Make yourself a Priority! | Dr Sathya | Sid Warrier Podcast

Introduction and Guest's Background

[00:00] Ladies and gentlemen, welcome to another episode of the Sid Warrior Podcast. This is a very special one because I have with me a guest that I've been waiting to talk to for a while now. She is the CEO of Preventive Health in Apollo Hospital, Dr. Satya Sreeram. And what's more fascinating for me is that she has a history in neuroscience. She's done a

[00:20] PhD in Neuroscience from Johns Hopkins Hospital. Very, very glad to have you here, doctor. Welcome to my podcast. Thank you for coming. Thank you so much, Dr. Sid, for having me. It's truly a pleasure and a privilege to be here. Tell me a little bit about your journey. How did you go from PhD in Neuroscience to being a CEO of Preventive Health?

[00:40] in a major Indian hospital. So I actually love biology, loved biology growing up. It is one of my favorite subjects to hear amongst the general public, but I think amongst doctors, we share that love. I did my PhD in cellular and molecular medicine and specialized

[01:00] in neuroscience at Hopkins. But after that, I realized that I really wanted to do much more with my background and not simply just research in a laboratory, which is the traditional path that most PhDs take. I joined McKinsey & Company, which is a management consulting firm

[01:20] right after that and worked with them to understand healthcare businesses across the entire spectrum from hospitals to health insurers to direct to consumer businesses, pharmaceuticals and so forth. And when I moved from the US to India back in 2010, continued that journey with

[01:40] McKinsey also picked up a few additional business skills through my stint at the Hindu group Media. So understood how to connect with consumers, much more understand how consumers think. And so subsequent to that, bringing all of these various facets and experiences together, my love for science

[02:00] science and medicine, propensity for business and directly understanding consumer attitudes and mindsets and working to move them towards a path that is better for all of us. That's the role I'm in today as the CEO of Preventive Health at Ebola hospitals. Amazing.

Communicating Health to the Public

[02:20] Austin at Hindu is specifically interesting because you learn so much about how to communicate a message with the public because it's one thing to know, but it's a whole other challenge to tell other people of what you know. And that's right. And I think the biggest learning for me was how there are so many different

[02:40] types of customer segments and each of them thinks, understands, perceives and acts very differently. So how do you actually take any sort of product or service and create opportunities for various different segments to engage with it? Especially

[03:00] especially in a space that's as wide as what we're talking about in preventive health. We need people almost at every age and every decade to be thinking about it from a different perspective. And therefore, even as they evolve over the course of their own lives, how are their perceptions, mindsets changing, and then

[03:20] do we appeal to them through different medium as well as different kinds of messaging. So let's take from what I'm hearing from you, you're taking preventive health as a product to pitch to the consumer. So just like any CEO of any company would think you're looking at preventive health as a product,

Why Preventive Health Is a Hard Sell

[03:40] Now how do you sell preventive health to the public? What is the challenge? Why is preventive health traditionally been so difficult to sell to the public even though it is for their own good? And we know that it helps them. Why is this so difficult? In my understanding of how people respond and behave to this topic, you're absolutely

[04:00] right. You will never find somebody who will say, no, I don't want to be proactive about my health. Everyone knows the right answer is to be proactive about one's health. However, what holds them back, in my opinion, are a few things. The first foremost is the fact that this

[04:20] is intangible. You are not able to see it, feel it until such time that it actually becomes a symptom. When it becomes a symptom, at that point typically it's a little bit too late. You will start coming into therapy, which is treating

[04:40] and curing and managing, not preventing. We do not understand what is going on inside our bodies. How much plaque is building up in our arteries? How much fat is accumulating in our liver? What is going on in our brain when we have so many different distractions and visual

[05:00] stimulations at the same exact time. This is all very intangible and that I think is the primary reason. I think the second reason is you lose sight of your own health typically in the mid 30s all the way till about the mid 50s to about early 60 because

[05:20] When you are younger, you are single, you have yourself to think about, you seem to have time to also make sure you hit the gym, think twice about what you are putting in your bodies in terms of nutrition and generally good about it. And then come along sort of family responsibilities, professional careers start to take

[05:40] off in that mid-30s. And soon after in the 40s, parents are aging, they draw on your time. Children are getting too difficult-agrous, they don't simply listen to what you have to say, so you have to do much more work to get to know them and be their friend and be part of their lives.

