Category Archives: policy

healthcare, healthy habits, meaning, musings, nutrition, policy, storytelling

Eternal youth for just $43K per day – or just exercise and eat well????

This is funny, only because for the super rich, this seems like a feasible way forward… instead of eating well and exercising. A really interesting insight into how broken our thinking on health truly is.

https://ama.com.au/ausmed/eternal-youth-may-be-yours-just-43000-day

Eternal youth may be yours, for just $43,000 a day

21/01/2014

Like a bad fairy tale, scientists believe they have developed a way to stop people getting older, but at a cost that puts it out of the reach of all but the super-rich.

A team of researchers at the University of New South Wales, working in collaboration with geneticists at Harvard Medical School, claim to have unlocked the secret to eternal youth, and to have developed a compound they say not only halts the ageing process, but can turn back the years.

The catch is, the treatment is prohibitively expensive, with estimates it would cost the average 86 kilogram man $43,000 a day, and the average 71 kilo woman $35,500 a day.

The compound was developed based on an understanding of how and why human cells age.

A series of molecular events enable communication inside cells between the mitochondria – the energy source for cells, enabling them to carry out key biological functions – and the nucleus. The researchers found that when there is a communication breakdown between the mitochondria and the nucleus of the cell, the ageing process accelerates.

As humans age, levels of the chemical NAD (which initiates communication between the mitochondria and the nucleus), decline. Until now, the only way to arrest this process has been through calorie-restricted diets and intensive exercise.

But the researchers, led by University of New South Wales and Harvard University molecular biologist Professor David Sinclair, have developed a compound – nicotinamide mononucleotide – that, when injected, transforms into NAD, repairing broken communication networks and rapidly restoring communication and mitochondria function.

In effect, it mimics the results achieved by eating well and exercising.

“The ageing process we discovered is like a married couple. When they are young, they communicate well but, over time, living in close quarters for many years, communication breaks down,” Professor Sinclair said. “And just like a couple, restoring communication solved the problem.”

In the study, the researchers used mice considered equivalent to a 60-year-old human and found that, within a week of receiving the compound, the mice resembled a 20-year-old in some aspects including the degree of muscle wastage, insulin resistance and inflammation.

Professor Sinclair said that, if the results stand, then ageing may be a reversible condition if it is caught early.

“It may be in the future that your age in years isn’t going to matter as much as your biological age,” Professor Sinclair said.

“What we’ve shown here is that you can turn back your biological age or, at least, we think we have found a way to do that.”

The problem is, the compound is prohibitively expensive, at least at the moment.

It costs $1000 per gram to produce, and in tests so far it has been applied at a rate equivalent to 500 milligrams for every kilogram of body weight, each day.

Professor Sinclair admitted the cost was major consideration, and said the team was looking at was to produce the compound more cheaply.

As part of their research, the scientists investigated HIF-1, an intrusive molecule that foils communication but also has a role in cancer.

It has been known for some time that HIF-1 is switched on in many cancers, but the researchers found it also switches on during ageing.

“We become cancer-like in our ageing process,” Professor Sinclair said. “Nobody has linked cancer and ageing like this before, and it may explain why the greatest risk of cancer is age.”

Researchers are now looking at longer-term outcomes the NAD-producing compound has on mice, and suggest human trials may begin as early as next year.

They are exploring whether, in addition to halting ageing, the compound can be used to safely treat a range of rare mitochondrial diseases and other conditions, such as cancer, type 1 and type 2 diabetes, muscular dystrophy, other muscle-wasting conditions and inflammatory diseases.

The research was published in the journal Cell.

Kirsty Waterford

healthcare, policy

US doctors not happy or satisfied with career

 

 

http://www.cbsnews.com/news/1-million-mistake-becoming-a-doctor/

$1 million mistake: Becoming a doctor
ByKATHY KRISTOF  MONEYWATCH September 10, 2013, 1: 43 PM

 

ISTOCKPHOTO

(MoneyWatch) If you are brilliant, ambitious and gifted in science, you may consider becoming a doctor. If so, think twice. According to a new survey by personal finance site NerdWallet, most doctors are dissatisfied with the job, and less than half would choose a career in medicine if they were able to do it all over again.

There are many reasons for the dissatisfaction, said Christina Lamontagne, vice president of health at NerdWallet. Most doctors enter the field thinking they’ll be able to spend most of their time healing the sick. Yet the paperwork burden on doctors has become crushing, and could become even more complicated under the Affordable Care Act.

“Administrative tasks account for nearly one-quarter of a doctor’s day,” Lamontagne said. “With additional liability concerns and more layers in health care, we can understand the drain this takes.”

Play VIDEO

Doctor: Patients should take active role in care

Worse, the cost of becoming a doctor has soared, with higher education expenses leaving the average newly minted physician with $166,750 in medical school debt, while average salaries are declining. Nearly one-third of doctors — 28 percent – saw a cut in pay last year, according to NerdWallet’s research.

To be sure, pay is still high, with of six-figure positions in the country, according to government data. But it also takes between 11 and 14 years of higher education to become a physician. That means the typical doctor doesn’t earn a full-time salary until 10 years after the typical college graduate starts making money.

That lost decade of work costs a cool half-million dollars, if you assume this individual could have earned just $50,000 annually, and the typical medical school candidate is smart and successful enough to earn considerably more. Add in the time and cost it takes to pay off medical school debt and a dissatisfied physician may well consider pursuing medicine a $1 million mistake. (This assumes the average $166,750 medical school debt  takes 30 years to repay at 7.5 percent interest — a total cost of $419,738.)

