Health and Hygiene

The unit opens with a word cloud: the word HEALTH in huge letters, surrounded by dozens of smaller words such as fitness, diet, mind, relaxation, happiness, hygiene, lifestyle, mental, wellness, nature, science, sport, care. The bigger a word, the more important the designer thought it was. The question is: what does health mean?

Look at the words again and you will see they fall into groups:

Part of health	Words from the cloud
the body	fit, fitness, athlete, gym, training, exercise, running, muscle, diet, nutrition, physical, body
the mind	mind, mental, relaxation, happiness, cheerful, positive, spirit
daily habits	hygiene, lifestyle, self-care, maintenance, activity, living
help from others	medical, medicine, care, healthcare, science, information

So health is not only “not being ill”. The World Health Organization (WHO) wrote the definition that is still used today into its constitution, signed in 1946 and in force from 1948: health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. In plain words: a healthy person is well in body, well in mind, and gets on well with other people. Not having a disease is only part of it.

Before you read

What kind of text it is

The text is an interview: a reporter from News-Medical (a website of medical news) asks questions, and an expert answers them. The expert is Chun-Kai Chang, who runs the telehealth business of Advantech, a Taiwanese company that makes computers for factories, hospitals and other businesses. Notice that he sells telehealth equipment: he knows the subject well, and he also has a reason to speak well of it.

An interview is easy to follow because of its shape: each question sets the topic, and the answer that follows stays on it. So to find something in the text, look first at the questions. The title’s acceleration means “getting faster”, and the reporter also speaks of its momentum (the force that keeps something moving once it has started): the interview is about why telehealth is growing so fast, and what comes next.

The interview, part by part

1. What telehealth is

Telehealth is a way of giving medical care remotely (from a distance), usually by video chat. It connects patients and clinicians (doctors and nurses who treat patients) wherever they are. It can be used for many kinds of care: primary care (the first, everyday care from a family doctor), psychotherapy (treating mental and emotional problems by talking), physical therapy (exercises to recover from an injury), and even emergencies. A specialist can reach patients anywhere there is an internet connection.

Its benefits for healthcare providers (the hospitals, clinics and doctors who give care) and for patients: care can be faster, safer, more effective and, in the long run, cheaper. During the COVID-19 pandemic, it let patients get care without going to a hospital, which protected both the patients and the hospital staff from the infection.

2. Why it is growing so fast

Chang names two drivers (causes that push something forward):

1. The COVID-19 pandemic. As precautions (steps taken to stop something bad), people had to keep apart (social distancing) and avoid touching. Hospitals ran short of beds. So they had to incorporate (include) telehealth to keep caring for patients at home, without a break (care continuity).
2. Too few doctors. Every year more people need care, because the population is aging (more old people) and more people have chronic (long-lasting) and non-communicable (not spread from person to person) diseases, such as diabetes and heart disease. People in rural areas are underserved: they get too little care, because there are not enough resources near them and the cities are far away. Telehealth lets the few specialists reach many more patients.

3. What comes next

Telehealth will not replace meeting a doctor face to face; it will be added to what hospitals already do. Chang predicts that:

• patients will choose hospitals and doctors by how easily they can reach them online;
• because it is convenient, more people will use preventive care (check-ups that stop problems before they start) and follow-up care (checks after a treatment);
• this will mean fewer readmissions (patients having to come back into hospital) and fewer complications;
• triage (sorting patients by how urgently they need care) will start in the field, in the ambulance or the village, before the patient reaches the hospital.

4. Watching patients from far away

Remote patient monitoring means collecting a patient’s health data all the time through wearable devices (small machines worn on the body, like a smartwatch or a sugar sensor stuck on the arm). They measure vital signs (pulse, blood pressure, breathing, temperature) and blood sugar, and send the readings in real time (as they happen) to the doctors, who watch and review them. With the whole picture of a patient’s health, a doctor can make a more precise diagnosis (a more exact finding of what is wrong).

5. Doctors working together

Telehealth also connects clinicians with each other. A doctor can call in a specialist in another city to treat a patient together. This ranges from surgical mentoring (an expert guiding a surgeon through an operation over a video link) to the Tele-ICU and Tele-ER, where the staff in an intensive care unit or an emergency room work with a distant specialist team, for example when a patient has a stroke (a blocked or burst blood vessel in the brain, where every minute counts). This helps hospitals that are short of staff in their busiest departments.

