Dr. David Kessler, as you've probably heard, is out with a terrific best-seller called "The End of Overeating: Taking Control of the Insatiable American Appetite."
The cover grabs your attention: very pure white glossy background with a carrot cake and carrots.
I don't like carrot cake. But as I told Dr. Kessler, if the cover picture were an Oreo, I wouldn't be able to have his book in my house.
I got to know Kessler while I was covering tobacco back in the late 1990s, but hadn't seen him in quite a few years until he spoke at a conference of health writers I attended last week.
He was the luncheon speaker: the healthiest of the box lunch options, the one I chose, was vegetables -- drenched in salad dressing -- on a white-bread roll, an apple, and two chocolate chip cookies in plastic wrap. I didn't want to eat them until Kessler began talking about how smells triggers cravings and my friend Ivan sitting next to me unwrapped his cookies. But, concentrating intently on the dress I wanted to wear at a college reunion this weekend, I ignored Ivan and the cookies, and listened to Kessler. Luckily, they weren't Oreos.
Anyhow, David happened to be heading to Washington this week, and we ended up having a longer and more provocative conversation about fat, policy, parenting, Oreos and social norms than either of us expected.
Hmm. New America is doing a flu shot clinic (seasonal, not swine) at the office this week, I believe for the first time.
Apparently, only two of us in the health policy program (you know, the ones who write about prevention and wellness) have signed up for this free service.
Maybe everyone else already got theirs.
We've mentioned soaring U.S. health costs many times before, but a recent Commonwealth Fund report puts into perspective '"what we pay for" versus "what we get" from our health system. In comparison to other industrialized nations, according to The Washington Post, the U.S. is one of the top spenders on health care -- $2.4 trillion annually -- but we rank near the bottom in preventable deaths.
The report, Reducing Preventable Deaths Through Improved Health System Performance, found the US had the highest rate of preventable deaths, with 110 out of 100,000 dying in 2002-2003. For example, controlling for age and whether death is preventable from certain conditions, the study found women under the age 75 died from health care-amenable causes at a rate of 96.41 per 100,000 in the U.S., versus 68.15 in Canada and 57.40 in France. Though all countries made progress in lowering rates of preventable deaths between 1997 to 1998 and 2002 to 2003, the United States made the least progress, dropping from 15th overall in preventable mortality to 19th, said a similar study in Health Affairs.
A growing number of Americans rely on federally qualified health centers for care, reports The Wall Street Journal. Last year, community health centers, as well as migrant and homeless health centers, served approximately 18 million people. That number is expected to hit 20 million this year, according to the WSJ and the National Association of Community Health Centers.
As you know, there's been a ton of argument about whether prevention saves money -- and one of the issues has been how narrowly we define "prevention," whether we treat it as a synonym for "screening for early detection of disease" or whether it's something bigger.
Today, a report by the Trust for America's Health (TFAH) and The New York Academy of Medicine (NYAM) comes down firmly on the side of prevention (broadly defined) as a money-saver.
The report, Compendium of Proven Community-Based Prevention Programs, is a comprehensive review of studies which document community-based disease prevention from all around the world. Specifically, the report looks at programs aimed at decreasing smoking, increasing exercise, and improving healthy eating. The goal of these programs is not just to detect disease early, but to prevent it altogether.
We all know you can earn rewards for frequent flying. But what about for routine trips to your doctor?
Emphasizing primary care and preventive services is a key goal of health reform and many contend the savings from such programs can help finance a health care overhaul (and make us a healthier country). Yet, the details of how these savings might be realized are less clear.
Indiana is one state to find some answers. Contributing to a statewide effort to improve population health, Managed Health Services, one of three Medicaid plan administrators in Indiana, now offers the CentAccount Healthy Rewards Program. Participants accrue dollars on a CentAccount Mastercard debit card as a bonus for participating in appropriate preventive care services -- in the appropriate care settings. LIke the doctor's office, not the E.R.
I was about to recommend Minna Jung's thoughts on preventive care at the RWJF's Users Guide to the Health Reform Galaxy blog, when I realized she ended her post by recommending mine.... But the points we both made, about the need to understand that prevention is broader than giving people screening tests to detect disease, and that its economic benefits may not be easily measured in the short-term windows of federal budget policy, are illustrated in the real world at the Cleveland Clinic.
I was at a conference yesterday and couldn't post about President Obama's nomination of Dr. Regina Benjamin to be surgeon general. Today I'm reposting what I wrote last September when she won a MacArthur "genius" grant,"
I met Dr. Regina Benjamin only once but she's not easy to forget. She took the time to travel to Missisippi in the spring of 2007, about 18 months after Hurricane Katrina, to talk to a small group of health care journalists. We weren't writing about her that day, we were just learning from her, and she was fine with that. Dr. Benjamin is a family physician in the tiny shrimping community of Bayou La Batre in southernmost Alabama. It is racially and ethnically mixed, including an influx of Vietnamese who were drawn to its shrimping fleet, probably the only thing in the fictional home of Forest Gump that was familiar to them...
Business Week takes a look at the medical home model, and finds that, lo and behold, primary care docs can provide high quality coordinated care and boost their income to boot.
Improving patient centered primary care—which means care coordination, prevention, wellness and management of chronic conditions—is a key theme of national health reform, supported across ideological lines. A medical home can take various forms. It can be a large group practice or a solo one like Dr. Peter B. Anderson's in Newport News, Virginia, profiled by Catherine Arnst in the Business Week story. (Or this doctor profiled last year in the Washington Post, a slightly different model). As Cathy writes:
The "home" is the office of a primary-care doctor where patients would go for most of their medical needs. The general practitioner would oversee everything from flu shots to chronic disease management to weight loss, and coordinate care with nurses, pharmacists, and specialists. A 2004 study estimated that if every patient had such a home, the resulting efficiencies might reduce U.S. health-care costs by 5.6%, a savings of $67 billion a year.
At a meeting we attended about health reform the other day, one side of the room was saying of course prevention saves money and the other side was saying with equal certitude that of course prevention doesn't save money. (Forget the irony that we were having this discussion over a pizza lunch. With no salad.) A lot of other people are having this debate, and we attended a helpful panel discussion recently sponsored the Alliance for Health Reform.
We'll grant that if you look, you can find good solid economic arguments that prevention (depending on how it's defined, but more on that in a minute) doesn't save money. At least it doesn't save money in the five- or 10-year budget windows that Washington is used to talking about (and which legislation must be measured against). Economist Louise Russell has been writing about this for years, and her widely cited article earlier this year in Health Affairs (and a shorter version on the Hastings Center blog) makes that argument. Note she is not saying prevention isn't a good thing; she's saying it isn't a "money-saver," strictly defined.
But you can find good solid arguments, too, that prevention and wellness does save money, and can save it quickly. A number of major corporations—Intel, Pitney Bowes, IBM, to name a few—report a high return on investment within a few years (sometimes sooner). They have taken a variety of steps—incentives for diet and exercise, tobacco-counseling, health screenings, no-copay screenings—that are producing a healthier workforce at lower cost.
As they say on Facebook... It's complicated. Let's break it down.