Tag Archives: healthcare

Public Health’s ‘Moonshot’ – Part 2: A Local Context

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Courtesy of Inspector Insight

 

In the first post of this series, I briefly described healthcare system expenditures, as a percent of GDP, for the U.S. and a number of OECD member countries. When coupled with population health outcomes data, the amount spent per person on healthcare in the U.S. seems excessive and arguably wasteful. Individual health behaviors, genetics and a broad range of social and environmental factors account for 90% of an individual’s risk for premature death. Addressing the factors outside the healthcare system, through a reallocation of spending into social services such as employment programs and supportive housing, may play a key role in improving population health outcomes.

Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age”. As such, a contextual understanding of communities and their history is critical to tackling deep-seated social issues. Below, I focus on the community of Durham, North Carolina for place-based contextual understanding.

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The Robert Wood Johnson Foundation (RWJF) is the nation’s largest philanthropic organization dedicated to improve health. RWJF’s focus, once solely on innovation in the healthcare system, has evolved to address the social and environmental factors as well in “building a culture of health.” Shifting the way society viewed health – from the absence of illness – was an integral part in this movement. It emphasized health as a resource for living fulfilling lives and collectively contributing to a competitive and thriving nation. It developed and strengthened relationships with key stakeholders and facilitated cross-sector collaboration. And it’s engaging leaders in communities.

In 2013, RWJF named six communities with its “Culture of Health Prize.” Distinct from its traditional grantmaking program, this prize awards $25,000 to communities for the work and successes they have already achieved. By shining a spotlight on a selected group of communities each year, RWJF is able to share lessons and first-hand knowledge with community leaders nationwide. Durham, North Carolina, was one of six communities selected for the Culture of Health Prize in 2014 for the work the Partnership for a Healthy Durham has done since 2004. The Partnership is just one example of community-engaged efforts to improve the lives of Durham residents. A few additional innovative models will be introduced in subsequent posts to illustrate social impact at the local level and offer ideas to accelerate their collective impact.

Durham

Approximately 250 miles southwest of our Nation’s capital, Durham is situated at the northernmost point of North Carolina’s Research Triangle, with Raleigh and Chapel Hill to its east and west, respectively. In its former life, the city was well-known for tobacco and textile production, but fast forward to 2017 and the “City of Medicine” is in a constant state of transformation. Durham was recently anointed as a destination for foodies, “The South’s Tastiest Town,” and boasts a vibrant and diverse culinary and social scene. A major factor in its Renaissance was a collective effort to attract entrepreneurs and catalyze innovation. Community and business leaders invested a significant amount of resources to revitalize downtown and its efforts appear to be paying off. Once described a “nascent startup scene” by Madrigal in the Atlantic, now exudes self-confidence with two Durham-based startups collecting back-to-back wins in 2014 and 2015 at Google Demo Day in Silicon Valley. The startup community has also made waves nationwide for its efforts to empower and nurture diversity; its epicenter, American Underground, a Google Tech Hub, houses 48.2% minority- or female-led companies thanks to initiatives like Code 2040 – a nonprofit organization that creates pathways to the technology industry for underrepresented minorities – and strong partnerships within the Research Triangle.

History

In the early 20th century, Durham had the most African American millionaires per capita than any other city in the U.S. Their success in finance and insurance was evident with a section of downtown named “Black Wall Street” (Forbes) and the city was also known as the “Capital of the Black Middle Class”. The Hayti District, an independent black community founded shortly after the Civil War, became a self-sufficient community and housed residents of all social class along with a variety of businesses, schools, library, hotel and a hospital. African Americans owned and operated over 200 businesses within the boundaries of the District. It flourished for decades through the 1940s until an urban renewal project in the 1950s tore through more than 200 acres in the heart of Hayti, displacing residents and businesses alike. The project was intended to ease commuting for suburban residents by realigning streets and construction of “the Durham Freeway”, NC-147.

Historically, urban regeneration or renewal served as a method for social reform in England to address substandard and unsanitary living conditions in rapidly growing industrialized cities. In the U.S., it came in the form of federal policies used to “reshape” American cities. The Housing Acts of 1949 and 1954 disbursed federal funding for cities to “acquire” areas identified as “slums” and were given to private developers to construct new housing. Additionally, the Federal Aid Highway Act of 1956 allocated 90% of federal funding to states to construct new highways that connected to the larger Interstate System. Large urban cities including New York, Chicago, Pittsburgh and Boston undertook urban renewal projects like Durham in the 1950s. While urban renewal projects generated economic development and improved quality of life in those cities, the destruction of neighborhoods left former residents in dire situations.