Moreover, primary care physicians — those who go into pediatrics, family and internal medicine — earn barely more than the amount they accumulated in medical school debt, between $173,000 and $185,000, according to the study that looked at data from George Washington University’s School of Public Health, the American Association of Medical Colleges and Medscape.

The least satisfied physicians are those who go into internal medicine, according to the study. On average, these doctors see two patients every hour while spending 23 percent of their time on paperwork. They work an average of 54 hours per week, take home about $185,000 annually, and a fifth have seen a decrease in pay. Just 19 percent would choose the same specialty, and only one-third would choose a medical career if they had to do it over.

“The frustrations that patients have about not getting enough time with their doctor is mirrored by the frustration their doctors have with not having enough time to spend with their patients,” LaMontagne said.

The best paid doctors are orthopedic surgeons, who take home an average of $405,000 annually. The most satisfied appear to be neurologists, who earn an average of $216,000, while working an average of 55 hours per week. Sixty-percent would choose the same specialty, and 53 percent would go into medicine again. Oncologists — the doctors who treat cancer patients — are also generally satisfied with medicine and their jobs, with 62 percent saying that they would go into medicine and 57 percent reporting that they would choose oncology as a specialty.

Radiologists are the physicians most likely to have suffered a pay cut in the past year, with 42 percent reporting a decline in salary. However, they’re also among the best-paid doctors, earning an average of $349,000. More than half would both choose to be doctors again and choose the same specialty.

The doctors who work the longest hours are cardiologists, who report being on the job 60 hours per week. Some 54 percent would choose the same medical specialty, but only 44 percent would go into medicine again if they did it over. The average cardiologist earns $357,000 annually, though 39 percent have seen a cut in pay in the past year.

Those least likely to have suffered a pay cut are emergency doctors, who earn an average of $270,000 and work an average of 46 hours per week. Just 19 percent of emergency doctors suffered a cut last year, but only 41 percent would go into medicine or emergency medical care again.

Across all specialties, physicians see roughly 13 patients per day, work 52 hours per week and earn an average of $270,000. However, family and emergency doctors see nearly 75 percent more patients than anesthesiologists.

© 2013 CBS Interactive Inc.. All Rights Reserved.
healthy habits, nutrition, policy, politics

Tobacco, Firearms and Food

“But the job of government is not to encourage profitable businesses at the cost of public health; it’s to regulate them so that the public is served. Who is this country for, anyway?”

http://www.nytimes.com/2014/01/15/opinion/bittman-tobacco-firearms-and-food.html

The Opinion Pages
Tobacco, Firearms and Food

Mark Bittman Jan 14, 2014

Let’s say your beliefs include the notion that hard work will bring good things to you, that the golden rule is a nice idea though it may occasionally have limits, and that it’s more or less every person for him or herself. Your overall guiding force is not altruism, but you’re not immoral; you’re a good citizen, and you don’t break any major laws. This could describe many of us; most, maybe.

Now suppose you’re in the business of producing, marketing or selling tobacco or firearms — products known to sometimes kill others. You need not be a corporate executive or a criminal arms dealer; you might be a retailer of cigarettes, a person who sells them along with magazines, a marketer, a gun shop owner. In any case, your conscience is clear: you’re selling regulated legal products and, as long as you’re obeying the regulations, you’re doing nothing illegal. (“Wrong” is a judgment call.)

You sleep well, believing that the government would further regulate your product if it were necessary. And if regulations were to change, you’d change with them. But to act otherwise — to hold back your energy from production or sales just because of moral or social pressure — would be foolish, and put you at a competitive disadvantage.

For many years after knowing about the lethal nature of tobacco, our government did little or nothing to limit its consumption. That’s changed gradually in the last 50 years, and more dramatically since 1998, because of successful lawsuits and because the Food and Drug Administration often tries to pursue its mission. (For a variety of reasons not worth going into, firearms are more challenging to regulate. Let’s leave it at that for now.)

O.K., so suppose we pass legislation that discourages you from producing or selling tobacco or firearms while at the same time actively encouraging you — supporting you — to change to producing apples or cotton or washing machines or screwdrivers; as long as you could see a way to increase profit, you’d probably look at the new opportunity. After all, it’s not as if you wantto produce agents of death. You want to make the best living you can selling stuff that’s legal and that people want. Markets change, and flexibility is important, and the government can and does affect your business, even if it’s by inaction.

Now let’s apply this same way of thinking to the major food categories — and for the purposes of this discussion there are only three — and what it’s like to be a farmer or producer, or a manufacturer, processor, distributor, retailer of this stuff. Again, you’re agnostic about what you sell, but you’re profit-conscious. And the government can and does affect your business; it can help your business (“you didn’t build it yourself”) or hurt it, as it should if your business is harming others.

Let’s call the first food group industrially produced animal products. Producing and selling as much as possible is the way to go here, since the penalties for damage your product does to human and animal health and to the environment (including climate) are virtually nonexistent. You can treat the animals as you like and damn the consequences, from salmonella contamination to antibiotic resistance to water contamination to, of course, cruelty. There are even incentives, in the form of subsidized prices for animal feed.