[06:00] And suddenly between all of these responsibilities, the person you deprioritize the most is you. And this sandwich generation between especially the mid-30s and the mid-50s, that's when you lose sight of your health. And unfortunately, that's exactly the time where our body is going.

[06:20] through a number of ships, women through menopause, lots of cardiac stressors for men, lots of shifts. And if we are not watchful and aware of it at that time, the repercussions are when we actually wake up in our 60s and it's an habit to it.

The Rise of Non-Communicable Diseases (NCDs)

[06:40] It sounds very serious and a wake up call for most people because a lot of my audience are in their early 20s and these are not things that they would have thought about because most of the time they're out there watching productivity videos. They're out there watching how to hustle more, how to

[07:00] How to get more work done by sleeping four hours in a day. These are not topics that they're thinking about. So this would come as maybe a rude shock to some of them that, oh, this is also there. Now, can this be an additional stressor or is there a calm, easy way of doing this without

[07:20] So the reason, doctor said that we're talking to your audience is because much of this is about good habit formation early in life. And if you actually focus on that, especially so in your 20s and start to make things part of your routine and ensure that despite the many distractions

[07:40] are to come, you maintain at least a fraction of those. What matters to you, what gives you joy and what will keep you healthy? Then I think we have most of the battle won. So when the topic is on habit formation, that is like you rightly said, there are so many distractions that come in the way, so many things that

[08:00] seem to take us away from a good health. It's almost as if, the way our society is structured, the focus is predominantly on achieving financial, professional health first and physical health later. Now, this could be a function of capitalism.

[08:20] where as long as someone is productive, the fact that you are healthy or not that comes secondary. So every single person has to take their own responsibility into their own hands and think about what is good for themselves. Now today the challenge is that non-communicable

[08:40] chronic diseases are increasing. But the public still does not seem to fully understand what they can do. So what are the things that they should know to improve their own life? So what are these habits that they should start inculcating? So Dr. Sid, you're absolutely right. The chronic conditions are increasing.

[09:00] In the medical field, we call them non-communicable diseases or NCDs. These are typically things like diabetes, hypertension, obesity. More recently, mental health is also starting to contribute to a lot of this. In 1990, about 25% of the deaths in the country were due to the NCD.

[09:20] But in 2019, that number is at 65%. 65% of the deaths in this country now are due to NCDs. Majority of these are preventable, as long as we identify them early or we manage our health proactively

The Rise of Non-Communicable Diseases (NCDs)

[09:40] so do we don't even get them. There are five things I think that we should keep in mind. The first is nutrition and diet. Whatever we put in our bodies, that's how I define that bucket. Everything from the food on our plate to the sugar in our coffee and that

[10:00] piece as well as the different how often we binge and so forth, right? So the diet and nutrition. The second piece is how much we move and I see this quite deliberately. If you go for a run in the morning, great.

[10:20] fantastic. But after that if you're sitting in a chair for 12 hours straight that's not good either. So it is about how much we are moving collectively through the day because that's what impacts our metabolism rate. That means how much of what we consume are we breaking down through

[10:40] The third piece is sleep. Very important and increasingly now shown to actually impact this metabolism rate. It's important to get enough sleep even though we all want to do more with less sleep. Whatever works for you as long as it doesn't

[11:00] doesn't impact your energy levels as well as your basal metabolic rate. It's good. Make sure that you are fully aware of what less sleep is doing for you if that's the part that you're going down. The fourth piece is what I'm going to collectively call mind health.