Poverty

A slow decline in manufacturing of textile and tobacco in Durham in the 1950s resulted in rising unemployment among working-class black residents due to segregation and discrimination. Coupled with urban renewal in the 1950s and 1960s and Civil Rights movements, the divide between whites and blacks grew. Sarah Willets of Indy Week describes an initial divide between affluent landowners and its workers even when the city was incorporated in 1869. An initial divide in opportunity which persists to this day.

“While some parts of Durham have single-digit and even less-than-1-percent poverty rates, in other neighborhoods, half the residents struggle to make ends meet.” — Sarah Willets, Indy Week

“We’ve always been taught the story of America is one of upward mobility. Durham very much embodies that. But some of the darker sides of the American story are here too.” — Justin Cook, Photographer, Slate Magazine

Photographer Justin Cook’s series, “Made in Durham” and various other pieces in the Indy illustrate what Willets captures in her story on Mayor Bell’s lasting dichotomous legacy – a thriving upward mobility amongst young professionals contrasted with historically African American neighborhoods that struggle with staggering rates of poverty and violence.

Alison Templeton, a research assistant at the UNC Center on Poverty, Work and Opportunity, released an update on urban poverty in Durham using current Census data in 2013. Templeton identified census tracts as “distressed” based on its performance compared to the state’s average on the following: per capita income, unemployment and poverty rates. 22% distressed census tracts in Durham County were identified in the report, which rose from 15% back in 2000. Other poverty-related statistics in Durham’s distressed tracts:

Poverty 46.7%
Child poverty 55.2%
Elderly poverty 25.6%
HS graduation 72.6%
Families led by Single Mothers 66.5%
Homeownership 27.6%

Poverty and the consequences of sustained poverty for individuals and communities significantly impact population health outcomes. Understanding historical context is a crucial first step in adequately addressing deep-seated social issues.

Public Health’s ‘Moonshot’ – Part 1

Advocates for cancer research and prevention efforts converged in Washington, D.C. last week for One Voice Against Cancer’s (OVAC) annual lobby day on Capitol Hill. OVAC, a collaboration of roughly 50 national non-profit organizations, delivered a unified message to Members of Congress on June 6 on the need for increased cancer-related appropriations. A point of discussion in my meetings with legislative staff was the President’s Budget Proposal for FY 2018, which featured budget cuts at both the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) and increases for the Department of Defense. Armed with OVAC “asks”, I decided to focus my meetings with legislative staff from Senators Burr and Tillis and Representative Butterfield on the economic impact in North Carolina if funding levels were reduced. North Carolina is home to three National Cancer Institute (NCI)-designated cancer centers, which are awarded over $2B in annual NIH funding and employs thousands of employees.

Our advocacy training included a presentation by Dr. Warren Kibbe from NCI on the state of NIH funding and a quick brief on the Cancer Moonshot Initiative. Led by former Vice President Joe Biden, the initiative focused on concentrated and collective action to accelerate a decade’s worth of progress in preventing, diagnosing and treating cancer into a five-year time frame. The Cancer Moonshot has buy-in from academic, public and private sector partnerships. My immediate thought: why doesn’t public health have this type of dedicated initiative with annual federally-appropriated funds?

The Robert Wood Johnson Foundation’s Culture of Health initiative is public health’s “moonshot”. Its Action Framework parallels the Cancer Moonshot Initiative in identifying focus areas and key performance metrics to measure progress. RWJF’s Culture of Health has achieved significant buy-in from a myriad of cross-sector stakeholders. The only distinction between the two initiatives, from my perspective, is dedicated federal support. Imagine the possibilities if public health’s “moonshot” received the same attention and resources as the Cancer Moonshot Initiative. A decade’s worth of progress in a 5-year timeline for the social determinants of health would really change the trajectory of the field of public health.

In the next few posts, I plan to take a deeper dive on exploring innovative ways to address the social determinants of health, specifically at the local level, in the city where I currently live – Durham, North Carolina.

Below, I offer background on the U.S.’s healthcare system to provide a larger context the many layers and contributors to an individual’s health outcomes.