6. The challenges

The biggest problems, Chang says, are:

• infrastructure: many hospitals lack the basic systems telehealth needs: enough hardware (machines), the right technology for each kind of doctor, and a reliable network (broadband, 4G or Wi-Fi). A weak network makes it hard to reach rural areas and mobile clinics (clinics in a van that travels from place to place);
• a learning curve: it takes time to learn a new way of working. Users must learn new tools, booking virtual visits online, new triage steps and new billing (how patients are charged).

His answer: make telehealth a regular service and include it in health insurance. Then hospitals would have a reason (a motive) to invest in the equipment and systems, and to deploy it (put it into use).

Words from the interview

Words linked here open in English Vocabulary, where you can see an example and practice them in the word game. The meanings below are the ones the words have in this text.

Word	Meaning here
telehealth	health care given from a distance, by phone, video or the internet
remotely	from far away
clinician	a doctor or nurse who treats patients
psychotherapy	the treatment of mental and emotional problems by talking
pandemic	a disease that spreads over a very wide area, often the whole world
incorporate	to include something as a part of something else
continuity	going on without a break (care continuity: a patient’s care is never interrupted)
chronic	(of a disease) lasting a long time or coming back again and again
non-communicable	(of a disease) not passed from one person to another, like diabetes
underserved	not getting enough service
tackle	to deal with a difficult problem
triage	sorting patients by how urgently they need care
diagnosis	finding out what disease a person has, and its cause
collaborate	to work together
ICU	the intensive care unit, the part of a hospital for the most seriously ill patients
infrastructure	the basic systems and equipment something needs to work (networks, machines, buildings)
learning curve	the time and effort it takes to learn something new
deploy	to put something into use, ready for action

A. Crossword

B. True or false?

C. Answer the questions

D. Talk about it

Most of these words begin or end with a consonant cluster: two or three consonant sounds said together with no vowel between them, like the str in strength or the ksθ at the end of sixth. Here they are as dictionaries write them.

Word	British	American	Listen for
infrastructure	/ˈɪnfrəstrʌktʃə/	/ˈɪnfrəstrʌktʃər/	fr and str in one word; stress on IN
staff	/stɑːf/	/stæf/	st at the start
chronic	/ˈkrɒnɪk/	/ˈkrɑːnɪk/	ch says k: kr
strength	/streŋθ/	/streŋθ/	str at the start, ŋθ at the end
milk	/mɪlk/	/mɪlk/	lk at the end
school	/skuːl/	/skuːl/	sch says sk
shield	/ʃiːld/	/ʃiːld/	sh is one sound, /ʃ/; ld at the end
curious	/ˈkjʊəriəs/	/ˈkjʊriəs/	kj (a y sound after the k)
stethoscope	/ˈsteθəskəʊp/	/ˈsteθəskoʊp/	st and sk; th as in thin
blend	/blend/	/blend/	bl at the start, nd at the end
strand	/strænd/	/strænd/	str at the start, nd at the end
sixth	/sɪksθ/	/sɪksθ/	ksθ: three consonants at the end
scream	/skriːm/	/skriːm/	skr at the start

When someone tells you about a problem, English gives you many ways to suggest something or to advise them. They go from gentle (an idea for them to think about) to strong (a warning):

To	Say	Example
offer an idea	How about / What about + -ing?	How about talking to her parents?
suggest kindly	Why don’t you + base form?	Why don’t you go to a dentist?
say what you would do	If I were you, I’d + base form	If I were you, I’d ask her not to beg.
advise	You should / ought to + base form	You should try talking to Sneha.
suggest gently	Perhaps / Maybe you should + base form	Perhaps you should try talking to her.
advise firmly, with a warning	You’d better + base form	You’d better see a doctor, or it will get worse.

And to answer a suggestion: That’s a good idea. / I’ll try that. / I’m not sure that’s a good idea. / I’ve tried that, but… / It might work, I suppose.

A. The conversation

Shanti and Selina are talking about a friend. Here is what they say, in our words:

• Shanti is fed up: her friend Sneha keeps asking her for money, and she asks Selina what to do.
• Selina first says what she would do: if I were you, I’d ask Sneha not to beg.
• Shanti doubts that is a good idea, so Selina suggests more gently: perhaps you should try talking to Sneha about it.
• Shanti has tried that already, but Sneha wasn’t interested. So Selina has a third idea: how about talking to her parents?
• Shanti isn’t sure, but in the end agrees: it might work, I suppose.

