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Fixin' Healthcare

Monday, July 31, 2006

The Lifestyle Chronicles - 76 Trombones Led The Big Parade

Dr. Anne Karen Jenum and collegues at the Norwegian Institute of Public Health in Oslo tested a program to boost physical activity in a low-income, multi-ethnic, urban district with high rates of obesity, heart disease and physical inactivity. The program included participation by community leaders, wide distribution of information, organized physical activities and free counseling for nutrition and smoking cessation. A control community was included for comparison. Results of the three year effort were reported in the July 2006 issue of the journal Diabetes Care.

There was a 9 % net increase in physical activity in the study group. An increase in mean body mass was observed in both districts but the increase in the intervention district was half that observed in the control district. Beneficial changes in the lipid levels and smoking habits, and blood sugar levels for men, were small but significant.

The authors conclude that low-cost community-based strategies that get people moving can succeed and result in reduction of health risk factors.

Communities influence behavior and health depends upon behavior. It does seem like a good place to start and parades usually attract a crowd.

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Sunday, July 30, 2006

The Lifestyle Chronicles - Young Women And Little Children

People today grow taller, enjoy better health and live longer than their ancestors. Most of these gains are the result of public health measures, such as sanitation, immunization and better nutrition, and antibiotics effective against life threatening infections.

Dr. David Barker, a professor of medicine at Oregon Health and Science University in Portland and a professor of epidemiology at the University Southhampton in England, has examined historical data and animal studies that indicate health in middle and old age can be determined by conditions and events during fetal life (pregnancy) and the first two years after birth. The Barker hypothesis leads to a health care system that allocates resources to public health with emphasis upon pregnancy and early childhood as a means to improve and maintain optimum health status throughout life.

This would have a profound impact upon American medicine. American society through its political system and economic structure favors medical care with much of it allocated to the elderly. At best, this relieves suffering and modifies disease processes but does not cure or eleminate diseases. It is a situation that generates immense and expanding cost with diminishing returns.

If the Barker hypothesis proves to be true, don't expect such truth to create an immediate or significant change in health care. In spite of the widespread dialogue supporting science and evidence-based decision making, the political and commercial interests are heavily vested in the current medical care system and they hold the trump cards in health policy.

A public health care system is based upon community health that should emphasize pregnancy and children but does not exclude any person or group. Senior citizens want and need attention, but the medical care system is an expensive and ineffective way to give it. A public health care system can best serve the elderly by development of effective and efficient long-term care.

National health policy that promotes health would be an interesting new perspective. I wonder if the special interest groups are ready to give up sickness.

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The Lifestyle Chronicles - Life, One Step At A Time

If asked to chose one thing that ranks first for healthy lifestyle, it would be physical activity. And, walking ranks first as the best way to begin and extend physical activity. Physical activity impacts metabolism in a positive manner in multiple ways. Consistent physical activity over an extended period of time usually influences stress, sleep and nutrition.

England has launched the National Step-o-meter Program by distributing 100,000 pedometers to adults across the country. Over 8,000 health professionals in primary health care trusts will be trained to help people get the most mileage by using their pedometers.

"Physical inactivity costs the National Health Service #1.7 billion annually excluding the treatment of disease brought on by obesity. Treating disease caused by obesity cost an additional #1 billion annually. Each pedometer cost #3." Of course, there are additional personnel costs but, if effective, the leverage is high.

Pedometers are intended to serve as motivators for physical activity. The trained health professionals may be better if they are good health coaches capable of inspirng people.

How much different from a drug benefit is that approach to health policy?

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The Lifestyle Chronicles - Seeking Inspiration And Motivation

Is there anyone who does not know about healthy lifestyle?

Not many.

Do they consider poor health the result of their behavior?

Not really.

Do they expect medical care to save them?


Do they understand health or medical care?


Whose fault is that?