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Healthcare expenditures in the United States was approximately $3.2T, or $9,900 per capita, in 2015 which accounted for 17.8% of its gross domestic product (GDP). When compared to 12 other high-income member countries of the Organization for Economic Cooperation and Development (OECD), the U.S. spent significantly more annually. According to the Commonwealth Fund, the U.S. spent roughly $3000 more than Switzerland, the runner-up in per capita spending, in 2013. As a result, it outspent the next highest spender, France, by 5.5% of GDP in 2013. But despite its additional spending, the U.S. underperforms on population health outcomes such as life expectancy and chronic disease prevalence when compared with other OECD countries. Additionally in its analysis, the Commonwealth Fund compared healthcare expenditures to those spent on social services – retirement, disability benefits, employment programs and supportive housing, among others – for 11 OECD countries. In this comparison, the U.S. spent the least on social services at 9% of GDP, with Canada and Australia spending 10% and 11% of GDP, respectively. France and Sweden spent the most on social services at 21% of GDP. This imbalance in spending, posit the authors, may contribute to the country’s poor health outcomes.

Policies to improve population health have historically focused on the healthcare system according to Kaiser Family Foundation’s Heiman and Artiga. The Affordable Care Act, signed into law in 2010, expanded access to healthcare services for millions of Americans. However, as the authors explain, research demonstrates that healthcare is a relatively weak health determinant. Individual health behaviors, genetics and a broad range of social and environmental factors account for 90% of an individual’s risk for premature death. Thus, addressing the factors outside of the healthcare system may play a key role in improving population health outcomes, and the value it generates could justify reallocation of current spending levels.

Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age”. Examples of social determinants of health include social economic status, educational attainment, the physical environment, employment and social support networks. Social determinants form the basic foundation for each individual and his/her life experience. It also sets a baseline for future health outcomes. For example, an individual who is unemployed for an extended period of time may become homeless, food insecure and have limited access to healthcare services. It’s reasonable to conclude that this individual may be at higher risk of premature death due to his/her life experience. Unfortunately people all over the world have lives filled with adversity and struggle. Social, economic and/or environmental disadvantage creates differences in health outcomes, also known as health disparities, in populations across the world. One goal of Healthy People 2020, a strategic 10-year plan to improve U.S. population health, is to achieve the highest level of health for all people. Health equity includes the elimination of health and healthcare disparities.

One population of interest are known as “high utilizers” or vulnerable patients with complex social, behavioral and health needs. According to Anderson, the top 5% of individual utilizers account for about 50% of overall healthcare expenditures. Programs that pair patient navigators, community health workers and behavioral health resources with identified “high utilizers” have been implemented recently with hopes of improving health outcomes and generating value. A thorough review and analysis of the results for impact and effectiveness in improving health and cutting costs for this subset of patients is a critical next step.

Public Health in Action – Anchored Upstream

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Public Health River Metaphor

A man was fishing in the river when he noticed someone was drowning. He pulled them out and attempted to resuscitate them. Shortly afterwards, he noticed another person in the river and saved them too. He then noticed another, and another and another. Soon he was exhausted and realized he would not be able save all of the drowning people.

He went further upstream to find out why all these people were falling into the river.

On arriving further upstream, he discovered a broken bridge was causing people to fall into the river and end up drowning where he had been fishing.  He decided he would fix the bridge to stop them falling in, instead of fishing them out after they were already drowning.

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There’s a radio ad campaign for the Powerball Lottery in my local area, Raleigh-Durham, North Carolina that has stood out to me more than the hundreds of others I hear on the radio. In the ad,’Wolfman’ (picture Michael J. Fox in the Teen Wolf movie) visits the barber shop for his regular hair cut. ‘Wolfman’ throws out a few ideas – maybe I should shave it all off? “Or maybe a mullet?” His barber asks why the sudden change from his usual cut. ‘Wolfman’ described that his life was so monotonous lately and he wanted to change things up a bit. The barber then responds by recommending that ‘Wolfman’ purchase a Powerball ticket because every jackpot is worth at least $40 million – a life-changing amount; a change that  coincidentally ‘Wolfman’ was looking for. A disclaimer followed in the final seconds stating the odds of winning a Powerball jackpot, which was a measly 1/292 million. Ads, like this one, that tap into our well of emotions leave us particularly susceptible to any product that marketers are hawking, despite the impossible odds or practical necessity in one’s life.

While 1/292 million are nearly impossible odds, 1/4 seems almost certain in comparison. A recent article from the Atlantic highlighted results from Urban Institute’s study on medical debt. 23.8% of adults under 65 in the US has medical debt. Southern states, like Mississippi and Arkansas, have higher rates of medical debt – both over 35%. Furthermore, insurance coverage had a minimal positive effect: 23% of adults with health insurance still had medical debt compared to 31% of uninsured. As mentioned in the article, this has been a common criticism of the Affordable Care Act, aka Obamacare: that expanding health insurance does little to reduce high costs of health care for individuals (out-of-pocket costs) as well as the healthcare system as a whole.