[11:20] This includes stressors. It includes all of the distractions we have today in the digital world, as well as because we just have so much going on in our lives. The brain is constantly stimulated and has to constantly decide what is important to file away and organize.

[11:40] and process and what is not. And as a result of this mental overload, there is a significant amount of mind health issues. It could be as simple as working memory. That means I don't even remember what my to-do list is and I have to put it down in order for me to remember.

[12:00] or it translates into extreme forms of anxiety and depression that we need to diagnose and help people around us understand that this is what they're going through. And the fifth pillar is actually the consumption of harmful substances. Sometimes this is

[12:20] tobacco, alcohol, drugs of all sorts. If it's in small quantities, it may be okay for a period of time because we don't want to get people to say, listen, being healthy means not enjoying life. However, know and understand the impact

[12:40] that it is having on you physically and then make those informed decisions. So for me, these are the five pillars that I think about when you have to be proactive about your health and what is in your control because there are things that are not in your control. Your age, it is what it is.

[13:00] Your genetics, family history, what you're passed down from your family, it is what it is. And therefore, in order to compensate for some of these unmodifiable risk factors, what you can do is find a way to proactively manage these life. Yeah, a lot has been returned.

[13:20] about genetics. And it's interesting because if you lead a healthy life, you are slowly changing the epigenetic factors in your own body. And if you have kids and if they lead a healthy life and if they have kids, they lead a healthy life, you can actually change genetics over a period of generation.

Why Younger Generations Are Facing More Health Issues

[13:40] So while we say that, oh, because I have a strong history of diabetes, now there's nothing I can do, that's not entirely true. There is a lot that we can do. And that's right. Even the culture of your family history might change. We are coming across these stories of young people, maybe even fit people.

[14:00] people who go to the gym and they get heart attacks. More and more people in their 30s are being diagnosed with diabetes. It seems that younger and younger people are getting affected by diseases that earlier we used to think only affects older people. What is happening? What is the shift

[14:20] that is happening in the country and how do we navigate this again without causing a sense of panic? There are two things I think fundamentally that is causing this. The first and it is now quite proven research that indicates that the underlying genetic of the

[14:40] Indian population, the South Asian population is very different from the Caucasian population. Cardiac issues, diabetes and in our own research at Apollo, we're finding that some cancers as well are happening much earlier in the Indian population. So we're getting diagnosed younger.

[15:00] compared to the Caucasian population. Unfortunately, a lot of our medicine and guidelines are drawn from Western countries and therefore, and data and therefore, I think we all have to form our own rules because genetically, we are different people, we have evolved

[15:20] differently. The second fundamental difference is this over the last I'd say 20, 30 years, there has been a substantial transformation in how we lead our lives. With the advent of urban infrastructure, lots more cars on

[15:40] road, jobs that require us to sit in front of computers much more, the access to a lot more food than our grandfather's generation, all of these are contributing to the lifestyle choices that we are making. We no longer have to walk or

[16:00] cycle 5 kilometers to go to school. Many children go in auto rickshaws or buses, some others even in privileged AC buses and barely have to take a few steps. Same with adults, they have to travel and walk quite a bit through public transportation to get to their places of work. That's no

[16:20] longer the case. A lot of these shifts in our lifestyle has happened in the last 20 years or so. And the repercussions of that is what we are seeing. The general national debt in movement, so to speak, that we were all supposed to move a lot more and now we are moving

[16:40] less and eating more. We are eating as if we are walking for 10 kilometres a day, but we are actually barely covering 2,000 steps. That's right. I mean, there's a thumb rule that says stop eating when you're 80% full. It's a simple thumb rule. Every one of us can easily adopt it. We roughly know when we are

[17:00] getting there. That means that extra portion of rice, right or that third serving of something is something that you could say no to. All you have to counter is that little voice in your head that says, it's so tasty, it's so tasty. I think many of us are privileged

