Tag: public health

Prevention is Not Only Good Health Policy, It’s Good Economic Policy

Nov 24, 2009• 26

By KENNETH THORPE, PhD

The current debate around how to best control burgeoning health costs has pushed the issue of prevention to the forefront. That’s right where it should be. By shifting our health care to be more pro-active and prevention-oriented, we can make a major impact on common and costly chronic diseases such as diabetes. In turn, this will help to secure the financial stability of our health care system and continued economic growth and prosperity.

Over the past century, the burden of disease among Americans has shifted from acute and infectious illness to chronic disease. With more than 75 cents of every dollar in this nation spent on patients with chronic disease, prevention offers the opportunity not to spend more money — but spend smarter. By embracing prevention, we can help more Americans lead healthier, active lives free from disease, so that they can avoid costly complications and hospitalizations, and remain productive in their communities and workplaces.

Prevention today involves a lot more than flu shots, cancer screening, and annual checkups. It is a pro-active strategy of disease avoidance and mitigation that should be embraced throughout and beyond the health system. In the context of chronic illnesses such as asthma, cancer, depression, heart disease and diabetes, prevention runs the gamut from lifestyle changes to screening for risk factors and symptoms, to early intervention to slow or reverse disease, to active management of already present cases.

Smoking and Mental Illness

Oct 12, 2009• 24

By MAGGIE MAHAR

At last weeks Health 2.0 Conference Maggie Mahar, author of HealthBeatBlog got more than a little feisty about Al Waxman’s suggestion that we make people with bad health behaviors pay more. She said that 95% of smokers had some form of mental illness, and therefore we were punishing the mentally ill. Really? Read on for Maggie’s explanation (lifted at her request from a comment elsewhere).—Matthew Holt

According to the New England Journal of Medicine,

“The link between smoking and anxiety also helps explain why smoking is so strongly correlated with mental illness. “smoking rates have been reported to be over 80 percent among persons suffering from schizophrenia, 50 to 60 percent among persons suffering from depression, 55 to 80 percent among alcoholics, and 50 to 66 percent among those with [other] substance-abuse problems.”

Poverty is highly correlated with smoking because poverty is stressful. U.S. soldiers also smoke in greater numbers than the population as a whole–even if they didn’t smoke before joining the army The NEJM reports:

“Serving in the military is a risk factor for smoking even for those who did not start smoking prior to the age of 18. Smoking is the number-one health problem for vets,” says Dr. Steven Schroeder, former President of the Robert Wood Johnson Foundation, where he focused on smoking cessation. “And reports are showing that many US soldiers serving in Iraq are turning to smoking to relieve their stress.”

At the Health 2.0 conference, Al Waxman asked the audience how many thought that smokers should be “penalized” for smoking, presumably by paying more for insurance. I pointed out that the vast majority of adult smokers are poor; many suffer from some form of mental illness.Do we really want to punish people who are living in poverty and are mentally ill?

Five Recommendations for an ONC Head Who Understands Health IT Innovation

Mar 6, 2009• 14

By David C. Kibbe, Brian Klepper and John Moore. Kibbe

Now that the legislative language of the HITECH Act — the $20 billion health IT allocation within the economic stimulus package — has been set, it’s time to identify a National Coordinator (NC) for Health IT who can capably lead that office. As many now realize, the language of the Bill can be ambiguous, requiring wise regulatory interpretation and execution to ensure that the money is spent well and that desired outcomes are achieved. Among other tasks, the NC will influence appointments to the new Health Information Technology (HIT) Policy and Standards Committees, refine the Electronic Health Record (EHR) technology certification process, and oversee how information exchange grants and provider incentive payments will be handled.

Musings on Integrating Care at the IOM

Feb 26, 2009• 5

By Matthew Holt

So I’m in
DC figuring out how the East coast medical policy elite tries to change the world. While the rest of DC is buzzing about Obama’s speech and budget, The Institute of Medicine is having a conference on Integrative Medicine. But most people think it should be called integrative health.

What is integrative health, you ask? Good question.

