Workplace Wellness: The Cost of Unhealthy Behaviors in America is $623 per Worker

Jane Sarasohn-Kahn

Posted 11/14/11 on Health Populi

The health status of the American workforce is declining. Every year, unhealthy behaviors of the U.S. workforce cost employers $623 per employee annually, according to the Thomson Reuters Workforce Wellness Index. People point to smoking, obesity and stress as the 3 most important factors impacting health costs.

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Actual Causes of Death in the US: Not What You Think

Kenneth Lin

First posted 8/26/11 on Common Sense Family Doctor

Any standard public health or medical school prevention text includes (or ought to include) some version of the figure below, which illustrates that the leading causes of death in the U.S. at the turn of the century (heart disease, cancer, stroke) were actually surrogates for what have come to be known as the actual causes of death: unhealthy behaviors such as tobacco use, poor diet, and physical inactivity.

The most effective preventive services that primary care clinicians provide, then, are not screening tests but counseling interventions that aim to change one or more of these behaviors for the better. Community-level initiatives such as tobacco-free restaurants and campuses, pedestrian-friendly cities, and the increasing access to nutritious food sources play a critical role in changing health-related behaviors, too.

Unfortunately, the impact of behavioral or “lifestyle” approaches to prevention is likely to be limited by two factors: 1) even intensive interventions produce very modest benefits; and 2) behaviors don’t exist in a vacuum, but are largely shaped by economic and social circumstances. Family medicine professor and former U.S. Preventive Services Task Force member Steven Woolf has published a number of studies showing that the risk of death is strongly associated with levels of college education and income; his research team at Virginia Commonwealth University worked with the Robert Wood Johnson Foundation to develop an interactive County Health Calculator that illustrates how many premature deaths could be avoided by eliminating educational and income disparities.

Researchers from Columbia University went a step further by publishing “Estimated Deaths Attributable to Social Factors in the United States” in this month’s issue of the American Journal of Public Health. Using estimates derived from the literature on social determinants of health and year 2000 mortality data, they found that the “actual” causes of death looked like this:

1) Low education: 245,000

2) Racial segregation: 176,000

3) Low social support: 162,000

4) Individual-level poverty: 133,000

5) Income inequality: 119,000

6) Area-level poverty: 39,000

Clearly, we know a great deal more about successful strategies for fighting clinical and behavioral causes of death than we do about social causes, some of which often appear intractable. But I could not agree more with the authors’ conclusion that “these findings argue for a broader public health conceptualization of the causes of mortality and an expansive policy approach that considers how social factors can be addressed to improve the health of populations.” The point being: poverty, discrimination, and low education aren’t just social or political issues best left to non-clinicians – they’re health issues, too.

Kenny Lin is a family physician practicing in the DC area.

Health is Bliss

Jane Sarasohn-Kahn

First posted 7/14/11 on Health Populi

In the ever-morphing space between health, wellness and beauty is the latest online portal called Bliss.com. The project was launched by Glam Media, which brings together women-focused brands and social media. Glam boasts a reach of 200 million across all of its online properties, and estimates that Bliss.com will realize an 11 million member community. Its target is “yogis, fitness enthusiasts and health conscious moms,” according to Glam’s website. Bliss Connect is the social networking component on the website for user-generated content.

[In a small-world, two-degrees of separation from my health care world, Glam was in fact inspired by Esther Dyson in 2002.]

With hyperlinks to “eat well,” “get fit,” “mind+spirit,” “head to toe,” and “sanctuary,” this website grabs onto the zeitgeist of Whole Health. Today’s features include “Exercise in Bed,” “Summer Snacks That Won’t Blow Your Calorie Budget,” and “Healthy Now, Healthy Later,” a four-step process to help you sustain good health habits — sponsored by One-A-Day vitamins.

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Prevention Politics Injures Patients

Kenneth Lin

First published 5/31/11 on Common Sense Family Doctor

PPIP is an acronym that officially stands for “Put Prevention Into Practice,” which serves as both the name of the Agency for Healthcare Research and Quality’s programs to disseminate the preventive care recommendations of the U.S. Preventive Services Task Force as well as the tagline for a series of case study questions about these recommendations that I wrote for the journal American Family Physician from 2008 to 2010. Given theunfortunate events that have occurred since the USPSTF became inextricably linked to the Obama health care reform bill, however, I now propose a new meaning for PPIP: Prevention Politics Injures Patients.

In a recent New York Times editorial, “Squandering Medicare’s Money,” Archives of Internal Medicine editor Rita Redberg, MD pointed out that the Medicare program paid physicians more than $40 million in 2009 for screening colonoscopies in patients over age 75, and $50 million in 2008 for PSA screening in men age 75 and older and Pap smears in women age 65 and older. That’s nearly $100 million alone for 3 tests that the USPSTF concluded have few or zero health benefits and have a high potential to cause harm, and it doesn’t count the additional millions (billions?) of dollars of additional testing and procedures that result from these unnecessary screenings. Dr. Redberg writes:

Our medical culture is such that if the choice is between doing a test and not doing one, it is considered better care to do the test. So while Medicare is obligated to follow the [U.S. Preventive Services] task force’s recommendations to cover new preventive services, it has no similar mandate to deny coverage for services for which the task force has found no benefit.

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Prevention: The Answer To Curbing Chronically High Health Care Costs

Kenneth Thorpe

First published 5/24/11 on Kaiser Health News

While Congress tries to control health care spending, lawmakers should be careful to make choices that are pennywise but not pound foolish.

In April, the House voted 236 to 183 to repeal the health law’s prevention and public health trust fund. Republicans said they opposed giving the Secretary of Health and Human Services wide discretion on how to spend this money. But the result is a setback for the first dedicated source of funding for national prevention efforts and could be a missed opportunity to reduce spending even further by preventing the largest driver of health care costs — chronic disease.

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To Fix Your Health Habits, Do It All At Once

Kenneth Lin

First published 5/13/11 on Common Sense Family Doctor

As a physician, I have mixed feelings about the popular reality television show “The Biggest Loser.” On one hand, some of my patients are surely inspired by seeing severely overweight people, many of them suffering chronic weight-related health problems, make various positive lifestyle changes and rapidly lose weight. Unfortunately, others may assume that eating meals prepared by professional nutritionists and getting one-on-one coaching from a celebrity personal trainer are fundamental to the contestants’ successes. Since most people don’t have access to such help, they may conclude that it’s not worth trying to fix all their unhealthy habits.

That, however, would be the wrong conclusion to draw.

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The Missing Link in ACOs: Patients

Mark Lutes and Joel Brill

First published 3/15/11 on Kaiser Health News

In 2009, researchers reported the discovery of “Darwinius masillae,” a small lemur-like creature that lived some 47 million years ago. Many paleontologists have postulated that D. masillae was the missing link, marking the point at which the evolutionary lineage of humans diverged from that of more distant primates.

It seems to us that, in the recent debate about accountable care organizations, one could also detect a missing link.