Health policy in most recent years have been focused primarily on health insurance and affordable access to healthcare services. In the river metaphor above, focusing on health insurance would be akin to pulling people out of the river while they were drowning – providing them healthcare when they were sick, rather than figuring out how to prevent, or at least greatly reduce the risk of, illness. In public health and health care lingo this is what’s referred to as “looking upstream.”

In my interview below, Dr. James Leone, professor at Bridgewater State University, describes his career in “looking upstream.” Other upstream heroes of mine include:

Dr. Rishi Manchanda

Dr. Camara Jones

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Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role as professor at Bridgewater State University.  Describe why you’re passionate about Improving men’s health…why others should care about the health disparities between genders.

James Leone: My journey into public health education and higher education was a bit random/arbitrary. I began in clinical practice serving as a certified athletic trainer (ATC) where I worked in various settings including: professional with the New England Patriots, clinical outreach at high school, collegiate and physical therapy clinics. I also worked with coordinating rehabilitation clinics and strength and conditioning services in a variety of settings. Not too long into my clinical practice, I received an offer to teach sports medicine/athletic training at Southern Illinois University Carbondale, which was a new challenge for me professionally. I continued to teach and clinically practice, but my love of education rose to the top of my priorities, so I pursued a PhD in public health education. I saw value in what I could contribute on an individual level with people, however, my brain has always been geared towards the “bigger picture” – I guess you can say I embrace an upstream mentality/approach. This was my entry into health promotion and public health studies. I made my way up to Bridgewater State University (BSU) after serving on faculty at Southern Illinois University Carbondale, Northeastern University, and The George Washington University (GWU). Additionally, I currently serve as an adjunct professor at Northeastern University where I have taught courses in athletic training, physical therapy, physician assistant studies, and recently in the master of public health program.

As previously mentioned I have embraced a more “upstreamist” approach in my world and professional view. That said, I realized that male health always seemed to be lacking whether from personal experience or reviewing study after study and large data sets. I always have championed efforts to advocate for groups, be it my athletes or gender (in this case). Also, in 2007 I was approached by my former Chairperson at GWU to offer a class in men’s health, which I quickly embraced since my thought process was already in-tune with this topic. I quickly realized that evidence was lacking in terms of “why” men live sicker and die sooner than women. Also, there were few academic resources (i.e. books) from which to facilitate the topic. I set out consuming as much as I could to develop my course and my knowledge in this area of research. This journey led me to propose a textbook on male health (published in 2012) as well as develop two courses on male health (one at GWU and the other at BSU, presently). I am currently pursuing opportunities to develop male health curricula further so that beyond greater awareness of the topic and issues, we can move dialogue into action and advocacy by training public health professionals and providers on gender-specific needs of men and boys.

So, why do I care about male health topics? I have always been an advocate for people, ethics, and basic human rights. Poor health outcomes in males challenges these aforementioned principles, negatively impacting overall population health. From the public health perspective, we are morally and professionally obligated to help right these wrongs so as to create a more equitable society aimed at a “true public health for all.” I believe Sir Geoffrey Vickers captured it best in his quote, “public health consists of “a successive re-defining of the unacceptable.” I believe gender disparities, particularly those affecting men have been “unacceptable” and warrant our full and undivided attention at present times.

Me: What inspires you on a daily basis, especially when things get hard?

JL: My commitment is based on my ethics and morals, which guide my actions. My intolerance for average often guides my “drive” to improve most things in my personal life and professional practice. Knowing that I do work that directly corresponds to people’s health and experiences is more than enriching for me on a daily basis. When times get rough I often remain mindful of the transient nature of life and experiences – the viewpoint “nothing is guaranteed in life” often helps me to keep my life and work perspectives in check most days.

Me: I saw your presentation at this year’s American Public Health Association (APHA) conference on men’s health as a national security concern.  Can you describe your perspective on this issue?

JL: I was in a graduate school lecture discussing public health initiatives and Harry Truman’s 1946 speech was referenced in the talk. As part of that talk, Truman commented on the nature of the military and investing in the health of the youth to strengthen the defense system of the U.S. Of course, at the time, the vast majority of the military were younger men whose overall health and qualifications for military service were being called into question. The latter point got me thinking as to what it would be today; likely, things have gotten worse with rising overweight and obesity issues nationally. This perspective motivated my presentation at APHA in November. Overall, I think this is an incredibly important issue for two main reasons: 1. Of course we want to a strong system of defense if called upon, and 2. And perhaps most importantly, poor men’s health brings to light the overall issues in male health in the U.S. When we are able to gain the attention of the Department of Justice and Department of Defense, we might actually see Congress move on some of the issues in men’s health that we have been advocating for over the past few decades.

