The Health Playbook

TL;DR. This is the practical chapter: what to actually do, what to measure, when to get checked, what to ask, and what to ignore. Chapter 63 explains the evidence behind these choices; this one is the operational version. Nothing here is a substitute for a clinician who can examine you, and everything here is defensible as a default. If you read only one page of it, read the twelve-item list below and the red flags table, because between them they cover most of the preventable harm in this book.

Key takeaways

• Twelve actions cover most of what is achievable. The first four dwarf the rest.
• Measurement beats sensation. The diseases that kill most people are silent for years, so how you feel is a poor guide and a small number of cheap tests is a good one.
• Know six numbers about yourself: blood pressure, HbA1c or fasting glucose, LDL or ApoB, waist-to-height ratio, resting heart rate, and roughly what you can do physically.
• Screening is worth it only where trials show reduced deaths, which is a short list, and the glossy full-body scan is not on it.
• Every year past 60, the highest-value activity is preventing a fall, not treating anything.
• Four emergency skills, learnable in an afternoon, matter more than anything else you can do for someone else.

The twelve, ranked

In short: Ordered by expected benefit, and the first four are worth more than everything below them combined.

The daily and weekly template

In short: One realistic pattern. Adapt it; do not treat it as a prescription.

Daily

• Move. Walk. Take stairs. Break up sitting every 30 to 60 minutes. Any amount beats none, and the steepest part of the benefit curve is the first 15 minutes a day.
• Get outside in the morning, for the body clock and, if you have children, for their eyes.
• Eat protein at each meal (roughly 25 to 40 g), plenty of plants, and something with fibre.
• Drink to thirst plus a margin. Judge by urine colour, not by counting glasses.
• Brush twice with fluoride toothpaste, spit and do not rinse; clean between teeth once.
• Take prescribed medication, including on days you feel fine, which is all of them for preventive drugs.
• Protect your skin from the sun when the UV index warrants it.

Weekly

The six numbers to know

In short: These describe the state of your body better than how you feel does.

One more worth knowing once: your family history of early heart disease, cancer, diabetes, and psychiatric illness, in first-degree relatives, with ages. It changes screening decisions and almost nobody has actually asked their relatives.

Screening: what to have, and when

In short: A short list with proven mortality benefit, and the exact ages differ by country, so treat this as the shape and follow your local programme.

What not to have, on current evidence: whole-body MRI or CT in people without symptoms, "executive" full-body panels, coronary calcium scoring in genuinely low-risk people, ovarian cancer screening, and routine annual general health checks as a ritual, as opposed to their specific proven components (Chapter 63).

Vaccination across life

In short: Childhood schedules are well known and adult vaccination is where the gap is.

By decade

In short: The priorities change, and the early ones are about building capacity while the later ones are about protecting it.

20s and 30s: build the ceiling. Peak bone mass, peak muscle mass, and peak aerobic capacity are all set now, and the rest of life descends from them. Do not start smoking. Establish an exercise habit including resistance work. HPV vaccination if eligible. Know your blood pressure. Sexual health testing between partners. Address mental health early, since most lifetime psychiatric illness begins here. Do not accumulate head impacts. Contraception and preconception folic acid if relevant.

40s: find the silent things. Blood pressure, lipids, glucose. Weight trajectory matters more than any single reading. Start colorectal screening at 45 in most countries. Review alcohol honestly. Get snoring with daytime sleepiness investigated. Keep or start resistance training, because this is when the losses begin to show. Get a lipoprotein(a) measured once.

50s: defend what declines fastest. Muscle and aerobic capacity now need active defence rather than maintenance. Bone assessment if there are risk factors. Hearing tested. Cancer screening as offered. Shingles vaccine at the recommended age. Discuss menopause management rather than enduring it (Chapter 51).

60s: add power and balance. Power declines before strength and is what prevents falls. Vaccination becomes more important. Abdominal aortic aneurysm screening for men. Eye examination annually. Continue everything above, and increase protein toward 1.0 to 1.2 g/kg.

70s and beyond: prevent the fall, and subtract. Falls prevention is the single highest-value activity: strength and balance training, medication review, vision correction, blood pressure checked on standing, home hazards removed. Maintain protein and resistance training, which work at any age. Deprescribe: ask which medicines still have a purpose. Protect social connection deliberately. Discuss what you would and would not want if seriously ill, and write it down.

