The Lifestyle Chronicles - Neighbors, Friends And Family

A study published in the June 2006 issue of American Sociological Review shows that Americans have fewer confidants and those ties are more tightly interconnected and more focused on the strong bonds of the nuclear family than they used to be. That means fewer contacts created through clubs, neighbors and organizations outside the home.

The study found the mean number of people with whom Americans discuss matters important to them dropped from 2.94 people in 1985 to 2.08 people in 2004.

The researchers from Duke University and the University of Arizona found that the number of people who said they had no one with whom to discuss such matters more than doubled, to nearly 25 percent.

Non-whites and people with less education tend to have smaller networks than white Americans and the highly educated.

The percent of people who count at least one person of another race in their close network went from about 9 percent to more than 15 percent.

The percent of people who talk only to family members about important matters increased from 57 percent to about 80 percent. The number of people who depend totally on their spouse has increased from about 5 percent to about 9 percent.

It will take time to understand them but these results are telling us something about lifestyle.

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The Lifestyle Chronicles - Ask What You Can Do For Yourself

U.S. Surgeon General Richard Carmona views growing health care costs and declining health status as a health problem rather than an economic issue. Unless the focus is shifted to prevention, the suffering will continue to increase and no one can afford the cost.

Someone give that man a loud round of applause. He should lay out a specific plan of attack and the President should ask Congress to approve it. Nothing deserves more attention than a national initiative to improve health status by means of prevention, risk management and early detection. The "War on Terrorism" pales in comparison.

Fortunately, prevention is getting more attention. Tommy Thompson is still out there carrying the flag and his focus is on corporations where there is incentive to save money and increase productivity. And, the Centers for Medicare and Medicaid Services (CMS) are directing attention (and, hopefully, priority) to prevention for Medicare. The American Diabetes Association is on the march and the American Heart Association has taken up the fight on trans-fat.

Ask not what your doctor can do for you, ask what you can do for yourself. Come on, up and at 'em. It is all in how we live each day. What's there to lose except lack of energy and limited perspective on life?

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The Lifestyle Chronicles - Pot Bellies

How about that! The fat is coming home to roost and most of it is in the gut. Those pot bellies we love so much.

A research team from Wake Forest University has demonstrated (abstract #328-OR) in male monkeys that not all calories are equal. In their study diets rich in trans fat cause a redistribution of fat tissue into the abdomen and lead to higher body weight even when the total dietary calories are controlled.

The monkeys were given the same amount of daily calories with 35 percent coming from fat. The amount of calories was only enough to maintain weight. One group of monkeys received 8 percent of calories from trans fat while the other group received 8 percent of calories from monounsaturated fat. This amount of trans fat is comparable to people who eat a lot of fried food.

Trans fat is in vegetable shortening, some margarines, crackers, cookies, snack foods and other foods made with or fried in partially hydrogenated oils. Most trans fat is formed when food manufacturers convert liquid oils into solid fats such as shortening and hard margarine by adding hydrogen.

This is an example of highly processed food containing excessive amounts of toxic components causing harm to metabolism. People may be correct when thay say their "metabolism is shot". In the movie "Supersize Me", the star of the show ate fast food all day everyday for one month. In addition to gaining weight, by the third week he was complaining of depression, headaches and fatigue, and his liver enzymes which had been normal were rapidly increasing.

Obesity crept up around America during the last half of the 20th century. It is caused, in part, by Americans eating too much highly processed food associated with lack of physical activity. Highly processed food is calorie dense, nutrition poor and contains elevated sodium, fructose and chemically altered fats that are toxic to metabolism. This type of food is created and marketed to disguise the hazards. It is a man-made problem.

Is it possible America will ever learn? Or, is it just as likely not to be a matter of knowing but an inability to control appetite? There is no medication or surgery that can compensate for unhealthy lifestyle, nor is there likely to be one. Inspiration and motivation are necessary for healthy lifestyles and satisfied lives. Discipline is required and it can be taught and learned. To be safe, don't eat food with nutrition labels.

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The Lifestyle Chronicles - I Would Rather Be Healthy

David Gratzer, a senior fellow at the Manhattan Institute, takes issue with the study that compares the American and Canadian health care systems. That study was a telephone survey of 3,500 Canadians and 5,200 Americans. The authors conclude Canadians have better access to health care at lower cost and they are more healthy than Americans.

Dr. Gratzer's op-ed piece entitled "Where Would You Rather Be Sick?" appeared in the June 16th issue of the Wall Street Journal. He points out that problems in public health should not be confused with flaws in the health care system. A sedentary lifestyle and obesity have little to do with access to health services. And, he presents data indicating the American health care system excels in taking care of people stricken with serious ilness.

I think Dr. Gratzer makes a very important point. The American health care system is designed for the care of sick people and the outcomes are the best that can be expected. That being said, it is a system for medical care and it shoud not be applied to everyone. The expense is inherent to the process of specialization, technology and research. Access should and must be based upon need rather than demand.

The basis of poor health status in America is not lack of medical care. Americans are less healthy because they are ignorant about health and they lack the discipline to manage their lives in a manner to achieve optimum health status. Emphasizing medical care diverts attention from the task at hand. Let us discontinue marketing medical care and create a public health care system to assure the best (optimum) health status possible for everyone.

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The Lifestyle Chronicles - A Thorn In The Lion's Paw

A Healthcare Systems Engineering Workshop is scheduled for June 15-16th in Arlington, Virginia. A recent joint study by the National Academy of Engineering and the Institute of Medicine identified involvement from the systems engineers and researchers as a means to improve quality, safety, and efficiency in healthcare in America. This workshop will build upon that study and begin to envision a program to go forward.