Me: What made you decide to be involved in the men’s health movement and the American Public Health Association Men’s Health Caucus (MHC)?

JL: I saw the APHA MHC as a strong platform from which to pool my energies and resources on advancing male health. I value like-minded people, but also, I am challenged by various ways of thinking and working towards solutions in these groups. I have learned that even though there is a shared value and perspective, we all have something unique to contribute to the conversation over men’s health. The men’s health movement attracts me simply because we as a society must look upstream to the issues that we generalize and deal with downstream. We have grown too normalized with poor men’s health and the forces that drive it. I think working with Men’s Health Network, MHC, and APHA can embolden an area that has gone largely unnoticed even at the detriment of society.

Me: What are the current needs in the Boston metro area (or focus in on the city you live in) as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

JL: I consider Boston and the surrounding areas as “lucky” because we have so much access to health, healthcare, education, and most of the social determinants that can positively affect population health. However, when we look below the generalized population data, we still see a consistent and stark contrast in the health of the privileged and the socially marginalized as with most other major cities. Boston struggles to meet the needs of harder to reach populations and men just like most other major cities in the U.S. We do have some excellent and progressive programming such as the Men’s Health Center (Whittier Street) in Roxbury and the men’s health program through Cambridge, however, the salient question is always: are we meeting the needs of the most vulnerable at the right moments so as to promote long-term individual and population health – I guess time and statistics will tell that story.

Public Health in Action – Vital Plan Strives for Impact, One Person at a Time

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There’s one lecture from graduate school that I constantly remember. In that particular Healthcare Delivery in the U.S. course lecture, my professor walked through a clinical visit with a recurring patient. Medical students and residents learn to obtain three important pieces of information from the patient: chief complaint (the reason for their visit), symptoms and a brief medical history. He then opened it up to us – was there anything else we would like to know? Coming from a public health perspective, our questions dove deeper into the social determinants of health -physical environment (housing), SES (access to health insurance, employment), etc. –  to clarify if there were any underlying issues causing the patient to return with similar health issues. That deeper dive, he said, was the distinction between the fields of medicine and public health.

An article published by WBUR last month illustrates a shift in medical school and residency programs to integrate public health principles, most notably the social determinants of health, into their learning objectives.

A holistic understanding of each patient is ideal when tailoring a plan not only to treat illness, but to achieve long-term well-being. The whole-person approach to treating chronic illness is what makes Vital Plan a unique part of the vast healthcare landscape.

My interview with CEO Braden Rawls catching up 2 years after our first interview, below.

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Me: I can’t believe it’s been almost 2 years since I published our first blog interview.  How’s Vital Plan?  What’s new that you can share with us?

Braden Rawls: It’s been a busy two years! Vital Plan has grown its customer base significantly, and this has allowed us to recruit ten new team members to continue improving our programs and expanding our reach. What really clicked for Vital Plan was selling our herbal supplement products in bundles alongside supportive health programs. Our signature program is the Restore Program, which includes four supplements plus health coaching support and a six month online course with education about restoring balance in the body through diet and lifestyle.  We’ve received very positive feedback on this program from customers and have expanded it to an international audience, with customers across Europe, Canada and Australia.

Me:  Why was it important for Vital Plan to become B Corporation Certified?

BR:  B Corp certification is important for Vital Plan to showcase third-party verification of our commitment to doing business with integrity. We are on a mission to restore and rebuild trust in the herbal supplement industry after its reputation was tarnished by deceitful players. Being able to showcase our commitment to doing business with integrity has already proven valuable in gaining new customers and recruiting talent. From the start, our goal has been to empower everyone that our organization teaches individuals to become more proactive about their health and to be mindful of the way they live. B Corp gives us a framework to support this mission and put best practices in place to grow our company in a smart, sustainable way.

Me:  One of the illnesses that Vital Plan focuses on is Lyme Disease.  Could you describe why it’s been a major focus for Vital Plan?  How does Vital Plan’s approach differ from traditional approaches?

BR:  Lyme disease is an illness that is personal for Vital Plan, as our founder, Dr. Bill Rawls, suffered with pain and insomnia for many years before ultimately testing positive for Lyme disease. However, Dr. Rawls’ personal struggle motivated him to research microbial illness from all angles, and he feels that Lyme disease is only one microbe of thousands behind chronic illnesses such as fibromyalgia, chronic fatigue syndrome and rheumatoid arthritis. Dr. Rawls believes that the true problem is not the stealthy microbes, but rather suppression of our immune systems that is allowing these stealthy microbes to flourish. He feels that chronic immune dysfunction is the real driver of the increase in chronic disease in developed countries, as exposure to toxins, radiation, stress and processed foods has depressed our immune system and is allowing microbial disease to flourish.