[17:20] to know that we will get a chance to have that tasty meal another time, another day. So let's stop when we get 80% full. On my channel with my audience, I always draw this analogy of the prefrontal and the limbic where the limbic system, the emotional part of the brain, does not think we will get another

[17:40] chance to eat this meal. Because the limbic system is still living back in the day when we were in the jungle and you never know when you will come across a high calorie meal again. So let me eat as much as I can now. But the prefrontal cortex knows that of course you can just order it again tomorrow if you want to. So listen

[18:00] to your prefrontal cortex more and listen to your limbic system less. I think that is a good message. That's right. And that's what habit formation is. Right? That's exactly what habit formation does. Essentially, you have to do it enough number of times consciously, so that you are able to make it a habit and you're not even

[18:20] thinking about it anymore. How do you get that rational prefrontal cortex to overwrite the limbic system and typically when you're beginning a journey of habit formation give yourself 10 seconds that's all it takes. It's a simple thumb rule. Remember mama

Habit Formation and Overcoming Biological Urges

[18:40] and Nani used to say count to 10 beta when you're getting angry or go timeouts essentially are essentially about giving that time and it's no more than 10 seconds. So it's okay to pause in a meal and then say do I really need that and want that and

[19:00] Once you say no 25 times, the beauty of the brain is it is rewiring, it is forming new connections and the 26th time you do not have to think so much anymore. You will automatically just say, no, not interested, it does not do me any good. Another hack that I love, I come from a family that

[19:20] loves sweets. I think it's genetically ingrained in my husband's side of the family. What do we do between August and January, which is the most of the festive season where almost every other week there is some festival or the other and therefore a splurge

[19:40] of very unique sweets that have been tailored for that festival. So we have a simple rule in our home, any of these sweets will be cut into fours. What happens when you actually reach out and pick one piece and you have to reach out and pick up a second piece, you will think

[20:00] Again, right. But when you when the pieces are smaller that automatically right ensures that you are consuming less. So another hack. Our brain will count the number of units, but not the size of the unit. There is a there's a phrase that I came across in I think Apollo was promoting this, which is be pro health.

[20:20] Can you tell us what this means and why is this an important message for people to know? One of the things that we found over the years that is the easiest to do, especially during this 35 to 55 year period because you are

[20:40] stressed for time is screen yourself for the risks that you have. This is a very, very important part because you only have so much time. So you can spend three to four hours on yourself potentially annually based on your risk to do this.

[21:00] We've coined the word pro-health so that you are proactive about your health. We also know that when we say the word pro in any context, it actually means good things. You have pros and you have cons. You have pro, which is a good thing.

[21:20] So make proactively good decisions about your health. And the third reason we say be prohealth is because you will inspire other people around you when you are prohealth yourself. That is the most powerful

[21:40] careful gift that you have. Somebody asked me, I'm healthy, I take good choices, what can I do to spread this message? And my simple message back to them is you have to just be pro-health because the people you surround yourself with will see it, it will become tangible to them.

[22:00] They will watch your behaviors and soon they will pick up things that work for them and then they will pass this on. And so that's why we've coined this phrase B Pro Health so that each of us takes charge of our own cells proactively, but also contributes to inspiring our communities and the country. It's a beautiful point.

[22:20] because environment reflects us and we reflect the environment. So I found that when I hang out more with people who are health conscious, it becomes so much easier for me to be healthy. It's not so much of a struggle anymore. I find myself waking up earlier, eating better, sleeping on time, just because the people I'm

The Evolution of Preventive Health at Apollo

[22:40] hanging out with are like that. So if you don't have anyone around you like that, you be that person and others will find you. Speaking of Apollo hospital and the role it plays in preventive health, I was reading that one of the earliest centers to do

[23:00] health checkups or start health checkups happened in Apollo I think back in 1970s. That's right. So allow me to tell that story because it's one that we're very, very proud of. Dr. Pratapasi Reddy was actually a very successful cardiologist in the