Instead of getting bigger, re-organize to do it better. What a novel idea! There is absolutely no doubt the premise is correct but the implementation will be a nightmare. My suggestion is to pick a few demonstrations to prove the point and follow through with a plan that changes crucial pieces with an expanding boundary. Hospitals, Medicare and Medicaid are good areas to address once on a roll. Don't expect to be welcomed with open arms. There will be a lot of excuses and a few reasons given to slow the effort.

I have another suggestion, however, that will be more productive and could bring great change to health care. Why not design a new system for health promotion and primary and secondary prevention? If well done, the results would be amazing. And, the program will meet with far less resistance. Just a thought.

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The Lifestyle Chronicles - Prevention, Where Fore Art Thou?

Tommy Thompson, bless his heart, is still out there advocating preventive medicine, and the National Center for Disease Control reports a decline in risky health behavior among teens from 1991 to 2005. Investigators at Duke University reported evidence that physical activity reverses consequences of prior physical inactivity. So, maybe there is reason to hope for continued and increasing emphasis upon prevention and improvement in health status.

However, there are some dark clouds overhead and on the horizon. Of particular concern is the medicalization of prevention. Medical health professionals are trained to diagnose and treat people with illness and disease. They are by nature aggressive in this endeavor and, generally, this posture is appropriate to the situation. When a medical approach is applied to prevention the risk is unnecessary stress and cost due to inappropriate mind-set (illness and disease) and use of the wrong tools.

Use of statin agents to lower LDL-cholesterol is widespread and the recommendations advocate more aggressive utilization. Statin agents are usually prescribed in conjunction with advice to change lifestyle but the emphasis is clearly upon the drug. One reason may be there is a medical system in place to administer drugs. Another reason might be the absence of established mechanisms to change lifestyle and a lack of confidence that people can change their lifestyle. Among the many problems associated with using drugs for prevention are the cost and side-effects. And, if the truth be told, compliance with long-term drug therapy is not much better than the probability of changing lifestyle.

Another area of concern is expanding the use of technology for early diagnosis of disease before benefit has been confirmed. This is expensive and there are false positive results. The information obtained may lead to therapy that has not yet been demonstrated to be result in beneficial outcomes. The knowledge base about the early stages of disease needs to be developed before any reliable recommendations can be proposed.

It is entirely possible and even likely that prevention will become a different branch of health care separate and related to medical care. Primary care practitioners can be a factor but much will depend on how they are chosen and trained. Much of prevention is based upon inspiration and motivation. These are qualities more often found in coaches and educators.

Cost and universal application are additional issues that will determine the future of prevention. The likely course of development will be a system that is implemented at the community level for populations. This is in contrast to the current medical model that is better suited for the diagnosis and treatment of illness and disease on an individual basis.

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The Lifestyle Chronicles - The Pursuit Of Happiness

Life, liberty and the pursuit of happiness. Thomas Jefferson wrote these words at the beginning of America as a nation and they stuck. But, one has to wonder from where he drew the phrase "pursuit of happiness". Could he have known how prophetic he would be in labeling a major aspect of the American psyche?

Jefferson was a member of the privledged class who were the leaders of the American colonies. He and the other founding fathers had a stake in the future and they felt the heavy weight of responsibility for assuring that future. By the standards of history for measuring oppression this was hardly an oppressed group. However, the privledged class are known for the pursuit of happiness and leaders are known to feel the need to relieve the burden of responsibility by pursuing happiness.

For the most part, happiness and pleasure are passive emotions that come from things that happen to someone. They are fleeting emotions that have to be constantly pursued to maintain them. The achievement of happiness is often perceived to be a matter of luck.

Happiness and the pursuit of happiness have come to mean many things and all of them are highly valued. The pursuit of happiness is associated with individual freedom and Americans have elevated this combination to the level of an art form.

It is generally believed that good health is linked to happiness. However, the frenzy, stress and lifestyles that result from the pursuit of happiness have a negative impact upon health. Health care in America has morphed into medical care and it, too, has become ensnared in the process and fall-out of the pursuit of happiness. For example, consider the patterns and extent of both prescribed and illegal drug utilization.

Gregory Berns is a young faculty member at Emory University who has written a book entitled "Satisfaction: The Science of Finding True Fulfillment". He advocates satisfaction as a positive emotion experienced because of making things happen. The two main ingredients of a satisfying experience are novelty and challenge. A sense of accomplishment taps into the reward system of the brain that is different from the pleasure system. Motivation and commitment are related factors of the process that are mediated by dopamine and cortisol. A philosophy based upon biology is to stop pursuing happiness and pursue satisfaction in terms of trying, learning and doing new things.

Do I exaggerate? Think about it. Life, liberty and the pursuit of satisfaction. Now, there is a thought that might capture the imagination.

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The Lifestyle Chronicles - Can Medicare Help?

CMS Administrator Mark McClellan reported there will be an effort to increase use of preventive services by Medicare beneficiaries. It is difficult to get excited about something that already should have been the basis of health practice, especially when most of the examples given are early detection. However, there may be an opportunity to learn more about how to implement effective primary health care. I doubt it but hope springs eternal.

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The Lifestyle Chronicles - Please Make It Personal

"It is not personal, it's just business", said the spider to the fly.

"Does that make a difference?", said the fly to no one in particular.

"Is it life or business that moves on?" sang the chorus.

"It depends upon who you work for", whispered the animals in the forest.

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