Public Health and Primary Care Medicine

George Benjamin, MD, Executive Director of the American Public Health Association, has written a summary advocating a public health approach to health care reform. The APHA meeting in June will address this topic. He urges using the Prevention and Public Health Fund included in the health reform law to initiate that effort. Considering that twenty-five of the thirty years increase in life expectancy achieved during the twentieth century were due to public health and only five years the result of medical care plus up to fifty percent of some chronic diseases can be prevented, he makes a good case for the public health approach. Perhaps the health care reform law should be rewritten as the Prevention and Public Health Fund with attention and funding devoted to public health and primary care medicine. There also needs to be an assessment of the education and training of primary health care personnel.

Evaluation of Risk

How risk is presented makes a difference as to how people perceive the benefit. Relative risk may make a course of action appear much more beneficial but absolute risk may show the difference to be small. Cost benefit ratios and informed consent should help with these considerations.

Medicaid

Governors are asking for more flexibility to administer Medicaid. In all likelihood that would be a good course of action if the purpose is to deliver appropriate care to those most in need. However, the governors are overlooking something that does not need federal approval. All across America communities are pursuing programs to improve health of local populations through support of healthy lifestyle. Evaluating these programs, measuring effectiveness and sharing lessons learned are the next steps. The governors need to elevate these programs on the public agenda. What if the governors were to establish a goal of reducing the need for Medicaid by 50% over the next ten years? Granted it would be a stretch but that is what goals are about.

Sustainable Farming

Agriculture policy and health care policy are intimately related. The fault lines that run between industrial farming and sustainable farming are the same fault lines that run between medical care and health care. Industrial farming feeds a lifestyle that stimulates and sustains a culture of sickness, which is the basis for medical care. Sustainable farming with an emphasis on vegetables and fruit promotes a diet that leads to better health and avoids the environmental impact of industrial farming with its negative influence on health status. If sustainable farming became agricultural policy, there would be a ripple effect that would change American society at the most basic level with improved health status. Think of what that would do to the current budget debate.

Affirmation of Life

Dr. Albert Schweitzer described an ethical human being as someone who has the will to live enriched by continuous thought about the nature of the world and the universe and seeks solidarity with others who have the will to live for the purpose of improving life for the common good. Affirmation of life is the spiritual act by which a person ceases to live thoughtlessly and begins to devote themselves to their life with reverence in order to give it true value. (Albert Schweitzer, Out of My Life and Thought, Henry Holt and Company, Inc., 1949) In that sense an ethical human being gives thought to their daily life, understands health, achieves and maintains optimum health status and contributes to a healthy community.

A Helping Hand

Advice and support from someone you trust is a proven method to help with necessary changes in behavior, especially if a person is sick or at risk for sickness. Health is a community affair and artful living.

Is the U.S. a Drug Culture?

If you seek medical care, expect to be prescribed one or more drugs. It is what medical care does. This article describes how a psychiatrist from the "old school" was converted from talking with his patients to prescribing drugs. It would seem he sees a lot of patients, so the business is good. Perhaps drugs can cover up problems but I doubt they solve them. But business is business.

Unrealistic Optimism

Unrealistic optimism is not limited to clinical trials for cancer, it is the basis for a mind-set that gives more credit to medical care than is warranted. If medical care was the answer to optimum health status and a healthier population, the incidence of chronic diseases would not be increasing. At best, medical care achieves a stalemate with chronic diseases but the status quo continues to erode to the detriment of health status.

Truth Depends

Truth is not a relative term but it is a relative concept. Perhaps that is due to the large unknown and mystery of life but it is also due to bias, denial and ignorance of the known, whether intended or not. No doubt, there are many reasons that costs for medical care and health insurance premiums are rapidly increasing. The amazing thing is how policy makers on both sides of the political divide continue pursuing failed strategies. Instead of trying to reform health insurance and/or trying to provide medical care for everyone, the goal should be the best strategy to achieve the best health status possible for each individual and the population.

Medical care is the diagnosis and treatment of sickness, it is not a strategy to achieve the best health status possible. Medical care seldom achieves the health status present before a sickness. Decreasing the need for medical care by achieving a healthier population would lower health insurance costs.

Coconut Oil

If only health and medicine were exact sciences. But that is not the case. There are more unknowns than knowns and lots of partial truths. Some discoveries point one way initially only later to lead in another direction. Coconut oil got a bad review earlier but now it might not be so bad. It might even be good for you.

The Fountain of Youth

Exercise is the closest thing there is to a fountain of youth. Mitochondria are the energy producing component of the cell and they have been implicated in aging. This study is an interesting observation of exercise protecting the mitochondria and preventing aging.

Agriculture Policy

Federal policy has far reaching implications. Some are good, some are bad, some are intended and some are unintended. It is complicated. The passage of time can change the outcome of policy from intended to unintended and from good to bad. Too often public policy evolves to serve private interests rather than the public good. That usually happens when money replaces the original intent of the policy. Some policy is ill-conceived from the start with private interests trumping public good.

Mark Bittman offers suggestions for changing agricultural policy to benefit health, the environment and the economy. I believe Mr. Bittman is correct in his observations but I lack confidence that the federal government can reform policy to benefit the public good.