Me:  Vital Plan’s belief in addressing the underlying causes of disease is non-traditional.  Could you speak why your team is so passionate about taking this route?

BR:  The approach of treating symptoms is valuable for helping an individual to live more comfortably short term, but it is generally not a long term solution for fostering wellness.  Our team believes that disease in the body is often the result of environmental and dietary factors that are under our control, such as inflammatory food, chronic stress, and exposure to toxins and microbes. Through awareness of these disease factors, we believe that better health is in reach for many individuals. We feel that herbal medicine and natural healing modalities are also effective tools for individuals to take advantage of to promote healing and restore balance in the body.

Me:  Based on the patients that Vital Plan serves, what would you say are the biggest challenges for them to get back to normal? “Normal” being before their respective diseases produced symptoms so severe that it affected their quality of life.

BR:  For many people, diet and lifestyle changes are very difficult. However, once a person realizes that the food they are eating (or busy schedules they are slaves to) is making them sick, the changes become much easier to adopt. When you begin to associate foods or lifestyle practices with feeling good, your body will begin to crave those foods and practices instead of the ones that make you feel bad. It is all about training your brain to make those connections. Accelerating those connections for people is a big part of the mission behind our programs at Vital Plan.

Public Health in Action – A Silent Health Crisis

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Of all the things in the fields of both public health and healthcare that pique my interest and attention most, it’s health disparities, specifically the numbers 5 and 7.  In a country as productive and innovative as ours, it’s a particularly vexing reality check whenever I’m faced with those two numbers, which I’ve listed below along with their respective contexts.

5  – the difference, in years, of life expectancy between genders

*Life Expectancy at Birth in 2013: Female 81.2 years  Male 76.4 years

**Races considered: Hispanic, White, Black

5 & 7- the difference, in years, of life expectancy between females & males respectively

*Longest life expectancy to shortest in each gender

Health disparities are the end products of a variety of complex factors including, but not limited to the social determinants of health: SES, transportation, access to healthcare, employment, etc.  Additionally, they are also impacted by biological (our genes and family history), social (our culture and networks) and environmental (our physical surroundings) factors.  Lastly, health disparities are impacted by individual health behaviors and lifestyles.

The numbers 5 and 7, to me, represent a collective challenge: how can we bring these numbers down, thereby reducing  health disparities in our country?  What other perspectives do we need outside the fields of public health and healthcare to reduce health disparities?

My conversation with Steve Petty, Corporate Director for Community Health Improvement at INTEGRIS Health could offer some insight to the issues I’ve raised above.

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Me: How did you end up doing the work that you’re currently doing?

Steve Petty: I have been working in health care for 29 years.  I started in a marketing/public relations role and several other areas and have worked in community and employee wellness for the last 20 years.

In community wellness, our mission (the same as INTEGRIS Health) is to improve the health of the people and communities we serve.  Our department works in many at-risk, minority and under-served communities.  The state of Oklahoma has very poor health indicators for about everything you can possibly imagine.  We are working to provide health, wellness and health education services to those most in need, but to also educate people in general about the need to take care of themselves – know their health numbers (blood pressure, cholesterol, etc.), to get routine and regular exams, among others.

One area that continued to grab my attention was comparatively poor health indicators for men.   It was alarming to discover that such few men actually went to a regular doctor or health provider, let alone had access to any type of screenings.  INTEGRIS had been doing a Women’s Health Forum for many years then.  Most of their outreach efforts were for women who had insurance (employer-based or from retirement) but a majority of them were proactive with their health for the most part.

Two of my colleagues and I developed a proposal that would address men’s health in a different way that wasn’t intimidating to men, but still covered all aspects of their health and education.  Our leadership liked the idea, but a few seemed skeptical that we would be able to attract men to a health event.  We were confident that we could succeed if we tied it to something they were interested in, so, naturally, we partnered with the local sports radio station and used humor to make it a different kind of health event.

In our first event in 2004, over 300 men attended our event and we’ve had steady attendance ever since.  We continue to add more events and health screenings which have proven successful and have replicated many of these screenings and events in our rural communities where we have smaller hospitals and populations with limited access to health education programs and services.

