Episode 20 - Physical activity, prevention and the role of community in health

Summary In this episode, Tim is joined by Dr Callum Leese, a GP based in the Scottish Highlands, researcher at the University of Dundee and co-founder of the community initiative Healthiest Town Aberfeldy. The conversation explores a familiar tension in healthcare - we know physical activity is one of the most powerful tools we have for preventing and managing disease, yet it remains difficult to embed meaningfully into everyday clinical practice. Callum reflects on his experience during COVID, where rising rates of non-communicable diseases highlighted a system often focused on reacting to illness rather than addressing its root causes. He describes this as a kind of “whack-a-mole medicine”, where new conditions are continually treated as they arise, rather than working upstream to prevent them. This led to the creation of Healthiest Town Aberfeldy, a community-led initiative aiming to reduce barriers to good health at a local level. The project brings together food, movement and social connection through practical, visible and locally relevant activities - from cooking groups to growing festivals - grounded in the idea that health is shaped collectively, not just individually. The discussion also explores the real-world challenges clinicians face. Time pressure, limited resources, gaps in knowledge and lack of financial incentives all play a role in why preventative conversations don’t always happen. But alongside these barriers, there are also signs of progress, including growing recognition of social prescribing and more integrated, community-based approaches. A key theme running throughout the episode is the role of health coaching. Not just in how to have better conversations, but in knowing when to have them, how to tailor them, and how to work with the complexity of people’s lives rather than reducing health to single issues. Takeaways Physical activity is one of the most effective interventions in healthcare, yet remains underused in practice Healthcare systems often prioritise treatment over prevention, leading to reactive rather than upstream care Time pressure is a major barrier, but not the only one – resources, knowledge and incentives also play a role Community-led approaches can help remove practical and social barriers to better health Health is shaped not just individually, but by the people and environments around us Rural settings bring unique challenges to health, including access, cost and opportunities for activity Seeing relatable, local examples of change can be more powerful than generic advice Health coaching is not just about what to say, but when and how to say it Tailored, personalised conversations are more effective than generic information or advice People rarely present with a single issue – health challenges are often interconnected Simple questions like “What are you doing to look after your health?” can open meaningful conversations Active healthcare professionals are more likely to have conversations about physical activity Making healthy behaviours visible can be a powerful form of advocacy