Red flags: when to seek care urgently

In short: One table worth knowing. These are the presentations where delay changes the outcome.

Call emergency services immediately

Same day

Within days to a couple of weeks

Unintentional weight loss. A cough lasting over three weeks. Difficulty swallowing. Blood in stool or urine. A change in bowel habit lasting weeks. A new or changing mole, or a sore that has not healed in a month. A lump that is new, hard, or growing. Night sweats with weight loss. Persistent hoarseness. New unexplained fatigue with pallor. Progressive memory loss affecting daily function. Any new symptom that is worsening rather than settling.

How to be a patient

In short: Six questions that change the quality of what you get.

1. "What is the goal of this treatment?" Cure, extend life, or relieve symptoms. Patients and clinicians frequently believe different things here.
2. "What is my absolute risk now, and what is it with treatment?" Not the percentage reduction. Ask for the number needed to treat if you can (Chapter 17).
3. "What happens if I do nothing, or wait?" A legitimate option more often than it is offered.
4. "What are the side effects, and which should make me call you?"
5. "Is this still needed?" For every long-term medication, at least annually. Deprescribing is one of the clearest benefits in geriatric medicine.
6. "Can I have that in writing?" Especially sick day rules, action plans, and what to do if symptoms return.

Bring to appointments: a current list of every medication and supplement including doses, your family history, your own record of symptoms or readings, and your questions written down. Bring someone for anything serious, because people recall a minority of what is said in a consultation.

Ask for an interpreter if language is a barrier, rather than relying on a family member, which is associated with worse outcomes.

Emergency preparedness

In short: Four skills and three items.

Learn: CPR and defibrillator use, the recovery position, severe bleeding control, and choking management (Chapter 60). An afternoon, once.

Have at home: a smoke alarm and a carbon monoxide alarm (both tested), a basic first aid kit, and, if relevant to anyone in the household, an adrenaline autoinjector or naloxone.

Know: your own and your family's allergies and medications, your local emergency number and poisons information service, and where the nearest defibrillator is if you have a household member at cardiac risk.

What not to bother with

In short: These consume money and attention and have failed when tested.

• Multivitamins and antioxidant supplements in people who are not deficient. Several have caused harm in trials.
• Detoxes and cleanses. Your liver and kidneys do this continuously.
• Whole-body scans and comprehensive blood panels without symptoms or indications.
• IgG food intolerance panels, hair mineral analysis, live blood analysis.
• Most commercial "stem cell" and "longevity" treatments, none of which has demonstrated healthy human lifespan extension.
• Alkaline diets, and any product claiming to change your blood pH.
• Routine thermography instead of mammography, and other unvalidated substitutes for proven screening.

The one-page version

In short: If you remember nothing else.

• Do not smoke.
• Know your blood pressure and treat it.
• Walk daily and lift twice a week.
• Sleep seven to nine hours.
• Eat plants, fibre, and protein; less ultra-processed food and alcohol.
• Stay vaccinated and attend the screening that is offered.
• Get hearing, eyes, and teeth looked after.
• Treat low mood and isolation as medical problems.
• Wear the seatbelt, fit the smoke alarm, and prevent the fall.
• Learn CPR.
• Ask what your absolute risk is, and whether each medicine is still needed.
• Go early for the red flags, and stop waiting to see if things settle.

None of this guarantees anything. Fit non-smokers get cancer, and people who did everything wrong live to 95. What these choices do is shift probabilities, and over a life and across a population, shifted probabilities are measured in years.

Sources and notes

Every recommendation here is drawn from the chapter it references, and the underlying evidence and its limits are cited there. Screening ages and intervals differ substantially between countries on the same evidence, so local guidance (NICE, USPSTF, and national equivalents) takes precedence over the shape given here. Vaccination schedules are national and change; check current local recommendations. Effect sizes quoted are from Chapter 63.

A caution. This chapter is deliberately prescriptive because vagueness is useless, and every line of it is a population-level default rather than personal advice. Age, pregnancy, kidney and liver function, other conditions, and other medications all change what is right for an individual, and none of them is visible to a book.

Next: what the next fifty years plausibly hold. 👉