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Sunday, July 23, 2006

The Lifestyle Chronicles - The Sorcerer's Apprentice

America is addicted to technology. A variety of technologies have invaded every aspect of life and molded the American culture. The prevailing opinion and most of the readily available evidence indicate that society benefits from this influence. However, in nature and physics for every action there is an equal and opposite reaction. Close examination indicates there are insidious influences of technology with profound impact.

Two recent books illustrate the point. One is "The End of Medicine" by Andy Kessler and the other is "Insurgents, Terrorists and Militias" by Richard H. Schultz and Andrew J Dew. Mr. Kessler expresses a view that technology can and will transform medicine. Mr. Schultz and Mr. Dew note that a determined, resourceful and tenacious foe fighting on their home ground is extremely difficult to defeat with technology alone.

Improving the process of record keeping, transmitting health information, education of the consumer, assessing health risk and early detection of disease are not new ideas and technology will facilitate each of these processes. However, curing health problems by means of more health care and more technology is proving to be less than effective or efficient.

The differentiation for perspective on health care is at the point of thinking in terms of cure and prevention. The highest, most effective and most efficient technology in health is the human body. Both cure and prevention utilize this technology but prevention requires a mode of thinking and action prior to disease. Society badly needs to instill primary prevention into the lives of all citizens. Ultimately, the best way to transform medicine is to improve health status, and prevention beats cure hands down in this arena.

Technology often works against healthy lifestyle leading to less physical activity, providing food that interferes with optimum metabolism, supplying substances that are toxic to metabolism, creating stressful situations and polluting the environment. These are the issues of public health that are more basic to optimum health status than medical care.

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Saturday, July 22, 2006

The Lifestyle Chronicles - Light At The End Of The Tunnel

Most chronic diseases are linked to the lifestyle choices of diet, physical activity, smoking, sleep and managing stress. As poor lifestyle choices become more prevelant and the incidence of chronic diseases increases, the challenge is to alter these choices. One method gaining support is providing financial incentives, such as lower premiums or co-payments, for employees who choose to cease smoking, increase physical activity and control weight.

A recent Wall Street Journal/Harris Poll indicates consumer support for financial incentives is increasing. Fifty-three percent said it is fair to ask people with unhealthy lifestyles to pay higher insurance premiums than people with healthy lifestyles, while 32 percent said it would be unfair. In 2003, 37 percent said it would be fair and 45 percent said it would be unfair.

Changes in public opinion pave the way for basic shifts in culture and public policy. This change will have an impact as more corporations alter their approach to health insurance. Eventually, this will change Medicare and Medicaid. Then, there will be a national transformation in health care with the emphasis upon health rather than sickness. The impact upon America will be a paradigm shift in the quality of life and the economy.

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Wednesday, July 19, 2006

The Lifestyle Chronicles - Exactly

A paper appearing in the current issue of the journal Social Cognition reports on a study that confirms self-fulfilling prophecy. The study focuses on how negative information concerning old age can detract from performance. Lower performance on memory tests result from being told of inclusion with an older group and being reminded of the link between age and mental decline.

There are examples of this influence upon issues other than age. Women performed less well on math exams after reading that men tend to perform better on them. White men perform less well when they are told they are competing in math against Asian students.

Now, consider the effect on the population of the country when they are told everyday in numerous ways that they are sick. Don't overlook that a massive sick care system is marketing itself at all times. The current health care system in America is the result of sickness as national health policy.

Everyone would benefit from a culture that promotes optimum health status. People do what they think about and they think about the information that is consistently directed at them. The body follows the mind and both are capable of remarkable achievements. The four minute mile was a formidable barrier in the mind more than the body until Roger Bannister did it.

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Monday, July 17, 2006

The Lifestyle Chronicles - Sleep, My Children And Sweet Dreams

Research from the University of Warwick has found that sleep deprivation is associated with an almost two-fold increased risk of being obese for both children and adults. The data was obtained from 28,000 children and 15,000 adults. Those who sleep less have a greater increase in body mass index and waist circumference over time and a greater chance of becoming obese over time.

There is no doubt that adequate sleep is part of a healthy lifestyle. Fatigue from lack of sleep can contribute to increased stress and often is associated with increased appetite.