The next group is most easily labeled junk food; you might call it “hyperprocessed.” This comprises aisles and aisles of “edibles” sold in supermarkets and restaurants, and is often “food” that’s unrecognizable as such, ranging from soda and other sugar-sweetened beverages to things like chicken nuggets and Pringles and tens of thousands of other examples. These are mostly made from commodity crops, especially corn, soybeans and wheat. Federal subsidies abound in many forms here, from direct payments (in theory, these are ending, to be replaced by a bizarre form of crop insurance) to the ethanol mandate to virtually unregulated land use that permits toxic overapplication of fertilizers and other chemicals. There is also that same failure to recognize the public health and environmental costs of what is probably the least healthy diet a wealthy nation could devise. You could even say that the Supplemental Nutrition Assistance Program (SNAP, usually called food stamps) acts as a subsidy to junk food, since nothing limits using food stamps for food that promotes disease. It’s worth noting that for the past century the bulk of university research, much of it paid for with tax dollars, has gone into figuring out how to increase the yield of the crops and processes that turn out this junk that sickens.

Then, in the third group, there’s everything else, from fruits and vegetables — absurdly called “specialty crops” by the Department of Agriculture — to animals raised in sustainable and even humane ways. But here, disincentives abound: farmers may be encouraged to allow some land to go fallow, but not to be planted in specialty crops, and research money, subsidies, insurance, market promotion and access to credit are directed toward industrial food production, distribution and sales. These inefficiencies make most of this real food, which is health-promoting and closer to environmentally neutral, appear to be more expensive. (Only “appear,” though. If you account for the costs of environmental and public health damage, industrially produced junk food and animal products actually cost more.)

One could imagine a government that encourages more life-giving (and less disease-causing) agriculture just as one can acknowledge that sanity prevails when government steeply taxes tobacco and encourages its farmers to move on to something else. (I’m not saying, by the way, that tobacco farmers have been treated fairly; much more could have been done — and still could be done — to help them transition to other profitable crops.)

Of course this is disruptive; change the status quo, and someone is hurt. But the public health disaster created by our commodity-pushing agricultural policies is only getting worse, and calls for the same kind of action in industrial agriculture that we’ve seen in tobacco and, to a lesser extent, in guns. That kind of action will happen only when we have political representatives who care about food, health and the environment.

We can pressure corporations all we want, and what we’ll get, mostly, is healthier junk food. Really, though, as long as sugar is profitable and 100 percent unrestricted (and subsidized and protected!), marketers will try to get 2-year-olds hooked on soda and Gatorade.

But the job of government is not to encourage profitable businesses at the cost of public health; it’s to regulate them so that the public is served. Who is this country for, anyway?

healthcare, policy, rapid learning health systems

Commonwealth Fund 2013 Annual Report

Blumenthal is a top shelf operator and its terrific to see him leading the Fund on new work which includes constructive disruption of the US health system. His opening lines carry a finely crafted, powerful and persuasive message:

“Like every American, like every person on this globe, I treasure the access I have to health care. I know I’m privileged, but every time my family members or I are sick, we are taking risks, that we are entering a system that doesn’t function as well as it should. As a primary care provider, as a scholar, as a professor, I’ve been interested in the same things the Commonwealth Fund is interested in. A high performing health system and vulnerable populations.

We have a system that’s excessively costly, inadequate in quality. Poor results with many other countries on quality metrics. We spend far too much on health care – $2.7 trillion when no other country comes close to that.

It’s important that the most vulnerable access care, because in some ways, they are the canary in the mine. Their vulnerability highlights a general vulnerability.

The Commonwealth fund is dedicated to producing the right information at the right time to make decisions better and make our health care system better.

A high performing health system will be a health system in which the providers of care, the clinicians, doctors and nurses, enjoy their work. It matters to me not just as a policy maker, and a scholar, but as a father, as both my children are physicians in training, and I hope we can leave them a system they can truly enjoy working in.

[….]

The last area, and somewhat new, is what we’re calling breakthrough innovations, which are opportunities to fundamentally transform the system through innovative approaches to health care delivery”

 

http://www.commonwealthfund.org/Annual-Reports/2013-Annual-Report.aspx?omnicid=20

healthcare, policy

Google backing telemedicine via Helpouts…

  • aligned with US DHHS
  • doesn’t support third party payments
  • asynchronous comms allows more convenience
  • pricing is pitched at co-pay levels
  • various other services discussed

http://www.fastcompany.com/3022450/the-doctor-veterinarian-and-lactation-specialist-will-see-you-now-on-video-chat

THE DOCTOR, VETERINARIAN, AND LACTATION SPECIALIST WILL SEE YOU NOW–ON VIDEO CHAT

WITH SERVICES LIKE GOOGLE HELPOUTS, HOUSE CALLS ARE BACK IN A BIG, MODERN WAY.

When Google launched Helpouts in November, it opened a marketplace for experts–from scrappy entrepreneurs to big-name brands such as makeup retailer Sephora–to share their skills over video chat.

Now, while some clueless consumers are simply looking for mascara tips, the search giant sees a vastly different industry that can benefit from the service: health care.

That’s right, in addition to the many musicians, yogis, and IT pros chatting on the Helpouts platform, there are also doctors, counselors, veterinarians, and lactation specialists, among other medical professionals. By melding parts of its infrastructure–namely Google Wallet and Hangouts–the company gives consumers a single destination, either through a computer or Android phone, to book sessions with experts and to pay for them. Doctors can even prescribe medicine, as Helpouts is aligned with the U.S. Department of Health and Human Services.

“We believe telehealth, and Helpouts, can complement in-person office appointments and play an important part in the overall continuum of care,” Google’s director of business operations, Christina Wire, tells Fast Company. “We look forward to learning how users find Helpouts to be most helpful in their continuum of care.”