Notice how Selina keeps trying: when one suggestion is turned down, she offers another, a little differently.

B. Giving advice

C. Suggestions for a friend

Should, ought to and had better are all used to give advice: to say what is a good idea, or the right thing to do. They follow the rules of modal verbs: no -s for he, she, it, and the base form of the verb after them.

	Positive	Negative	Question	Use it for
should	You should study more.	You shouldn’t (should not) eat so much.	Should I go? What should I do?	advice; what is right or sensible
ought to	You ought to study more.	You ought not to eat so much.	(rare; use should)	the same as should, a little more formal
had better	You’d better* (had better) leave now.*	You’d better not* be late.*	(rare)	strong advice about now or soon, with a warning: or something bad will happen

A picture of a teacher and a boy shows it. The boy says, I failed my test. His teacher asks, What do you think you should do in future? And he answers, I should study a little more.

A. Study the sentences

B. Choose the correct answer

How to write paragraphs of advice

1. Open with the problem, clearly and kindly: describe what the person does, not who they are. (He sits on the sofa for hours, not He is lazy.)
2. Give the advice in a sensible order: what to stop, then what to start, each with a reason (…, because…, …, or…).
3. Vary the expressions: should, ought to, had better (not), If I were him, it would be a good idea to…. The same word five times sounds dull.
4. End with the result: what will be better if the advice is followed.

In your final exam, a paragraph like this can be asked in Free writing I (about 150 words, 6 marks, giving your views or advice) or, from given clues, in Guided writing I (about 100 words, 5 marks).

Before you read

What kind of text it is

Health is Wealth is a folk tale: a short, simple story, told and retold for a long time, that begins Once upon a time, has characters with no names (the king, the minister, the holy man) and ends with a lesson (a moral). The lesson is in the title: being healthy is worth more than being rich.

The story, part by part

1. A kind but lazy king

There was once a benevolent (kind and generous) king. Even so, his people weren’t happy with him, because he was lazy: he did nothing but eat and sleep, for days, weeks and months, in his bed. He became a couch potato, someone who sits or lies about all day and takes no exercise, and his people began to worry.

2. Too big to move

One day the king found he couldn’t move his body, not even a foot. He had grown so large that his obesity (being far too fat) became a joke: people called him the “bulky king”.

3. The doctors fail

The king called expert doctors from all over his country and offered them generous rewards to make him fit. None of them could. He spent an enormous (huge) amount of money, but it all went in vain (came to nothing).

4. The holy man’s offer

One morning a holy man came to the country. Hearing about the king, he told the minister at the palace that he could easily cure him. The minister was delighted, and asked the king to meet him. But the holy man lived far away, and when the king, who couldn’t move, asked for him to be brought to the palace, he refused: the king had to come to him.

5. The first visit

With strenuous efforts (great, tiring effort), the king reached the holy man’s home. The holy man complimented him (said good things about him): he was a good ruler, and he would soon be healthy again. He told the king to come back the next day for his treatment, and added a condition: he would be treated only if he came on foot.

6. Two weeks of walking

The next day the king could hardly walk a few steps, but with his followers holding him up, he got there. The holy man wasn’t there; a devotee (a follower) asked the king to come again the next day. The same thing happened every day for two weeks: the king never met the holy man, and never got any treatment.

7. The cure

Slowly the king noticed that he felt much lighter, had lost a lot of weight, and was more active than before. Then he understood why the holy man had made him walk: the walking was the treatment. Very soon he was healthy again, and his people were happy.

What it means. The doctors failed because the king expected someone else to cure him, and money can’t buy a habit. The holy man was wise: he knew the king would refuse to “just walk”, so he gave him a reason to walk every day, and let him find out the truth himself. The lessons: health is wealth (all the king’s money couldn’t do what two weeks of walking did), and a lazy life makes us ill; an active one makes us well.