We started planning our event back in 2003 and realized there wasn’t a lot of information on men’s health events anywhere.  Through internet searches, I stumbled upon the Men’s Health Network (MHN) webpage.  We finally found a resource to help us secure health education literature for our upcoming men’s health conference and MHN’s Jim Boyd and Scott Williams were crucial partners in planning that event and others since.  MHN has been one of our biggest supporters and partners in our efforts to improve the health of men and boys in Oklahoma.  The partnership has given me the opportunity to present our program and services across the country and at the 2009 International Society on Men’s Health in Vienna, Austria.  I’ve served on several committees through recommendations by MHN, and that’s how I got involved with the American Public Health Association (APHA) Men’s Health Caucus (MHC).  I was fortunate enough to be involved with the caucus early and have served in several positions since its inception in 2008.  I currently serve as the chair for the MHC and represent our group in the APHA’s Caucus Collaborative.

Me: What inspires you on a daily basis, especially when things get hard?

SP: I’m inspired by all the work being done which focuses on the health of men and boys.  It’s amazing to see how awareness and interest to keep men healthy has escalated over the years among government officials, businesses, marketing professionals and the public as a whole.   I’m also inspired by all of the great programs and services we’ve implemented here in Oklahoma, not just for men, but to improve health outcomes for the entire population, including children, senior citizens and minority populations.  We have a long way to go to show impact, but we are slowly making progress throughout the state.

Me: Can you share some of the progress you’ve made at INTEGRIS as it relates to men’s health outreach?

SP:  A large percentage of men have only limited contact with physicians and the health care system as a whole. Men not only fail to get routine check-ups or preventive care, but often ignore symptoms or delay seeking medical attention when sick or in pain. These poor health habits take their toll – beginning at early ages and rising significantly as males reach retirement age.

Because INTEGRIS is determined to raise awareness of this “silent crisis” and turn the tide, we’ve implemented an innovative men’s health initiative, Men’s Health University (a.k.a. Men-U). It’s designed to educate men and their families on the importance of men taking charge of their own health. Established in 2004, Men-U consists of free screenings and information, physician seminars, an annual wellness fair, (the 2006 event drew more than 700 people), and this website devoted solely to men’s health.

INTEGRIS Health Edmond- Shoot Straight! Keep your health care goals on target.JPG

By bringing men back into the health care system, INTEGRIS is helping them overcome one of their biggest health risks – that of just being a man. And knowledge is power. Even if males are aware of just two numbers, blood pressure and cholesterol, and take active steps to lower them if either reaches an unhealthy range, it can make a huge difference in their longevity.

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Me: Describe your vision for Integris Health.  Where do you see Integris and/or MHC in 1, 5 or 10 years and what kind of impact do you plan to make?

SP: My vision for INTEGRIS Health is really coming together for our community.  INTEGRIS is one of the few health systems in Oklahoma that gives back to the community in such a substantial manner.  We are finding new partnership and collaborative opportunities with agencies and organizations who have similar missions.  Additionally, we continue to explore innovative ways to make an impact on the health and wellness of our communities by sharing resources and services with partners like the Regional Food Bank, Oklahoma City County Health Department, the local Federally Qualified Health Center, churches and colleges.  All of these groups are coming together to hold events, offer services, programs and share resources, all of which help us improve the lives and health of our targeted communities.  I hope in the next year, our work to develop a comprehensive health, wellness and education resource center will come to fruition.  I hope we can replicate this model across our service areas in the next 5 to 10 years.  This will make a huge impact on patient access, especially if we can get other hospital systems to join with us.

Me: What are the current needs in Oklahoma City as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

SP:  The needs in all of these areas listed above are, unfortunately, not being met in many areas.  We observe access to care being a recurring obstacle for many individuals.  People can’t afford health insurance through the Affordable Care Act and/or their co-payments, so they have to use our emergency departments as a clinic or their healthcare provider.  We have about 19 free clinics in the metro area that are at capacity due to unmet needs of populations with limited resources or circumstances – uninsured, undocumented and underprivileged.

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Oklahoma, as a state, faces many challenges as documented in their annual state report, however, passionate community leaders like Steve Petty and his colleagues are working diligently to improve health outcomes at the local level.

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” –Margaret Mead

If you’re interested in learning more or working with Steve to improve health and well-being in Oklahoma, contact him at Stephen.Petty@integrisok.com.

 

How Digital Health will Disrupt the US Healthcare System

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One-sixth of the US economy is spent on the US healthcare system.  About $2.8 trillion is spent annually or an average of $8,500 per person.  When compared to other countries, the size of the healthcare system alone would rank fifth in the world.  An informative article from Vox analyzes this spending through various comparisons and graphs.