Telemedicine isn’t exactly a new concept. Defined very broadly, the term can be applied to, say, African villagers who used smoke signals to warn others of disease outbreaks. More contemporary forms of telemedicine include the use of Xbox to care for patients with chronic illnesses and telepresence robots, such as the human-sizedRP-VITA from iRobot that lets doctors interact with patients from afar. But with the advent of mobile technologies, telemedicine has the potential to go mainstream.

Using Helpouts, San Francisco resident Justine Lam, 34, consulted One Medical Groupabout getting a flu shot while traveling in Austin early November. The first time she connected, the picture was fuzzy and the call dropped, but the second time, she got a hold of a nurse practitioner, who coincidentally happened to be the one she usually interacts with.

“I travel a lot for work, so it’s difficult for me to get to the doctor’s office,” says Lam, who formerly worked in marketing and recruiting for a tech company. “It was super easy. I just log in, find the time available, and within an hour I was seeing a medical professional.”

One Medical provides its services over Hangouts at no cost to its members; it charges non-members $40 to $60 per session. Dr. Kevin Fell is one of the staff members who now works a weekly shift where he’s on Helpouts duty. “Surprisingly, it feels very personal,” he says. “It feels like being a country doctor and making a really personal house call with the help of modern technology.”

Technology, Fell notes, may not quite replace humans just yet: “I still think the one-on-one physical meeting with a patient is still very important–always has been, always will be.”

Patients like Lam are turning to online platforms for less severe illnesses. And some providers are keen on servicing Telecure, a company focused on providing virtual urgent care. It joined Helpouts in November and only sees patients if they meet certain criteria. For example, they can’t have a fever exceeding 103 degrees or be sick for more than two weeks.

But there are also online platforms that aim to provide medical help beyond the common cold. Grand Rounds was cofounded by a blood clot specialist focused on cutting-edge advances in medicine, the type of treatment that on average takes 17 years to trickle into medical practices. “That’s been the bane of my existence,” cofounder Rusty Hofmann says. “I felt ethically compelled to start this company to fix this problem. The work that I do on blood clots was developed at Stanford in 1992, and 15 years later there were still hospitals 10 minutes away from Stanford not offering this treatment.”

Using the web, patients are able to consult with specialists, who review their medical history, imaging, lab tests, and other information before writing a four-page opinion describing the best course of action. Grand Rounds’ efficiency, Hofmann says, is dependent on asynchronous communication, allowing patients and doctors to use the platform without having to coordinate schedules while also giving doctors the time to research patients’ conditions.

One of the biggest obstacles standing in the way of broader telemedicine adoption is a familiar force: insurance companies. While President Obama hopes telemedicine can help reduce health care costs, the Affordable Care Act doesn’t go so far as to require insurers to pay for remote consultations. “Helpouts does not have a system in place to submit sessions to health insurance plans for reimbursement,” says Google’s Wire. “Reimbursement for Helpouts sessions is at the discretion of the health provider and the health plans they work with.”

Pearl.com, a 10-year-old online marketplace that started with a health care vertical, has tried to involve insurance providers for years. “We would love it if insurance companies would cover online doctors and telehealth,” says CEO and founder Andy Kurtzig, noting the site hit a major milestone in November with experts earning $100 million to date. “We would touch base once in a while, and the answer’s always no.”

Virtual health care companies try to make up for the lack of insurance coverage by pricing their services comparable to copays. Across the board, Pearl.com sessions begin at $15 and average about $30. Telecure prices its 15-minute sessions at a flat $25, and most consultations don’t exceed that, says CEO Garick Hismatullin. The company, in part because it doesn’t have an advertising budget, also added a way for patients to pay for their services with tweets–“social currency,” Hismatullin says. “We were looking for a way to make people more aware of our service,” he says, mentioning the pay-by-tweet option is available only on its site, not Helpouts. “This was a direct result of us watching thousands of incredibly satisfied patients, to let them do the talking for our company instead of paying for advertising.”

Helpouts is playing a role in hastening telemedicine’s adoption, but changes take time. “Services like Helpouts have the power to bring back doctor house visits after 50 years,” says Google’s Wire.

There will always be reason to physically go to a doctor’s office, but One Medical’s Fell is amazed at technology’s potential to transform health care. He recalls being at Mayo Medical School in the early ’90s and first hearing about telemedicine. “There was a doctor who said, ‘When you guys are older and in practice, you’re going to be able to see and meet with patients wherever they are, wherever you are,'” Fell remembers. “Most of us at the time, we didn’t even have an email address.”

[Base Images: Flickr users Phalinn Ooi & Official U.S. Navy]

data saving lives, entrepreneurship, healthcare, healthy habits, nutrition, policy, politics, quantified self, rapid learning health systems, research methodology

HICCUP: Health Initiative Coordinating Council

This manifesto aligns tightly with my own vision of how preventive health funding should be financed – data-driven and in a for-profit context.

HICCup

 

The HICCup experiment: Manifesto

Just imagine:

It’s 2019 and the mayor is having a bad day.  She wants to spearhead a new community program for bike-sharing, but she’s not sure the town can afford it.  Meanwhile, one of the new council members is pushing for an overhaul of the school lunch program.  She sighs as the assistant deputy mayor walks in.  “What now, Henry?” she asks with a slight edge in her voice.  But Henry is cheerful: “Mayor, I think we may have a way to fix this. I was just reading about the HICCup Experiment in a town just like ours…. It seems that if we did both the bike program and the school lunches, and made some other changes..”

“But what about our rising health care costs?” asks the mayor.