Words from the story

Word	Meaning here
benevolent	kind, generous and wanting to do good
couch potato	a person who sits or lies about for hours (watching TV) and takes no exercise
obesity	being very fat, in a way that is bad for health; obese is the adjective
enormous	very big
in vain	without success; everything went in vain: all of it came to nothing
reside	to live in a place; a residence is a home
strenuous	needing great effort or energy
compliment	to say something nice about someone
devotee	a person who follows and admires a religious leader or a god
considerable	large, a lot of
regain	to get something back that was lost

A. Complete the sentences

B. Answer the questions

C. The queen’s story

Personal hygiene means keeping your own body clean: washing, brushing your teeth, trimming your nails, wearing clean clothes. The listening has two parts: a short talk with hygiene tips, and then a conversation in which Kris helps his friend Sam at work. CDC’s own recording is below: read the questions in B first, then listen, as many times as you need.

A. Before you listen

B. The textbook’s audio: answers

What the talk and the conversation say

The talk’s tips, in short: bathe with soap every day and wash your hair regularly (look out for lice and dandruff); wear clean underclothes, clean, ironed clothes and fresh socks every day; clean your shoes; brush your teeth twice a day and floss once; change your toothbrush every three months; keep your nails short and clean; and wash your hands with soap before and after eating, after using the toilet, and after coughing or sneezing, using a hand sanitizer when there is no soap and water.

In the conversation, Sam is worried: customers come to his counter, look uncomfortable and go to the next one, so he sells nothing. His friend Kris tells him kindly what is wrong: he hasn’t shaved or showered, and his body odor (the bad smell of sweat) is turning customers away. Sam admits he has been too busy to bathe. Kris advises him to shower, wear clean clothes, and use a little deodorant after showering, and Sam promises to take care of himself.

C. Hygiene tips

You already know the first conditional, for something that may really happen: If it rains, we will stay at home. This unit adds two more, for things that are not real:

Type	Form	About	Example
second	if + past simple, would + base form	an imagined or unlikely situation, now or in the future	If Sarita had an Android phone, she would join the virtual class. (She hasn’t got one.)
third	if + past perfect, would have + past participle	a past that did not happen, and its imagined result	If the king had lived an active life, his health would not have worsened. (He didn’t, and it did.)

Instead of would, the result can have could (was able to) or might (perhaps): If you asked them, they might help. If he had driven carefully, he might not have had the accident.

A. Study these sentences

B. Complete with the correct form

C. Complete the conditional sentences

Kwati is a thick soup of several kinds of sprouted beans, often nine, cooked by the Newar community and now by families all over Nepal. It is eaten especially on Janai Purnima, the full moon of Shrawan, which is also called Kwati Purnima (Newars call the day Gunhu Punhi). The beans are soaked for three or four days until they sprout, which is why the soup is said to give strength in the wet, tiring monsoon.

The task gives the ingredients and the steps of a kwati recipe, but the steps are jumbled. Put them in order first.

How to write a recipe

A recipe is a set of instructions for cooking a dish. It has:

1. A title: the name of the dish, and often how many people it serves and how long it takes.
2. The ingredients: a list of everything needed, with amounts, in the order they are used.
3. The method: numbered steps, in order, one action per step.

The steps are imperatives: they begin with the verb and have no subject (Melt the ghee. Add the onion. Fry for five minutes.). Sequence words help in a paragraph recipe: first, then, next, after that, once…, finally. In your final exam, a recipe can be asked in Guided writing I (about 100 words, 5 marks, from given clues).

The ending -logy comes from the Greek logos, “word, reason”: a word ending in -logy usually names the study of something. The first part says what is studied.

Word	The first part means	It is the study of
pathology	pathos: suffering, disease	diseases (a pathology lab tests blood and samples)
epidemiology	epidemic	how diseases spread, and how to control them
archaeology	archaios: ancient	the cultures of the past, from what people left behind
geology	gē: the earth	the rocks and the physical structure of the earth
metrology	metron: measure	measurement
sociology	socius: companion	human society
anthropology	anthrōpos: human being	the origins of human beings, their cultures and relationships
meteorology	meteōron: a thing high in the air	the atmosphere and the weather
astrology	astron: star	the belief that the positions of the stars and planets affect people’s lives

The person who studies it ends in -logist: a pathologist, a geologist, a meteorologist. The adjective ends in -logical: pathological, geological.

Practice on this unit in the style of the final exam (Grade 9’s exam follows the SEE’s kind of chart). Try each one as in the exam, then open the answer.