US Healthcare: Past & Present

In the past decade, healthcare reform in the US has focused on providing people with more access to healthcare by means of affordable health insurance.  Key facets of the Affordable Care Act include non-discrimination of potential enrollees with chronic conditions and creating health insurance exchanges which helped consumers buy insurance.  Though strongly contested through King vs. Burwell and National Federation of Independent Business vs. Sebelius, the ACA remains as intact as law.

On the other end of the health spectrum is public health and preventive medicine.  The main principle of public health is prevention through health education, epidemiology and health behavior change, among others.  Several industries have grown in the space outside of direct healthcare, including health/wellness/fitness, complementary and alternative medicine and most recently wearable technology through apps and sensors, illustrated in a TED talk by Ted Wolf in “quantified self

Startups & The Future of Health

The market size of offerings outside of the healthcare space is growing and appears to be an ongoing trend.  Key stakeholders in healthcare are jockeying for position.  Hospitals systems like the Mayo Clinic and Cleveland Clinic, insurance companies like Blue Cross and Kaiser Permanente as well as retail giants CVS and Walgreens have all embraced recent trends.  The onus has been on consumer engagement to improve population-level health outcomes.  For example, Kaiser Permanente celebrated a 10-year anniversary of their social marketing campaign KP Thrive last year and continues to promote healthy lifestyles in partnerships with national initiatives. Even CVS rebranded to CVS Health to “help people on their path to better health.”

Two startups based in the Triangle of North Carolina have been growing rapidly and have the potential to impact population health.  First is startup, Validic, based in Durham, NC.  It offers wellness companies and healthcare providers a platform to manage and analyze their patients’ wearable technology-based data.  In its most recent round of funding, Validic secured another $12.5 million, which included Kaiser Permanente’s ventures arm, Kaiser Ventures.  Considering the number of apps to collect health data from various sources, Validic looks to be a key player in data aggregation and management of personal health data.

The second startup that grabbed the attention of “high-profile investors” a few weeks ago is Predictify.me. The Raleigh-based startup takes large data sets and “extrapolates” them into the future data sets.  Future data sets enable analysts to forecast and can plan strategic moves accordingly.  Chief Data Scientist, Dr. Usmani, is renowned for his work in public safety and counter-terrorism in his native country of Pakistan.  Despite starting in the private sector for consumer buying habits, Dr. Usmani and Predictify.me aims to focus on making social impact.  Innovating to improve the healthcare system just may be the social impact that Predictify.me is looking for.  Imagine if predictive analysis took place with an individual health consumer.  How might researchers, public health practitioners and companies utilize this to keep individuals healthy?

The US economy cannot sustain the pace of healthcare spending and the potential applications outside of the healthcare system seem ready to bring more value for each dollar spent.  How wearable technology will affect population-level health outcomes is still unknown.  But with Validic, Predictify.me and others leveraging technology to obtain, manage and analyze data sets, don’t be surprised if health outcomes start to improve.

Originally published on Startup Grind

Public Health in Action – Champions of Change

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The Looking Glass by Dave Meier

It’s been a full year since I created this blog and after reading each of my posts from the past year, I feel like it’s only the beginning.  Switch/Health has evolved so much more than I could have ever imagined.  Initially envisioned as a “one-stop shop” for all topics that directly or indirectly affect health outcomes, it has become a link to many great stories.  Stories of local leaders affecting real change in their communities.  Stories that describe how health and the healthcare system look from various lenses.  And most importantly, stories that describe their own evolution in finding purpose in their work.  I feel extremely humbled for the opportunity to share their stories with you.

The leaders listed below have been instrumental in empowering people in self-awareness and improvement.  I’m inspired to continue my search in finding the unsung heroes making an impact.  And I hope their stories offer you some insight and inspiration as well.

A Maria Hester – Dr. Hester Empowers Her Patients
Bri Isaacs – YogiBriii in the OC
Betty Jung – Web Master and Lecturer Betty Jung
Elizabeth Greenberg – Non-Scents Makes A Lot Of Sense
Rachel Safeek – Rachel Safeek Fights the Status Quo with “Fight Stigma”
Heather Freeman – Heather Freeman Believes We All Have Capes
Braden Rawls – Health Doesn’t Have to Cost an Arm and a Leg
Jonathan Bonnet – Walking the Walk
Elizabeth Poindexter – Mobilizing for Collective Impact
Ryan Shaw – Leveraging Health IT to Improve Outcomes
Patricia Carcaise-Edinboro – Hearing the Unheard
Michael Allen – Mind the Gap
Prathima Kannan – Communities Creating a Culture of Health

“The best way to find yourself is to lose yourself in the service of others.” — Mahatma Ghandi