[23:20] US and he returned home to India to take care of people here in the 1970s. And one of his friends from the US visited and they were both chatting about why Indians were actually having heart attacks much earlier than the Caucasian

[23:40] populations that they were used to seeing. And therefore, they came up with the idea and solution of an annual preventive medical checkup and thus was born the Master Health Check that we all know of very well in 1974. And since then, it

[24:00] It's actually been almost delightful to see so many centers across the country providing that service. I think over the last few years with the substantial increase that we're seeing and all of the different distractions that we have,

[24:20] One of the things that we have realized is we need to do more than just a simple set of tests. We unfortunately have Google as a competition now back then. It didn't exist. The doctor is a very, very important expert to be able to help

[24:40] interpret the results. If I take one blood test result that is red, it's actually perhaps a very general marker. What is actually causing it to be red can only be red in combination with a few other tests. And that interpretation is very important. So we

[25:00] have insisted on a doctor review to make sure that it's not you making a decision based on red, yellow, green on whether you are healthy or not. You may be at the cusp of a green almost going to orange. But if you know that, then you can actually do something to make sure you don't go into that orange zone.

[25:20] I think the other thing that we've realized is many of us go and do the master health check and then come back, look at the results, integrate it ourselves, put it in a drawer and then decide tomorrow we go on that walk and that tomorrow never comes. So one of the things we have said is we are living in a

[25:40] digital age. We do have access to you the individual much more so than back then. So how do we make sure that we keep you more informed about why you need to do this? There is content and information that we can credibly develop as a puller and be able to share with you so that we are arming

[26:00] you with the information you need to be pro-health. When we talk about being pro-health or trying to get your tests done in time, there is a divergence in who has access to these tests. So in urban

[26:20] in the middle class or up population, I think they have more access or they might give this more importance. Whereas somebody from a rural background, somebody who's financially not that well off might not prioritize this access. What can we do to make

Making Preventive Healthcare Accessible for All

[26:40] this preventive health care more accessible across the board irrespective of your geography or your financial status? Pro-health which is a polo is now evolved health check. The genesis of it came from a rural area. Our German

[27:00] actually went back to the village he hailed from in the Chittor district of Andhra Pradesh and put together a program called Total Health in 2013. And the idea was to take access to the rural areas, number of villages, screen

[27:20] them at scale, catch things early, give them information and the opportunity to check back into the local primary care center for that quarterly glucose readings or BP readings and if cancers are identified how do you take them to a

[27:40] hospital to get them the right therapy and so forth. And we actually followed people over several years and fine tuned the follow-up program, the nudging program and then created through health which we brought into the urban areas.

[28:00] are now delivering through 100 centers of Ebola hospitals and clinics. We are working with CSR groups and foundations of companies to be able to take this model to other such rural areas because once you have the setup and you have mobile buses that

[28:20] are fitted with X-rays and mammograms and echo ECG treadmill beyond just the blood tests allows us to get a proper holistic view of what is happening inside your body and therefore advise you accordingly. So we are looking for CSR partners as well to be able to take this

[28:40] to other parts of the remote areas of India as well. That's a very interesting thing because I have seen the Apollo buses, the medical buses that go around doing these scams and another thing that I've noticed is a lot of semi-urban housing societies have a

[29:00] small little clinic somewhere inside the society ground where all the residents of a housing society can get there. In fact, the society that I'm staying in has one. So once in a year they will hold camps and nowadays these housing societies are huge. There are some 1,000, 1,500

[29:20] members in a housing society. So that is another interesting way of spreading primary health care or preventive health care. Absolutely. Absolutely. I fully agree. And I think that the buses that are equipped with the imaging, right, is allows us to really get that holistic view. So we've actually

[29:40] found ways to modify our bus over the years to make it more compact so it can reach more places, but have enough of the equipment that we need to actually screen your head to toe. We go to residential societies like yours, we should actually catch up about what you do there. I also find that

