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Want to avoid secondhand smoke? Try these five tips: 1. Don't allow smoking in your home. If your guests smoke, ask them to do it outside. If your partner smokes, encourage him or her to quit. 2. Patronize restaurants and other businesses that enforce no-smoking policies. 3. Don't allow smoking in your vehicle. 4. Choose smoke-free care facilities for children and aging loved ones. 5. If you must share space with someone who's smoking, sit as far away from the smoke as possible.

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Trying to avoid the freshman 15? There’s a dorm for that.

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Lenny BernsteinMisFits columnistTrying to avoid the freshman 15? There’s a dorm for that.

(from Frostburg State University/ ) - The pool at Frostburg State.

CAPTION By Lenny Bernstein, E-mail the writer

You’re 18 years old, headed off to college, and you want to maintain the exercise regimen you followed as a high school athlete. Or perhaps you’ve decided that your first year away from home is the perfect time to break some poor eating habits developed in Mom and Dad’s kitchen. Or maybe you’re just dreading the Freshman 15 that other kids pack on in campus dining halls.

Well, there’s a dorm for that.

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A few colleges in this region offer fitness- and wellness-themed residences, places that take schools’ increasing interest in their students’ health and welfare to another, 24-hour level. They are more philosophies than boot camps, but the kids who live in them love them, and school officials believe they are working.

At Maryland’s Frostburg State University, for example, it’s the bWell dorm, where 70 freshmen with an interest in wellness and fitness pursue that lifestyle. They attend the kinds of health-oriented programs that many schools now offer new students, but they also do P90X and Insanity workouts together, learn how to cook healthful meals, take a substance-free pledge and try to prevent one another from going on those midnight fast-food runs.

“There’s really no requirement to come in here other than deciding that I want to be a healthier person,” said Chandler Stroup, a grad student and resident director at the dorm. “But the best part,” he added, “is that we’re all on our own individual plan; we all are looking for our own goal. I’m looking to be healthier physically. Someone right next door is interested in getting better at healthier eating.”

Last year, Stroup’s goal was simply not to gain weight during the many hours he sat in front of a computer. He lost five pounds. This year he’s intent on keeping up a running schedule of five to eight miles, three or four times a week.

“For me, it’s been helpful for knowing that I can maintain a busy schedule and exercise,” he said.

At Goucher College, a small liberal-arts school in Baltimore, it’s the Sondheim residence. There, 64 students, freshmen and upperclassmen, troop off to yoga classes together, take dance lessons, learn how to cook healthful meals and sign a contract that requires them to abstain from alcohol, drugs and tobacco, said Billy Daly, a 19-year-old sophomore who is starting his second year in the residence. There are occasional family-style dinners and a true interest in creating an environment where there’s no pressure to drink.

“I think the best thing were the people in the dorm,” he said. “They really do create that environment where you feel comfortable. It really is like a family.”

And at Mount St. Mary’s University in Emmitsburg, Md., 30 freshmen in one dorm and 20 upperclassmen and women in two small houses are taught how to pursue more healthful habits. “Instead of eating ramen and unhealthy fast food,” said Christian Barber, associate director of residence life, “they would [learn] ways to cook on a budget and healthy food options.”

Themed dorms on college campuses are nothing new. You can take your pick almost anywhere — Spanish immersion, vegetarian, quiet, music, environmental issues. Nor is programming aimed at encouraging healthful choices novel anymore. At the University of Maryland, incoming students can take a summer course called Fight the 15: Introduction to Fitness and an Active Lifestyle. At American University, the newest dorm has a fitness center on the first floor, a conscious choice the university made when the building was planned, spokeswoman Maralee Csellar said.

But in 2008, April Baer, Frostburg’s new director of student wellness, decided the school should be doing more. “I wanted to provide a service to students that we had not yet instituted,” she said. They are “only in classes three to five hours a day. .?.?I wanted the themes we were providing to resonate even in their homes.”

