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Fixin' Healthcare

Sunday, August 27, 2006

The Lifestyle Chronicles - Well Known Problems

Clearly, it is well established that watching television is associated with decreased physical activity. In all probability, video games produce the same results. Further, the video games have been linked to decreased academic progress of males.

Repeated description of a problem reaches a limit unless the effort reveals a solution. What can we do about watching television that will make it more beneficial for health, or what can we do about substituting physical activity for watching television? It does not necessarily follow that less television produces more physical activity or better health status.

Describing social problems is easier than solving them - true, true and related but not necessarily causal or preventive.

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The Lifestyle Chronicles - Prevention, Preparedness And Maintenance

No longer is there any doubt that obesity and chronic diseases account for a large share, if not most, of the health problems and rising cost of health care in America today. And, it is encouraging to see an increasing emphasis upon health promotion and prevention. Although there continues to be too much reliance upon treatment, there is recognition of the greater potential with prevention.

Multiple factors contribute to the causes of chronic diseases and there are various routes for intervention to alleviate the disease process. Identifying the specific causes will lead to specific interventions for prevention and treatment. However, there are basic components of a healthy lifestyle that apply generally to optimum health status and prevention of many chronic diseases.

Getting everyone to avoid tobacco, toxic chemicals and unecessary drugs; be physically active; eat healthy food; avoid unhealthy food; get adequate sleep; manage stress and maintain a healthy weight is by far the most significant challenge facing health care today. This is an issue of life and living that goes beyond the somewhat more narrow focus and current understanding of lifestyle and medical care.

The August 28th issue of Time Magazine described a "national culture of unpreparedness". They were referring to floods, tornadoes, hurricanes, wildfires and earthquakes. Not only do people ignore preparation for these disasters, they place themselves in harms way by building and living where they should not and by lifestyle habits that are known to be hazardous to health. If the hugh problem of poor maintenance and lack of maintaining the infrastructure of society is another related aspect of this complex, then society, civilization and humans are in deep trouble.

"There are four stages of denial. One, it won't happen. Two, if it does happen, it won't happen to me. Three, if it does happen to me, it won't be that bad. Four, if it does happen to me and it's bad, there is nothing I can do to stop it anyway." (Eric Holdeman, director of emergy management for King County, Seattle, Washington) In addition to denial, what about the prevailing attitudes that it is someone else's problem, the government will cover the losses, medicine will find cures and sue the bastards?

Healthy lifestyle is a good beginning because it originates in the mind, creates positive attitudes, builds upon self-reliance and depends upon interaction between the individual and the community. Time Magazine referred to "trickle down apathy". The answer to that is not false optimism but building resilience and capacity, person by person. Those are the products of education and maintaining optimum health status.

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Saturday, August 19, 2006

The Lifestyle Chronicles - Heart And Soul

Should we be surprised by the news that angioplasties are performed at four times the national rate in Elyria, Ohio? Not really. Researchers at Dartmouth have reported for some time now the variation between different parts of the country for procedure rates.

That it is Elyria and angioplasties are specifics in a data base that describes our health care system very well. All anyone has to know about this particular situation is that the North Ohio Heart Center employs 31 cardiologists.

Don't be surprised that someone does what they are trained to do, particularly when it is lucrative. When you are a hammer, the whole world is a nail.

The health care system has been analyzed from here to there and back. The problems are well known but the responses are sporatic adjustments that are politically expedient. Thirty-one cardiologists clustered together will result in the care for a lot of hearts or a lot of care for as many hearts as might be available and paid for. Saturation bombing will do no good. They will disperse and move to other clusters or form new ones.

Will we ever learn that health care is about health and there is a better route to health than sickness? Maybe in the next life. Or, when sickness and war have collapsed the economy and we can no longer afford our excesses.

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Sunday, August 13, 2006

The Lifestyle Chronicles - Bending Of Twigs And Growth Of Trees

An interesting, and perhaps profound, concept has been expressed by James Allen Smith, a philanthropic historian at Georgetown University - "It doesn't take billions of dollars to influence public policy. It can be done with tens of millions or even a strategically placed few hundred thousand."

The closer to the roots of any issue, the greater the leverage and the more profound the impact for outcome. It is a concept that begs for intimate knowledge of the root of any issue and a grasp of the potential for outcome. Either one of these is difficult to achieve and both are relative to what is possible to understand at a given time.

Pride and humility are intertwined with degrees of certainty. Understanding of potential is always limited at any given time but that does not limit the effort to achieve the potential. And, there is potential for an optimum outcome versus potential for a specific outcome.

To see or understand something that others do not see or understand might arrive in the form of genius but change comes as "a thousand points of light". More often than not, the most significant insights seem to suddenly appear everywhere, and on the surface they come across as "common sense". It is only much later when that beginning has changed everything.

Basic functions in society continuously encounter problems but they continue to be basic functions because they are essential. Health, security, education and integrity of the economy are examples. The genius of a society that survives is to solve problems which occur within basic functions without ripping apart the fabric.

It is not the spending of money that makes a philanthropic foundation a change agent, it is using that money to develop insights to the roots of problems, issues and basic functions of societies and defining the potential for outcomes. The capacity to direct the attention of society is the greatest asset resulting from the size and prominence of the Gates Foundation. Health is a basic function of society and a focus of the Gates Foundation. One aspect of health the Gates Foundation might address is the mind-set of health.

