing. The Category A (life threatening 999 calls) have risen particularly sharply. The daily average Cat A incidents in May is 1062 incidents this is 13.2% up on May last year and is higher than December (our traditionally busiest time of any year), May is showing a 3.4% increase on April.
[attachment=0]20120508 How we saved 20 a patient by offering records access.pdf[/attachment]
Dr Rimon Chowdhury , one of my partners at Reedyford, emailed this link to me recently. There was a piece in Pulse about the benefits of allowing patients to access their own records. This can save money through reducing duplication of investigations, less missed appointments and can facilitate #selfcare
I can envisage a time when patients attending A + E are able to allow the clinical staff access to their online GP notes so that they can see what medication they are on , and possibly even leave details of a suggested management plan, follow up arrangements in trauma clinic etc.
The main challenge would be how do you roll this out to the patients? I propose that a roll out programme be developed that would free up admin time to lead groups of patients through a familiarisation process that would lead to them being given a kind of “online access driving licence”
If videos are made, and the learning prescription tried, and refined the process could become more slick and could even be delivered online. It hasn’t been clear what the possible total costs of doing this would be.
Please comment below so I can add your views to this posting
Language lessons Via podcast or webcast , YouTube Vimeo site to facilitate language that is used when visiting the doctors. In polish, Lithuanian and Urdu.
Could feature health information so there are several strands to this. I have been approached to work with the community radio in producing some health information podcasts – this could be part of this . Builds engagement in the community , breaks down barriers , and improves communication skills.
Contact me @stuartberry1 or retweet this / share the idea.
We have very limited resources in the nhs to support these ideas. Social media can help to spread the ideas, build the momentum & encourage our leaders and councils to consider them in their plans.
Vitamin d education. I could easily request via d levels (£30) and treat for fit d deficiency ( £40 ) a year for most of my patients . > 90% have low levels. As the population realises that many memebers of the community have low levels this causes more people to come forward. The vitamin d djinn or genie has come out of the bottle.
Vitamin d deficiency wasn’t something we looked for or treated 3 years ago. I suspect it is one of the fastest growing expenditure item on the drugs budget.
It is also not confined to the Asian population. I have encountered many ung white adults with very low levels of vitamin d as well. This should not just be attributed to modesty clothing.
Proposal is that we could devise a programme to raise awareness of the lifestyle factors that cause vit d deficiency. Encourage people to see vit d as a part of their diet ( we don’t routinely prescribe protein on nhs )
I suggest we adopt the line of one or two courses of vit d replacement to build up levels to therapeutic norm , then advise that the patient maintains this through diet. People mayb say they don’t want to take or buy CID liver oil supplements or eat fish – but I don’t believe the nhs can support vit d supplementation long term.
This could be costed out & worked up in more detail if there is enough interest.
This is the roundup of the suggestions from the twittersphere about how to get the most out of your 10 Minute appointment with the GP. Big Thanks to all the comments and clicks this got … clearly this was worthwhile doing and is not finished yet. #10minsGPguide
Please feel free to post more comments. These have been collated using @Grabchat
So the UK government has decided to launch a three-pronged initiative to help those who have dementia or care for someone who has it. Their plan is to encourage the early detection of memory problems, improve the quality of care received in care homes, and have also pledged to invest in research that may one day offer a cure.
These are great ideals – the problem is that they are coming at a time of NHS cutbacks. Care agencies are businesses working to a model that needs to generate profits in order to continue to deliver the service. If we want better care then we will have to pay for it one way or another.
Dementia clinics or memory assessment clinics have a long waiting list and patients can face intervals of several months between outpatient appointments. Early detection of dementia will be useful for the carers of these patients as hopefully it will enable them to link up with local support groups earlier, but unless extra investment goes into providing more dementia clinic appointment slots the patients will inevitably be looking at an even longer wait before their memory clinic appointments.
Self-care for patients with COPD – Formal Proposal of the Pilot
An estimated 3 million people have chronic obstructive pulmonary disease (COPD) in the UK. Most people are not diagnosed until they are in their fifties. However more people are being diagnosed with COPD at a younger age – from their late thirties to their early fifties. COPD is a condition that makes breathing difficult. COPD is a broad term that covers several lung conditions, including chronic bronchitis and emphysema. It usually develops because of long-term damage to the lungs from breathing in a harmful substance (such as cigarette smoke or chemical fumes). The treatments available for COPD help people to breathe more easily, but they don’t repair the damage to the lungs.
We are knocking about with some ideas for a COPD self-care project. I would appreciate some feedback before getting the idea worked up in more detail. This is the more patient friendly version. The more formal proposal is here ;
I am a GP ( family physician ) in Lancashire . I set up a weight loss challenge last year that was a pilot for combining health promotion with an element of competition to make it more fun, and try out some gamification concepts. I have been wondering what we could try next. COPD is another health issue that we are not short of in Lancashire.
COPD is a breathing disease that is much more likely to affect you if you smoke. It starts off as a mild irritating cough but can progress to life limiting dependence on piped oxygen. The only thing that stops the progress of the COPD is stopping smoking. Exercising more can help people with COPD regain some of their quality of life. The “pulmonary rehab” tends to be offered to the patients with more severe disease, once they have had a couple of hospital admissions for chest infections. The patients with more mild COPD may not realise that they have it – attributing their cough to their smoking habit. A special breathing test called spirometry is used to help diagnosis. It is available in many GP practices.
This BBC podcast explains why the environment that your mother was exposed to can influence the health of your children. Your vulnerability to specific conditions seems to be influenced by the conditions your parents were exposed to. Adverse environments can cause genetic damage. The legacy of poor nutrition can span generations. It could explain why heart disease is more common in deprived populations.
There is a suggestion that the higher prevalence of obesity,diabetes and radio vascular disease in the southern states of America can be explained by the hardships the population experienced in the American Civil War.
The environment that the male finds themselves in also has an impact on the vulnerability of their children to particular metabolic diseases.