A 2009 pilot program went well, and in the fall of 2010 the bWell residence was born, with a program that emphasizes stress mastery, nutrition and fitness, she said.

There has been no formal follow-up research, she said, but anecdotal evidence shows that residents are more engaged in campus life than many of the other 5,400 students, and many become campus leaders. The number of alcohol-related incidents at the dorm has been near zero since its inception, and there have been no repeat offenders, Baer said.

“We typically attract students who are seeking a special experience .?.?. and we engage them,” Baer said.

“We show them that fitness is more than just walking on a treadmill.”

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Also at washingtonpost.com Read past columns by Bernstein and Vicky Hallett at washingtonpost.com/wellness. There, you can subscribe to the Lean & Fit newsletter to get health news e-mailed to you every Wednesday.

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Why we're heading for a global healthcare crunch – and how to avoid it

The cost of providing healthcare is spiralling, but considering the value of services could help save money. Photograph: Alamy

Humankind has managed to get people to the moon, created devices which connect us with others anywhere in the world, and made 640 tonnes of metal fly through the air, so why can't we find a sustainable model for healthcare?

Healthcare spending is growing at an unsustainable rate, faster than economies and faster than wages. In the US, it is predicted that in just seven years health will cost 20% of GDP. The UK will catch up some time within the next 50 years, depending on inflation. NHS England recently revised upwards its expectations for efficiency savings, claiming that on top of the £20bn savings it had already predicted, an additional £30bn will need to be found between 2014 and 2020.

Commentators often argue that the answer to the problem is to refocus the healthcare system from delivering activity to delivering value; simply spending more money does not translate to better outcomes.

So what is value in healthcare? It may be patient outcomes or results achieved per pound spent; this is hard to visualise so it may be better to say that value equals solving health problems for patients to leave them in a better position than when they approached the service, and at a cost which is more efficient than paying for the long-term consequences of the presenting problem.

Spend a few minutes digesting these sentences, for they explain the root of the problem and the barriers to better value-based services in healthcare. The particular pressures that health services face are the difference between solving a problem and responding to an illness, and the difference between taking the long term or short term view.

To understand this fully let's look at the mobile phone industry. Telecommunications solves problems for people and adds value by making us more productive. It does this because technology adapts to how people want to use it.

Most people reading this article will have smartphones, but I can guarantee that we all use these technologies in different ways. We'll have different apps arranged to solve individual problems, creating individual opportunities and overcome unique barriers.

Smartphones, like some other products and industries, have created adaptive systems which allow us to boost our own productivity. In adopting a new device we will each make a judgement about the upfront cost versus the medium term cost of not buying something, and we might also make an investment in making our lives easier in future, at an immediate cost.

Those of us who work in healthcare will know that, in general, the system is focused on the short term to fix acute illness, rather than building physical resilience to avoid the longer term consequences of poor health. We also recognise that healthcare does not adapt to help people to solve their own problems. Instead, and quite unintentionally, it can make patients adapt around its own systems.

When it comes to value, many healthcare services work in the opposite direction: they take a short-term view and respond to things which have already gone wrong. But there are some exceptions.

Public health as a model is inherently value based, or at least it can be. Let's take vaccinations as an example. Depending upon who we are, and whether we are travelling to certain countries, we each receive different vaccinations. So the process of vaccination adapts around us and the lifestyle we choose.

Public health is also a longer term investment; we have vaccinations now to reduce the risk of contracting debilitating disease in the future. It is productivity-boosting by its very nature.

So where does this leave us? Now that we have a twopoint framework for value in healthcare, it would be interesting to use it as a thinking tool.

How could your service or services become more value based? Set some time aside to think it through, because if the theory is right (or at least nearly right) then this is what will determine the sustainability of what you do. And ultimately, the sustainability of the NHS.

Put differently, if we don't begin to do something about the barriers then perhaps we really are headed for a global healthcare crunch.

Anoop Maini is senior policy advisor to the health services regulator Monitor.

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

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