“That’s the point,” says Henry.  “HICCup showed that we can actually reduce those costs if we do multiple interventions simultaneously…even though none of them by itself would make a difference. And there’s an investment banker who just called us that’s eager to work with us to finance the project.  They’re asking us to set up a meeting with the big employers and Mercy Saints Health. Using the HICCup data, they think they can finance it all out of the health-care cost savings that would result, as long as we commit to following certain protocols.”

And the vision:

Now it’s 2040.  The mayor’s teen-aged son, also called Henry, is discussing his history project on the HICCup Experiment with other members of his MOOC.  “Of course,” he concludes, “the HICCup Experiment proved that multiple interventions can dramatically include the overall health of a community.  But the Experiment itself wouldn’t work anymore, as a funding vehicle.”

“Why not?” asks Susan, who clearly hasn’t done her homework.

Henry responds patiently with the obvious answer: “Because there are very few places with inflated, unnecessary health care costs anymore.”

The background

It is hard to find anyone in health care who does not believe that spending an extra $100 now on healthy behavior – exercise and proper nutrition, counseling for pre-diabetics, risk monitoring, and so on – could yield more than $120 in lowered costs and improved outcomes later. The numbers are fuzzy, of course, and there are plenty of methodological caveats, but there is little dispute about the plausibility and desirability of such an approach.

Yet neither individuals nor communities seem to act on the basis of this knowledge. Moreover, it’s likely that spending $110 now has no impact, as other factors dissipate any gain, but spending $110 million now (vs. a health-care budget of $100 million) should indeed return savings of $20 million annually over time.  Individuals often lack willpower or access to healthy food or convenient exercise facilities, and are surrounded by poor examples that encourage instant gratification rather than effort and restraint. And, on a broader, institutional scale, the money spent and the money to be gained do not belong to the same pocket.

Enter HICCup!

The goal of HICCup, the Health Initiative* Coordinating Council, is to facilitate the launch of five to eight community-wide experiments dedicated to proving that this can work, and to learning from both successful and unsuccessful efforts.  HICCup is a self-appointed counseling service and will persuade and guide local institutions to embrace a long-term perspective and launch a full-scale intervention experiment in their communities. For practical reasons, there are a few guidelines – but anyone who wants to do this without following our rules is welcome to do so.   (*Yes, it used to be “health intervention…” but initiative is more friendly and positive, and still let us keep the logo!)

For starters, HICCup will focus on communities of 100,000 people or fewer. The majority of each community and its institutions must be enthusiastic for the initiative to gain traction. If the community members mostly work for just a few employers and obtain health care from just a few providers, that makes the effort of corralling the players easier. And, of course, you need community leaders – mayor, city council, and others – who will work together rather than undermine one another.

So, how will this be funded? Not by HICCup, which is only a coordinating body.  The trick is for an investor in each community to capture some of what is being spent already on health care. As a rough calculation, assume $10,000 in annual per capita health-care costs, or $1 billion per year in a community of 100,000. (There are also all the separate costs of bad health, which are much harder to count or capture.)  That money ultimately comes from individuals and employers who pay it in taxes, insurance premiums or direct payments; the place to intercept it is somewhere between the payers and the health-care delivery system.

Instead of spending $1 billion a year, imagine spending $1.1 billion the first two years, but, say, only $900 million in the fifth year (possibly a $300 million savings off projected costs of $1.2 billion by then). That sounds like an attractive proposition – but only if someone else will make that initial investment in return for a claim to those presumed later savings.  These numbers are just for illustration; figuring out actual and predicted numbers for each community will be a key task.

The first challenge is for each HICCup community to get the involvement of a benevolent but ultimately profit-driven billionaire or hedge fund, or a philanthropic fund that sees a way to do good while earning money for future goodness. There are a lot of billionaires out there, some with vision. There are health-care companies that might bite, hedge funds looking for large-scale projects, and so-called social-impact bonds. There also are large employers that might decide to work with other employers in certain communities.

The funder makes a deal with whoever is responsible for the health-care costs (buyers): The funder makes upfront investment in health interventions and pays the health-care costs, against continued payment from the health-care buyers of the $1-billion yearly baseline, with the funder to keep (most of) the savings against originally predicted rising costs in later years. The money may be paid by employers, private insurers (which collect it from individuals, who, in the United States, are now required to buy insurance) or from government health-care funds, which will be the trickiest source.

One way or another, the investor/experiment manager will need to figure out how to realign some of the sick-care facilities and workers to some other role, including prevention, serving outsiders or some other use entirely.  That’s the second challenge HICCup experimenters need to address – one that is being addressed in part by the creation of Accountable Care Organizations, but without community involvement in preventive health.

All together now!


All these entities will be taking a substantial leap of faith. But we believe they can succeed – especially if they work together through HICCup to figure out the numbers, study the effects of small-scale healthy-living/preventive health-care efforts, and encourage one another to move forward. Regardless, each investor must work with existing institutions – if only to get at the revenue stream initially and benefit from the lowered costs in later years.

Although grants are a nice source of funding for demonstration projects and research, the best way for HICCup’s vision to catch on and be widely copied is by adopting a for-profit approach that attracts broader investment once it is shown to work.  Indeed, if a benefactor makes a donation, they feel good when they send off the money. An investor feels good only after the investment actually pays off.

