Where does proactive health / wellness fit into the picture?
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I would say under social determinants. Fitness and wellness are often a matter of access to resources for that
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Example: when I was in pediatric residency in Houston, where obesity is rampant and asthma is prevalent and severe, children could not simply play or bike outside given the built environment, roads, pollution, heat. Those with access/resources for gyms, ok. But that is not most.
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Another example: visiting Hartford for a conference with my sister’s family, I offered to get fresh fruit for sister’s kids. Drove blocks and only found bodegas with cerveza, canned foods, lotto tickets maybe a banana. Imagine trying to eat healthy in that “food desert.”
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I only recently learned the term “food swamp” as what is more correlated with obesity: https://www.theatlantic.com/health/archive/2017/12/food-swamps/549275/ … “In addition to being low on grocery stores, food swamps are also crammed with unhealthy food options like corner stores and fast-food places.”
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“researchers from the University of Connecticut’s Rudd Center for Food Policy and Obesity compared the obesity rate of U.S. counties to their ratio of fast-food restaurants and convenience stores to grocery stores and supermarkets—their level of food-swampiness, in other words.”
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“The food swamps had about four unhealthy options for each healthy one. ..The relationship between food swamps and obesity was especially strong in areas where people lacked both their own cars and access to public transportation.”
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I believe that about the link to a car or public transportation. Even with a car and GPS to identify what looked like grocery stores, I was stymied. Drove and drove and drove. That transportation issue applies the access through care too, hence this: https://www.bcbs.com/news/press-releases/blue-cross-and-blue-shield-and-lyft-join-forces-increase-access-health-care …
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If it were obvious & easy, it wouldn’t be worth taking on. Would be done already. But - there might be entrenched elements that require sunlight to reveal motivations around status quo.
Of course there are.
We couldn’t have a better experimenter to investigate.
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Here’s one answer: 1) Restore the physician/patient relationship aka disintermediation or Direct Patient Care 2) Reinstate reasonably priced catastrophic only policies 3) Mandate price transparency via independent, 3rd party (non-insurance-based) platforms 4) Expand HSA avail
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Have faith that smart people who put their heads together without being burdened by legacy systems and “old” thinking can innovate their way out of this mess. Best of luck, Dr. Gawande and team.
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This is not a hard problem to solve, just one in which entrenched special interest have milked the system via Medicare/Medicaid and private policies.
#universalprimarycare is the starting point. Then buy portable insurance for your risks...Thanks. Twitter will use this to make your timeline better. UndoUndo
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No comparison - comparing
@KPShare with@UHC is like comparing@Apple with@Android /@Microsoft. Apples and oranges (pun intended) - both are fruit but fundamentally different. http://www.davisliumd.com/wp-content/uploads/2016/05/LIU-Final-Board-Presentation-5-2014-1.ppt …Thanks. Twitter will use this to make your timeline better. UndoUndo
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Healthcare as a % of GDP grew from ~6% in 1965 to ~18% today (!). Life spans increased ~5 years during that time driven by lifestyle changes - not paying more or getting more care. Give them hell!
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Starts with Buckeyes questioning the status quo-
@Atul_Gawande- Erin allen and I have faith in you! Deconstruct what exists, reestablish core principles- let innovation work around these- start with#patientfirst as the core! How can I help?@EJSMD you ready?#allinforpatients - 1 more reply
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What’s your “one thing” upon which to focus, like Curly asked Billy Crystal’s character in “City Slickers,” Dr. Gawande?
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And we hope you have the answers! Looking forward to the next few years!
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Who’s up for ‘just culture’, appreciating the impact of social determinants of health, advance care planning, and doing the ‘right thing’ through education and communication? If that’s the plan, then I’m ‘all in’!
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Perhaps this is an opportunity to use public/private partnerships to advance the right types of policies.
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