[30:00] corporates and large complexes where employees come in. They don't take time off to go and do this because it takes half a day to go spend a few hours. But we're now working with corporates to take this on site to where their employees are and say, listen, we'll be parked here for a week, right? Two weeks. Those who want it

[30:20] can avail the service right here and then that allows them to actually spend far fewer hours away from their place of business and makes it more convenient and accessible even in the urban areas. That's such a good step. One of the challenges I realized with preventive healthcare

Final Thoughts on Prioritizing Health

[30:40] is it's very difficult to measure the benefit, especially in a certain individual's life. Because how can you measure something that didn't happen? We are far too focused on the things that did happen or can happen in the immediate future. And so the things that didn't happen we can

[31:00] take it for granted that, oh, I worked out and I didn't get a heart attack. Very difficult to measure it or to convey the importance of that. So what aspect of health do you think people ignore the most because it's so easily ignored? I think let me start with the aspect of health that people should

[31:20] would ignore the least because it is so visible and tangible and that's the belly fat. The fat around the belly very visible very tangible and it actually means that there is much more

[31:40] sits around your internal organs which is primarily in the abdominal region, stomach, liver, gallbladder, pancreas and then you can move to the lower abdomen with the uterus and the ovaries and so forth and the colon and all of this. And so

[32:00] It is very important to ensure that the waist circumference, take an inch tip simply around your belly button, measure what the waist circumference is and if it's less than 90 centimetres for men and less than 80 centimetres for women, you're good.

[32:20] Very simple thing to do at home and if it's not then please don't ignore it. Please don't ignore it. I think if I think now to aspects that people ignore the most, I can think of three things right off the bat. The first is the heart.

[32:40] right and associated with that the lung. There is no blood test that actually measures the pumping capacity and the electrical impulses that your heart actually needs to keep pumping. And there is no blood test that tells you how your lung is functioning, especially post COVID.

[33:00] and thanks to all the pollution we have these days. So the heart and the lung are very important and I think that they are the first thing that people tend to ignore because they are the most intangible. The second piece is actually what I'm going to call flexibility and strength and balance.

[33:20] Now, we don't realize and recognize the value of our bone and muscles until they are gone post 60, 70. And we are now seeing many people in that generation, whether in our colony or in our families with knee problems, back problems.

[33:40] hip problems, shoulder problems. Flexibility, strength and balance is another area that people tend to ignore. And the third piece, and you're going to love this one, is what I'm going to call cognitive function. We do not recognize

[34:00] and realize how much our brain is doing for us. And this cognitive and mental overload that we are actually doing to ourselves is having repercussions and will have very long-term repercussions that we don't recognize and realize today. And so

[34:20] So in our ProHealth program and Evolved Health, we are bringing in all of these elements to make sure that we are actually thinking about preventive health much, much more holistically and expanding that definition for you. Not just do I have a diabetes and blood pressure right.

[34:40] is something that I now feel should be taught in schools because it's so much more difficult to convince a 25 year old to think like this about health. So much easier to teach a 5 year old or an 8 year old that these are the different parameters. You just do this small little thing in each of these parameters.

[35:00] But over the next 40 years, your life will be very different. I hope that that is where the direction of preventive health goes into primary education. Doctor, thank you so much for this conversation. I wanted to ask you to give a final message if there's one thing that you want people to remember about improving

[35:20] their health long term. What would be that one take-home message be? I think in this journey, we tend to always deprioritize ourselves and women especially so because of our natural nurturing instincts.

[35:40] Please make yourself a priority. Every now and then it's okay to do that. So be pro-health and make yourself a priority. Beautiful. I think that's a very, very important message for each and every one of us. Everyone, I hope you enjoyed this conversation.

[36:00] there is going to be links below in the description for you to read more about BPRO Health and get your checkups done. Dr. Sathya, thank you so much for joining in. This was an amazing conversation. I really enjoyed it. Thank you. Thank you, Dr. Sith. Thank you.