Community officials and voluntary organizations also need to sign on…or  they can drive the process and find the benefactor/investor. They will also contribute by implementing complementary changes in school meals and gym classes; enacting zoning and other changes to encourage cycling, walking, and the like; hiring health counselors and care workers; and perhaps working with local restaurants and food stores to subsidize healthy choices and discourage unhealthy ones.   Local media can report on the experiment’s progress, and each community will likely engage in healthy rivalry with other HICCup experimenters.

Though it won’t get to keep the direct health-care cost savings, each community will get all the ancillary benefits of a healthy population, including an enhanced reputation.  Indicators of population health include not just rates of obesity, diabetes, high blood pressure, and diseases and related costs, but also whether the elderly can live (and be cared for) at home, absenteeism, school grades and graduation rates, employment statistics, accidents, and the like. Although the funder keeps the reduction in health-care costs, the community gets the benefit in the many payoffs from a healthier population over time.

Open enrollment

HICCup will not choose which communities participate. They will be choosing them selves. HICCup’s role will be to advise them and help them to communicate and learn from other communities going through the same process. We also want to be a clearinghouse for vendors of health-oriented tools, services, and programs. There are many bargains to be struck between communities and vendors offering discounts in exchange for wholesale adoption of their tools or programs.

However, there is one unbreakable rule: To work with HICCup, communities must collect and publish a lot of independently vetted data (without personal information, of course). For starters, they will need benchmarks of current conditions and projected costs, and then detailed statistics on the adoption of the measures, their impact and costs, and what happens over time.  HICCup will welcome input from lawyers and actuaries!

It is now time to try this on a broad scale. Five years from now, we will wonder what took us so long to get started. So, again, who will those investors be?

healthy habits, policy, politics

Education matters to health more than ever before

  • education matter more know because the economy has evolved to be more knowledge-based
  • white women are the key group affected by this change
  • whites as a group are no longer top of the heap
  • the graph below indicates that hispanic women of all educational levels are longer lived than most other groups of any educational exposure – interesting

 

education_health_rwjf

http://www.rwjf.org/en/research-publications/find-rwjf-research/2014/01/education–it-matters-more-to-health-than-ever-before.html

Brief (PDF): education_health_rwjf409883

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Education: It Matters More to Health than Ever Before

We know with greater certainty than ever before that Americans with fewer years of education have poorer health and shorter lives. In fact, since the 1990s, life expectancy has fallen for people without a high school education, a decrease that is especially pronounced among White women.

Why is the link between education and health more distinct today? In the current knowledge economy, education paves a clear path to good jobs and a steady income. Completing more years of education creates better access to health insurance, medical care, and the resources to live a healthier lifestyle.

This brief and video are products of the Virginia Commonwealth University Center on Society and Health’s Education and Health Initiative, a program to raise awareness about the links between education and health. This is the first in a series of four briefs that will explain these complex connections, discuss the role of health care reform, and demonstrate why investing in education can cut health care costs.

Key Findings

  • People with less education are living shorter, sicker lives than ever before.Americans with less education face higher rates of illness, higher rates of disability, and shorter life expectancies. In the U.S., 25-year-olds without a high school diploma can expect to die 9 years sooner than college graduates.
  • These health disparities are even more prominent among White women.While overall life expectancy has generally increased, it has decreased for Whites with fewer than 12 years of education—especially White women. White women without a high school diploma are living shorter lives than they did in 1990.
  • Investing in education saves lives and dollars. More education leads to higher earnings that can provide access to healthy food, safer homes, and better health care. In contrast, people with fewer years of education generate higher medical costs and are less productive at work.
healthy habits, nutrition, policy, politics

Big food go lite for the First Lady

  • Included only in the interests of balance, US big food exceeded a target to reduce calories – likely a modest, meaningless target, easily gamed? due to the GFC?
  • the denominator for the 6.4 trillion calories is 60.4 trillion calories
  • between 2007 and 2011, better-for-you, lower-calorie foods and beverages also drove financial performance for many of these same companies. Companies with a higher percentage of their sales coming from such products recorded stronger sales growth, higher operating profits, superior shareholder returns, and better company reputations.

http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2014/01/major-food–beverage-companies-remove-6-4-trillion-calories–fro.html

Major Food, Beverage Companies Remove 6.4 Trillion Calories from U.S. Marketplace

Independent evaluation finds industry exceeded Healthy Weight Commitment Foundation pledge to remove 1.5 trillion calories by more than 400 percent.

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Princeton, N.J.—Sixteen of the nation’s leading food and beverage companies sold 6.4 trillion fewer calories in the United States in 2012 than they did in 2007, according to the findings of an independent evaluation funded by the Robert Wood Johnson Foundation (RWJF) and announced today. The companies, acting together as part of the Healthy Weight Commitment Foundation (HWCF), pledged to remove 1 trillion calories from the marketplace by 2012, and 1.5 trillion by 2015. The evaluation found that, thus far, the companies have exceeded their 2015 pledge by more than 400 percent.

The participating companies sold 60.4 trillion calories in 2007, the year defined as the baseline measurement for the pledge. In 2012, they sold 54 trillion calories. This 6.4 trillion calorie decline translates into a reduction of 78 calories per person in the United States per day. This is the first effort to track all the calories sold by such major companies in the American marketplace.

“It’s extremely encouraging to hear that these leading companies appear to have substantially exceeded their calorie-reduction pledge,” said James S. Marks, MD, senior vice president and director of the Health Group at RWJF. “They must sustain that reduction, as they’ve pledged to do, and other food companies should follow their lead to give Americans the lower-calorie foods and beverages they want.”