The majority of the panelists are mainstream health care players like Bill Novelli (AARP), George Halvorson, (Kaiser Permanente), Ralph Snyderman, (Duke). They’re talking about integrating coordinated allopathic health care and information across an individual’s personal health plan. Snyderman, said we need to move from “find it, fix it” to a “personal health plan”. Halvorson said (surprise, surprise) that we need electronic health data on every patient, and to not just replicate the current silos of care in our new data strategy. Novelli went straight at the environmental factors—smoking, fast food et al. And to not ignore them. Mehmet Oz (he of the Oprah show) said that

Dr. George Lundberg for Surgeon General

Jan 25, 2009• 18

By Brian Klepper

The report that Mr. Obama’s Surgeon General choice might be neurosurgeon and CNN medical correspondent Dr. Sanjay Gupta produced an upwelling of strong opinion, particularly in the medical community. Some argued that Dr. Gupta has clearly demonstrated his abilities as an able communicator.

But others said that Gupta lacks the experience, seriousness and focus on public health. (I can’t help thinking that anyone who has achieved working neurosurgeon and national TV commentator status is pretty capable and serious, demeanor notwithstanding.)

And so it is that on Facebook, that Dr. Richard Lippin, a longtime Preventive Medicine physician based in Pennsylvania, has posted a letter he sent to President Obama and Secretary Daschle, urging the consideration of Dr. George Lundberg for Surgeon General.

The header reads: “We need a physician with the gravitas and the moral credentials and authority to use this bully pulpit position to speak for science and values based priority public health issues for all Americans. Dr. George Lundberg fits the bill.”

The letter provides a brief bio of Dr. Lundberg, the brilliantly eclectic, progressive, Alabama-born, down-to-earth physician who has been a visible mainstay of American medicine for decades. Dr. Lippin doesn’t mention Dr. Lundberg’s landmark 2002 book on American health care and reform, Severed Trust. (The title alone provides a lot of insight into Dr. Lundberg’s view of the world.)

But Dr. Lippin does believe the Surgeon General choice is about healing both America and American medicine, He writes, “we have a genuine crisis on many levels in US Medicine. Also we need desperately for the medical profession to regain its moral and ethical foundations and furthermore we also need medical leaders who must regain the trust of the American Public which has been dangerously eroded.

I agree with Dr. Lippin that those are the tasks, and I agree that Dr. Lundberg is a terrifically suitable candidate. Over many years, I have developed a warm friendship with him. It is impossible to not be bowled over by his range and grasp of issues, and by his unswerving willingness to stand clearly and openly for approaches that are tied to evidence and reason. The ultimate critical thinker, his judgments are founded most closely to merit, possibility and an unshakable belief in the correctness of the pursuit of excellence in health.

He is also bold and politically savvy. You don’t become the longest running Editor-in-Chief of the Journal of the American Medical Association (until he got politically at odds with them) and then build Medscape into the most widely read Web resource for clinicians worldwide unless you can continuously strike the delicate balances between science, sensibility and moral imperatives among your peers.

I can’t say whether Dr. Lundberg would be the best candidate for the job ahead. He has a huge following in the medical community, nationally and worldwide, the result of many, many years of consistently high performance infused with unassailable integrity. Whether he’s the right person for this moment is another issue, though, fraught with the complexities of political consideration, a vision consistent with the larger plan of the Obama team, fluency with the bewildering array of new technologies that are changing the face of medicine and the patient-physician relationship, and so on.

But Dr. Lippin makes an important point. American medicine is demoralized in the field. Overt, rampant financial conflict has caused many to believe that the profession has lost its compass. With that loss, the trust of patients and the authority that trust conveys have also diminished.

Restoring that trust and authority isn’t simply a matter of leadership or preaching, but will depend on fundamentally changing the business of medicine, a much larger task indeed that will require an orchestrated effort by all of us, not just physicians.

But the new Surgeon General, whoever he or she is, should be grounded first in science, evidence and best practice, in tirelessly advocating and maneuvering for a care delivery system that is as advanced and nuanced as the diagnostic and treatment approaches we’ve developed, and on advancing the health of ALL our people in ways that leverage rather than squander increasingly precious resources.