What is the outcome when a society thinks of health as the potential for well-being? What is the outcome when everyone in a society is educated to be healthy? How does a society reinforce personal achievement of optimum health while maintaining the capacity to treat sickness? How does a society prevent fear of sickness from overwhelming potential for health? How does a society achieve optimum effectiveness and efficiency for diagnosis and treatment of sickness without reinforcing sickness as an economic enterprise? How can a society render compassionate care for the elderly while maintaining perspective for optimum health status?

So many questions and so few current answers that have the potential for optimum health.

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Thursday, August 10, 2006

The Lifestyle Chronicles - Gulliver And The Lilliputians

One theory for a common cause of disease is inflammation. It has been implicated in cardiovascular disease as a trigger mechanism that initiates and propagates the disease process. Chronic inflammation generates tissue response and influences the immune response. A common cause of inflammation is infection, which is considered in some circles as a cause of artery disease with cholesterol as a secondary participant.

Flossing teeth is associated with better general health. One reason proposed is that flossing benefits gum health, reducing a source of chronic inflammation and improving the immune response.

Elevated C-reactive protein indicates the presence of chronic inflammation. In addition to lowering blood cholesterol statin agents also lower C-reactive protein. The implication being that the therapeutic mechanism of action for statins might be as anti-inflammatory agents.

Obesity is an inflammatory condition with fat cells exhibiting characteristics of immune cells and secreting inflammatory compounds. Inflammation is considered a basis for development of some diseases associated with obesity and it also may be a cause of obesity. An upcoming article in the NY Times Sunday Magazine by Robin Marantz Henig describes theories relating viral infections and intestinal microflora to the cause of obesity.

Dr. Nikhil Dhurandhar has coined the term "infectobesity" to indicate the possibility of viral infection resulting in obesity. Evidence supporting this conclusion originated with chickens dying from viral infection exhibiting increased abdominal fat associated with normal cholesterol and triglycerides. Adenovirus infection in animals resulted in the same condition. Humans with prior adenovirus infection accumulated excess body fat with normal blood cholesterol and triglycerides.

A second line of investigation is based upon the human body is a resevoir for a multitude of bacteria. Many of these bacteria are linked with human metabolism producing compounds essential for health and life, vitamin K is an example. Bacteria in the intestine have been demonstrated with assisting in the extraction of calories from food and storing these calories in fat cells.

Dr. Jeffery Gordon observed that germ-free mice ate as much or more than ordinary mice but had 60% less fat. When intestinal microbes from ordinary mice were transfered into the germ-free mice, both groups were the same weight within two weeks. The proposed mechanism is bacterial suppression of a protein that ordinarily prevents the body from storing fat. Further, the balance and interaction between different gut bacteria can increase calorie extraction from polysaccharides leading to additional body fat.

It is too early to draw any conclusions from these research activities that might lead to prevention or treatment of obesity. But, it does reinforce the notion that obesity is a heterogeneous condition and it is extremely complex. To understand the true nature of obesity may lead to a new understanding of health care; it is that basic.

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Monday, August 07, 2006

The Lifestyle Chronicles - Governor Mike Huckabee

I have just returned from the National Governors Association Meeting in Charleston. Arkansas Governor Mike Huckabee has been chairman of the group this year and he has established the theme of Healthy America. Considerable momentum has developed as a result of Governor Huckabee's efforts and Healthy America is a theme that will progress far beyond this year.

You just have to love Governor Huckabee. He has charisma in the form of stage presence, good humor, warm personality and dedication to healthy lifestyle. He draws people to him. There could not be a better champion for good health.

This has been a busy year for Governor Huckabee in his campaign to draw attention to his project. He definitely captured the attention of the media, in particular the media that programs for kids. In my opinion, the most impressive project is an industry alliance he facilitated with President and past Arkansas Governor Bill Clinton.

There was a round table discussion at the meeting with the President of Coca-Cola North America, the Chairman CEO of Pepsico and the Chairman and CEO of General Mills. These companies are committed to developing products and programs to promote good health and their potential is impressive.

Past Wisconsin Governor and HHS Secretary Tommy Thompson spoke about his ideas for health care reform. In particular, he advocates dividing responsibility for Medicaid with acute care to the states and long-term care to the federal government. An important aspect of the proposal is increased emphasis upon health promotion and disease prevention.

This is a proposal that deserves consideration with further development of details. Long-term care is the most serious problem facing the elderly and it will continue to grow until acute health care is more effective at prevention. The states working through communities are in the best position to create effective and universal preventive health care. The success of the states will change the nature of long-term care.

President George H. W. Bush spoke of a "thousand points of light" and Governor Huckabee is making this happen for better health status in America.

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Wednesday, August 02, 2006

The Lifestyle Chronicles - Desperately Seeking Health

The goal for health care goes beyond treating sickness and disease; it is to reduce the incidence of sickness and disease. This is a goal that requires a different type of consumer. One who is more knowledgable, resilient, resourceful, patient, persistent and in control of their lives. In other words, less of a patient.

Health is a behavioral issue. To improve health requires change in behavior. Change in behavior requires change in thinking. Change in thinking requires inspiration and motivation. Inspiration and motivation are based upon hope, anticipation, commitment, faith, capability and human relations, among other things.

Where are these qualities to be found in American culture and how might they best be cultivated? Optimum health is a group activity and the community is where it takes place. The search might start there.

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