In October 2009, more than 40 of the nation’s largest retailers, non-profit organizations, food and beverage manufacturers and trade associations launched HWCF, with the goal of helping to reduce obesity, especially childhood obesity, by 2015. Sixteen companies participated in the calorie-reduction pledge, announced in May 2010 as one pillar of the work of HWCF. The pledge was part of an agreement between HWCF and the Partnership for a Healthier America, an independent, non-partisan organization dedicated to advancing the goals of First Lady Michelle Obama’s Let’s Move initiative by working with the private sector to end childhood obesity.

Together the 16 companies produced 36 percent of the calories from all packaged foods and beverages, items such as cereals, snacks, canned soups, and bottled beverages, sold in the United States in 2007. In 2010 the companies noted that, in order to meet the pledge, they likely would develop new lower-calorie options, change existing products so that they had fewer calories, and change portion sizes to introduce more lower-calorie packaging.

In order to evaluate the impact of the pledge, researchers at the University of North Carolina at Chapel Hill (UNC) combined data on foods and beverages sold by participating companies with nutritional information for those products. They then determined which individual products were included as part of the pledge and tracked sales of those products over time. All data used were publicly or commercially available. The full, peer-reviewed study is expected to be published later this year.

“The companies whose sales we analyzed have a big influence over the foods and beverages almost every American eats and drinks every day,” said Barry Popkin, PhD, the W.R. Kenan, Jr. Distinguished Professor in the School of Public Health at UNC, who is leading the evaluation team. “The evaluation system we’ve created will enable to us to determine how changes to what’s sold influences what people consume.”

Other research has shown that, between 2007 and 2011, better-for-you, lower-calorie foods and beverages also drove financial performance for many of these same companies. Companies with a higher percentage of their sales coming from such products recorded stronger sales growth, higher operating profits, superior shareholder returns, and better company reputations.

“Making the shift from traditional items to lower-calorie ones is not just the right thing for customers, it’s the right thing for these companies’ bottom lines,” said C. Tracy Orleans, PhD, senior scientist at RWJF. “The next big question is how these changes to what’s available on store shelves actually impact the health of children and families.”

The 16 companies committed to the HWCF calorie-reduction pledge include:

  • Bumble Bee Foods, LLC
  • Campbell Soup Company
  • ConAgra Foods (includes Ralston Foods)
  • General Mills, Inc.
  • Hillshire Brands (previously Sara Lee Corporation)
  • Kellogg Company
  • Kraft Foods Group/Mondelez
  • Mars, Incorporated
  • McCormick & Company, Inc.
  • Nestlé USA
  • PepsiCo, Inc.
  • Post Foods
  • The Coca-Cola Company
  • The Hershey Company
  • The J.M. Smucker Company
  • Unilever
cool, healthy habits, nutrition, policy, politics

Top piece… obesity and diabetes

This guy is an arts/law student at Sydney University and he does a terrific job of crystallizing the issue… recognised in him winning the Wentworth Prize. Good on him.

Obesity cannot be controlled through personal responsibility alone

Policymakers have invested in the exhausted, glib explanation that maintaining nutritional health is a matter of personal and parental responsibility. But is it?

Assuming collective responsibility for obesity and diabetes would likely require highly invasive disincentives like sugar or beverage taxes. Photograph: Foodfolio/Alamy

McDonald’s cookies have an energy density comparable to hydrazine. Hydrazine is a rocket fuel used to manoeuvre spacecraft in orbit. It was astonishing, then, to watch a small child graze through two boxes of the desiccated biscuits in one sitting. His parents watched on, preoccupied with their own colossal meals: a noxious amalgam of meat, grease and sugar.

The prime minister, once our federal health minister, has explained his attitude. “The only person responsible for what goes into my mouth is me,” he said, “and the only people who are responsible for what goes into kids’ mouths are the parents”. The Gillard government agreed, ignoring recommendations produced by its own preventative health taskforce to tax unhealthy foods and eliminate junk food advertising directed at children.

Policymakers have invested in the exhausted, glib explanation that maintaining nutritional health is a matter of personal and parental responsibility – a corporate defence strategy adapted from the tobacco and alcohol industries. By implication, obesity is the result of individualirresponsibility: poor dietary choices, idle lifestyles, questionable parenting, or inadequate resolve.

Intuitively, it is easy to understand the political appeal of this doctrine. It conforms to cultural stereotypes, that “fat people” are slothful and indolent. Moreover, assuming collective responsibility for obesity and diabetes would likely require highly invasive disincentives like sugar or beverage taxes. Policymakers are eager to avoid the political liability associated with these proposals.

But this “personal responsibility” paradigm is troubling. First, it reflects popular indifference to the obesity epidemic. It is properly called an epidemic. Over 63% of Australian adults are overweight or obese. A fifthof all cancer deaths in the US are attributable to obesity. A quarter of the world population will likely acquire type 2 diabetes, while diabetes sufferers constitute two-thirds of all the deaths caused by cardiovascular disease. Globally, abnormal body mass index accounts for 23% of disability-adjusted life-years.

And if the number of sufferers continues to grow, children born today will enjoy shorter life expectancies than both their parents and grandparents.

Yet numbers make no sense unless they are properly communicated. Both obesity and type 2 diabetes are deeply human tragedies, but that is yet to register among the public and policymakers. They are tragedies that happen to “other people”, after a seemingly predictable descent into sedentary living and poor eating. Neither disease has the terrifying arbitrariness of cancer, nor the abruptness of a sudden heart attack – neither seems to warrant the same commitment to prevention.