While there is no question that Dr. Lundberg is worthy, I’d be surprised if the call for his consideration is heard in the din of this transition. Even so, it is deeply gratifying to see an outpouring of support by his peers, the result of successfully dedicating his life to advancing medical knowledge and its best application.

Nomination for U.S. Surgeon General

Jan 23, 2009• 1

By Richard A. Lippin, MD

This is a reprint of the letter originally posted to Facebook.

Dear President Obama and Former Senator Tom Daschle:

As a physician leader in the medical specialty Preventive Medicine for 30 plus years, I am writing this open e-letter to you to strongly urge you to consider George D. Lundberg, MD as our nations next U.S. Surgeon General.

My letter relates to the distinctly unique qualifications that Dr Lundberg would bring to this important position and to express my views about the position itself since various previous administrations have held variable views on how to define the activities of the position itself. And the “power of personality” of some of our best US Surgeon Generals has influenced the perception of the role.

Transforming medicine and saving lives

Dec 9, 2008• 5

By Sarah Arnquist Bestpractice

This week, Don Berwick will announce the results of the 5 Million Lives Campaign
before thousands of people in Nashville attending the National Forum on Quality Improvement in Health Care.

Twenty years ago, it was almost heretical to question the quality of American health care. The common refrain being that it was unarguably the best in the world.

Decades of work by Berwick and others, however, have dispelled that myth, and the underlying belief that medical errors and hospital acquired infections are simply an artifact of the business. These quality champions deem it unacceptable that as many as 98,000 Americans die annually from preventable medical errors, and that most Americans receive the recommended care only half the time. They’ve spent years building their case, and in turn created a social movement around their cause.

In the book, "The Best Practice," Charles Kenney chronicles this long march toward a culture within American health care that demands continuous quality improvement.

Gates Foundation to fund global informatics training

Dec 8, 2008• 1

By Neil Versel

The American Medical Informatics Association will announce today that it has received a $1.2 million grant from the Bill and Melinda Gates Foundation to promote health informatics and biomedical education and training worldwide, particularly in developing countries.

This will be the first project of a new program called 20/20, in which the International Medical Informatics Association
and its regional affiliates, including AMIA, will attempt to train
20,000 informatics professionals globally by 2020. This is an outgrowth
of the AMIA 10×10 program to train 10,000 people in informatics in the U.S. by 2010. IMIA will present details of 20/20 this week at the Wellcome Trust in London.

AMIA
will use the Gates Foundation money to develop "scalable" approaches
to e-health education, including a replicable blueprint for training
informatics leaders, including physicians, medical records
professionals, computer scientists and medical librarians.

Fighting AIDS for decades

Dec 1, 2008

By Sarah Arnquist

Every 9.5 minutes, someone in the United States is infected with HIV. Every 33 minutes, someone in the U.S. dies from AIDS.

While great gains have been made in the fight against HIV, still more than 53,000 new HIV infections occurred in 2006 and it predominately burdens minority communities. Young, black men and women are at the highest risk of new infection. The HIV incidence rate for black females is nearly 15 times the rate for white females, according to the CDC.

Today is the 20th anniversary of World AIDS Day. Here are some links to excellent summaries of the progress in fighting HIV in the U.S. and around the world.

Message from World Health Organization Director-General Margaret Chan.
Updated estimated U.S. incidence of HIV from the Centers for Disease Control and Prevention.
World Aids Day Blog.
Aids.gov HIV & AIDS quick facts.

Up in smoke

Nov 25, 2008• 1

By Sarah Arnquist

Taxing cigarettes is the single-most effective way to lower smoking rates, particularly among youth. And if we could lower smoking rates, we’d save hundreds of thousands of lives and billions of dollars each year.

Good Magazine demonstrates this strong correlation on a state-by-state basis in a fantastic interactive graphic. Go check it out.

In a related matter, I heard Matt Myers, president of Tobacco Free Kids, recently predict a federal cigarette tax increase to fund SCHIP. He said there’s strong bipartisan support, particularly to fund an expansion of children’s health coverage.