Maybe that is why they call it beauty rest.

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The Lifestyle Chronicles - Planning Communities For Health

Dr. Kenneth Cooper has been a pioneer and pace setter for establishing the scientific basis for disease prevention through lifestyle. The Cooper Clinic in Dallas has assisted people with health assessments and implementing a healthy lifestyle. Now, he plans to develop Cooper Life, a master-planned community focused on living the optimum healthy lifestyle.

Knowing the healthy lifestyle and living the healthy lifestyle are two different things and bridging the gap has proven difficult. If I know Dr. Cooper, we will all learn something from his effort. Sooner or later, this effort will have to be implemented in established communities throughout the country.

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Friday, July 14, 2006

The Lifestyle Chronicles - You And Me, Babe

The last half of the 20th century brought more changes to the culture and lifestyles of more people in a shorter period of time than at any point in the history of America. Associated with these changes is an accelerating incidence of chronic health problems and chronic diseases. There is no question these trends are related but sorting out the basic factors and determinig what to do about them has been difficult.

For example, it is a simple matter to identify overeating highly processed food and inactivity as causes of obesity. The fact this is happening throughout American society to double the incidence over the past 25 years and involve 60 million people creates a problem unlike any previously encountered. And, the association of type 2 diabetes, systemic hypertension and other chronic diseases with obesity makes this a serious problem that cannot be ignored.

To go a step further and explore one aspect of this situation might serve to indicate its complexity. Could it be possible the increased attention to the issue of privacy is related to a recent study indicating the number of close confidants for Americans is decreasing? And, what impact might either one of these matters have upon the number of people living alone? There are those who propose the result is more attention devoted to fewer people, but it is a small step from there to being alone. Further, the traditional social organizations that previously served as backup no longer function as they once did.

Evidence indicates that being alone is associated with increased health risk. A Danish study in the Journal of Epidemiology and Community Health reported that age (women over 60 years and men over 50 years) and living alone were the strongest factors for predicting someone would suffer an acute episode of heart disease. Smoking, obesity and high cholesterol were more common among those who live alone. Factors associated with the lowest risks included living with a partner, a high level of education and having a job.

Interestingly, divorced women in the Danish study had a lower heart disease risk. Relief from stress has to be a factor but women who live alone tend to have better health than men who live alone. One explanation proposed for this difference is that women have better social networks.

A study reported in the November issue of the American Sociological Review found that teens with less parental supervision were more likely to delay having sex if they lived in neighborhoods where the adults kept a close watch on area children.

Gary Ladd at Arizona State University published a book entitled "Children's Peer Realtionships and Social Competence: A Century of Progress" that examines a century of research on peers and the influence of these relationships on children's health and development. The conclusion is that peer relationships have an enormous influence on health and development.

Clinical studies show social support increases weight loss success by encouraging dieters to adhere to their diet and lifestyle improvement plans. Randomised controlled trials of four commercial weight loss programs sponsored by the BBC and published in the British Medical Journal, Volume 332, p 1309 found that each were effective for losing weight but those with group support were best for keeping weight off for the longer term.

UCLA evaluated a study of a demonstration project led by Community Health Councils, Inc. in Los Angeles that shows how incorporating physical activity and healthy eating into an office or organizational culture is effective for the participants. Published in the July issue of Health Promotion Practice, the study found that a six week wellness training program significantly increases vigorous physical activity among participants. A 12 week curriculum boosts fruit and vegetable consumption while reducing feelings of saddness and depression, as well as reducing waistlines.

Humans are social creatures and need others to be healthy. Achieving and maintaining optimal health status is a social activity that takes place at the level of the community. The women are better at it and the men need to learn.

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Tuesday, July 11, 2006

The Lifestyle Chronicles - Culture, Character And Health

The Wall Street Journal published an article on July 3rd by General Josiah Bunting, former superintendent of VMI. General Bunting discussed the qualities embodied in the leaders of America during the Revolution and Second World War, as well as the cultures that nutured them. He asks if "in our time of crisis will another generation bring forward men and women of the same metier as those of the Revolution and the Second World War?" His answer echoes the concern, if not alarm, expressed by many. Currently, American culture does not cultivate the qualities most needed for self-reliance and useful service to the nation.