Coca-Cola CEO: 'Obesity is a serious problem'.
Coca-Cola CEO: ‘Obesity is a serious problem’. Photograph: Geoff Abbott/Demotix/Corbis

Australians, for instance, remain acutely aware of the causal links between smoking and lung cancer or emphysema. Anti-smoking campaigns here are intensely visual and heavily funded. Comparable anti-obesity campaigns receive a third of the funding. Obesity is substantially lower as a preventative health priority.

Second, the personal responsibility doctrine allows government and industry to play an interminable game of pass-the-parcel with obesity control. At its most basic, obesity develops when a person’s energy consumption exceeds their energy expenditure. Commercial interests are best served by preserving the rate of consumption, and instead appealing to exercise and sport. “Think. Drink. Move.” intones Coca-Cola. “Confectionery is designed to be enjoyed,” writes Cadbury, “as part of a balanced diet and active lifestyle.”

Central, then, to the corporate responsibility mission is a selective emphasis on physical activity over diet, and a denial of the good food/bad food dichotomy. Blame is deflected instead onto the consumer. The CEO of Coca-Cola, Muhtar Kent, provides a typical illustration of this disingenuous, faux-conscientious marketing. “Obesity is a serious problem. We know that,” he silkily conceded. “And we agree that Americans need to be more active and take greater responsibility for their diets.”

So policymakers are stuck in a trap of industry’s design. Through the personal responsibility conceit, the debate over tackling obesity has been reduced to a simplistic binary: consumption control versus the promotion of sport and exercise.

It is a neat and digestible expression of the basic obesity problem, but it lazily defers some crucial questions. Consumption is the half of the obesity equation which has the greatest effect, and over which we have the most control. But governments have been caught up in the food politics of “energy-in-energy-out” without asking why 10% of the Australian population visits McDonald’s every day despite school curriculums saturated in dietary education, why Indigenous communities suffer disproportionately high rates of obesity and diabetes, or why ultra-processed foods are cheaper than healthy alternatives.

Clearly, understandings of personal responsibility will play an important role in any obesity control regime. Eliminating it entirely is unhelpful, and would only sustain the worn cliché that obesity is an exclusively genetic problem, to be cured rather than prevented.

Yet a country does not get fat for lack of responsibility. That cannot explain the rapid growth or severity of the obesity-diabetes epidemic. It is a caricature of the complex factors which influence the lifestyle patterns of individuals, and it fails to address the roots of overconsumption: cost of living, manipulative marketing, nutritional misinformation and – often overlooked – simple palatability.

Australia is the muffin top of Asia, and it is killing our citizens. Dispensing with the fiction of personal responsibility is the first step to a truly holistic solution – one which finds an appropriate balance between education, industry self-regulation, and firm government intervention.

healthy habits, nutrition, policy

Nutrition labels don’t work in NZ

  • Complicated nutrition labels don’t help… who would have thought?
  • Running, walking and traffic light labels were far better recalled.

http://www.foodnavigator-asia.com/Markets/Nutritional-food-labels-not-working-in-New-Zealand-says-study

Nutritional food labels not working in New Zealand, says study

By Ankush Chibber, 13-Jan-2014

Related topics: Markets, Asian tastes

A new study from New Zealand has found that nutritional food labels in use under the country’s daily intake system of labelling are not as effective as once thought and could be adversely impacting public health.

The study, which was conducted by researchers at the University of Canterbury, instead found that Kiwi consumers reacted better to labels which provide relatable, transparent information that is easily converted into exercise expenditure or clearly states which products are good and which are bad.

Under the study, UC researchers collected a total of 591 online responses from participants who were given an identical survey, where the way in which the nutritional information was communicated differed across the sample.

Michelle Bouton, a researcher on the study, said that they included a star system which displayed one, two or three stars on the product, depending on how many calories were in the product.

“A traffic light label was divided into five categories of the main nutritional components and coloured red [bad], orange [moderate] or green [good],” Bouton said, adding that they also included walking and running labels which stated how many minutes of exercise were needed to burn off the product.

Daily intake system ineffective

“Our findings showed that the current daily intake system was so insignificant that only 23% of participants recalled seeing it. This was alarmingly low compared to the recall rate of the running [89%], walking [93%] and traffic light label [70%],” she said.

Bouton said that through their study, the researchers found that those who were presented with the walking label were most likely to make healthier consumption choices, regardless of their level of preventive health behaviour.

“Therefore, consumers who reported to be unhealthier were likely to modify their current negative behaviour and exercise, select a healthier alternative or avoid the unhealthy product entirely when told they would need to briskly walk for one hour and 41 minutes to burn off the product,” said Bouton.

Traffic lights work

“The traffic light system was found to be effective in deterring consumers from unhealthy foods, while also encouraging them to consume healthy products,” she added.

“Although the running label was found to be effective with participants who reported a healthy lifestyle, it was found to be ineffective with those who were yet to adopt a healthy lifestyle. A consumer who does not actively exercise is less likely to start running than a consumer who is already active.”

Ekant Veer, associate professor of marketing at UC’s Department of Management, Marketing and Entrepreneurship and study supervisor, said the findings differ from what people initially thought would be an effective communication method.

“Information and numeric figures are ineffective at aiding consumers with low levels of health literacy to make healthy consumption choices. Images and colours are found to be much more effective and understandable forms of communication,” he said.

“As the overwhelmingly high obesity rates in New Zealand continue to climb, something needs to be done to improve the health of our society. This information provides valuable insight into understanding consumption behaviours’ associated to food labels. New Zealand still has one of the highest obesity rates in the world.”