American culture has changed throughout the history of the country. Yet, the qualities needed were present over a span of 170 years between the Revolution and the Second World War. Those qualities may not be readily apparant today, but are they missing?

No generation can designate itself as great. Only circumstances of the time and subsequent judgement of history can do that. The Revolution and the Second World War were periods that involved and mobilized almost all of American Society. It is difficult to imagine those circumstances today. America fought in Korea and Vietnam and now in Afghanistan and Iraq while maintaining life as usual on the homefront. The country came close to mobilizing for Vietnam but in the manner of protest that would be hard to conceive during World War II.

Changes in the American culture over the first 200 years cannot match the accelerated pace of change during the last half of the 20th century and continuing to the present. Science and technology have been major drivers for rapid change. Expanding affluence and personal freedom have enabled rapid change. Traditions have been difficult to maintain in the face of such rapid and profound change.

General Bunting refers to attitudes about health in modern American culture. It is paradoxical that Americans desire good health and invest heavily in the science and technology to achieve that end but the result is declining health status characterized by an increasing incidence of chronic diseases. I will go a step further than General Bunting and suggest that declining health status is the most serious threat resulting from today's culture. The well-being and productivity of the population and the economy are in danger. The major cause of poor health in America resides in the culture and lifestyles. Recognizing and responding to danger is so much more difficult when it comes from within. Whether Americans can respond remains to be seen.

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Wednesday, July 05, 2006

The Lifestyle Chronicles - People Power

The British Medical Journal (2006; 333, 1 July) contains a report on the analysis of 21 studies that reported the mortality and good or poor adherence to drug therapy of 45,000 participants. Good adherence had about half the mortality risk for that of poor adherence. Before we get too excited about the miracle of drug therapy, the benefit of good adherence was the same for placebo and drug therapy. The authors believe this supports the existence of a "healthy adherer".

Adherence to drug therapy is a manifestation of the ability to organize, develop a plan and sustain the motivation to put the plan into action. No doubt, these are the same traits that support a healthy lifestyle.

Perhaps the "health team" applies more to the consumer than the provider. Recruitment, training and inspiration for achieving and maintaining optimum health applies to the consumer. If that is the case, then we need more health professionals with the coaching ability to inspire people.

Just a thought. I'm not preaching revolution, yet.

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Tuesday, July 04, 2006

The Lifestyle Chronicles - While Nero Fiddled

It seems the American Medical Association (AMA) and the National Centers for Disease Control and Prevention (NCDC) jointly convened a committee to discuss whether children should be labeled as overweight, at risk for overweight, obese or perhaps some other designation. One has to wonder what else was happening in the world while this discussion was ongoing.

Perhaps it might be important to label children if the objective is to get as many as possible on some medical regimen. There are already enough medical labels passed around to get most children on a drug.

What about the habits for healthy lifestyle? Every young parent-to-be, parent, child and adult in America needs to know and practice these habits. No one with any label should be excluded. Everyone, all labels included, should be physically active on a daily basis, eat whole foods, avoid highly processed food, get adequate sleep, manage stress, avoid smoking and take no drug unless absolutely necessary.

At least the committee's work kept the experts busy. Meanwhile, life goes on.

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Monday, July 03, 2006

The Lifestyle Chronicles - Motivation, Inspiration And Confidence

Americans love experts. Knowledge is supposed to be power. But, how good is knowledge if there is no understanding or if it misused?

For the most part, people know the facts about healthy lifestyle. The knowledge does not deter the majority of Americans from lifestyles that are unhealthy. The task is to instill the confidence that everyone can develop the discipline to lead a healthy lifestyle and the results will make a significant difference in the quality of life. Motivation and inspiration fuel the process.

Everyone must live their life. No expert can live it for them.

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