A prescription to address healthcare’s blind side

A prescription to address healthcare’s blind side

An excerpt from the KevinMD.com blog item by JAMES S. MARKS, MD, MPH

f you have read Michael Lewis’ book, The Blind Side, or seen the popular movie based on it, you know that the title refers to the fact that quarterbacks, who are typically right-handed, can’t see when a 300-pound opponent is charging at them from the left side. Not being able to see the full picture puts the quarterback directly in harm’s way and makes it harder for his team to succeed.

There’s a blind side to health care too, and it’s keeping us from doing what matters most to improve people’s health and deal with our long term medical costs.

A recent poll of physicians revealed that 4 out of 5 believe that unmet social needs — things like nutritious food, transportation, adequate housing and employment assistance — are leading to worse health outcomes for their patients. And those physicians do not feel confident in their capacity to do much about them.

We know that our zip code can be even more powerful than our genetic code when it comes to people’s health.  Indeed, the conditions people live in day in, day out—and where and how they live, learn, work and play—have a greater impact on their health than the medical  care they receive to repair the damage to their health.

We can, and simply must, do more to keep people as healthy as possible in the first place.  And that means taking a serious look at those factors in our neighborhoods, workplaces and schools that shape our health from the earliest years of life….

 

…An organization called Health Leads has bridged this gap for physicians and patients in the six cities in which they currently operate. It empowers doctors to help remove the social barriers that keep people from taking the actions they need to be healthy. Doctors at facilities where Health Leads exists literally write prescriptions that help struggling families access basic resources like heat for their homes, subsidized child care or food for their kitchen tables.

 From the Health Leads Web Pages

Health Leads mobilizes undergraduate volunteers, in partnership with providers in urban clinics, to connect low-income patients with the basic resources — such as food, housing, and heating assistance — that they need to be healthy.

• 6 cities
• 21 sites
• 1,000 volunteers
• 9,000 patients

With Health Leads, a doctor can “prescribe” food, housing, health insurance, job training, fuel assistance, or other critical resources – just as they would medication. Patients take their prescriptions to the clinic waiting room, where Health Leads’ college volunteers are ready to connect them to these resources.

Health Leads’ straightforward, preventative referrals to government and community resources enable families to avert crises and to access increased income and education, which have been documented to result in better long-term health outcomes.

Health Leads‘ 21 desks are located in pediatric outpatient, adolescent, and prenatal clinics, newborn nurseries, pediatric emergency rooms, health department clinics, and federally qualified health centers.

Last year, Health Leads trained and deployed nearly 1,000 college volunteers to connect nearly 9,000 low-income patients and their families to the resources they need to be healthy.

By providing a transformative experience for hundreds of college volunteers, Health Leads is producing a pipeline of new leaders who will have both the conviction and the ability to revolutionize health care.

Health Leads volunteers are not social workers, but work in conjunction with trained and licensed social workers, nurses, physicians, legal aid workers and other clinical staff to ensure that patients can get and stay healthy.

A Better FDA? Why Not? « GxP Perspectives

 

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A Better FDA? Why Not?  [From the December 2011 GxP Perspectives Blog]

Is FDA necessary? Most people I know would say yes. We need a strong, independent, effective FDA. Does FDA need improvements? Again, most people I know can point to numerous issues that FDA could handle better. Today, in the Business Section of the New York Times, there is an article on why we need government and the benefits of better government. Yes, the article by Robert H. Frank is about the Tompkins County New York Department of Moter Vehicles, but he outlines some basic principles for better government. Like better use of technology to make government more efficient. FDA is making similar efforts regarding technology. That’s great and I encourage the development. Here are three other areas that I think that FDA can improve:

1. Consistent training for field investigators….

Click here to read the entire blog item

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Healthy People? Not Quite Yet —From “The Public’s Health” Blog

Healthy People? Not Quite Yet [ The Public’s Health]

Excerpt from Dr. Rubin’s blog

In 1979, the publication of Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention represented the first report emphasizing the importance of decreasing early mortality through health promotion and disease prevention programs. This led to the Centers for Disease Control and Prevention’s development of specific, national 10-year health objectives, contained within a collaborative initiative known as Healthy People. The 2010 objectives fell within 28 public health focus areas including cancer, diabetes, immunizations and infectious diseases, injury and violence prevention, nutrition and overweight, and many others (the full list can be found here).

So as a country, how well did we meet the Healthy People 2010 objectives? I guess that depends on your definition of success. A final review of the 2010 results showed that of the 733 objectives for which data were available:

 23% met the 2010 targets
 48% made progress toward the 2010 targets
 5% showed no change from baseline
 24% moved away from the 2010 targets

 Read the entire blog item here

Related Resource

• Structured Evidence Queries (SEQs) for the Healthy People 2020 Leading Health Indicators

  Healthy People 2020 (HP2020) is a ten-year health promotion program for improving the health of all Americans. Led by the U.S. Department of Health and Human Services, HP2020 is organized into 42 subject areas with 600 public health objectives. These objectives, developed and selected through consultation with a broad range of organizations, groups, and individuals, provide a framework for monitoring and measuring improvements in health status of the American population over the ten-year period from 2010 to 2020.

  The Leading Health Indicators (LHI) are a set of objectives carefully selected to represent high-priority health issues and actions that can be taken to address them.

  The Healthy People 2020 Structured Evidence Queries (SEQs) are pre-formulated PubMed search strategies intended to support both public health practitioners and researchers in their efforts to achieve specific HP2020 public health objectives. The HP2020 SEQs provide citations to the most up-to-date peer-reviewed literature from the PubMed database of the National Library of Medicine.

  For persons interested in using the SEQs or other NLM resources to create products for the LHI App Challenge, e.g., for mobile devices, please contact the PHPartners Team. More general information about PubMed linking and E-utilities is available from Entrez Programming Utilities Help

  ---

  The Structured Evidence Queries link each Leading Health Indicator objective to PubMed citations related to that objective. For two LHI objectives, in Clinical Preventive Services (vaccination rate for toddlers) and Injury and Violence (fatal injuries), a set of SEQs is provided to further assist users. Your feedback will help us refine the SEQs over time.

  To use an HP2020 SEQ to search PubMed, please expand the Leading Health Indicator topic area (“+”) and click the  button by the LHI objective.

  [Go to http://phpartners.org/hp2020_lhi.html to use the structured  evidence queries below]

  

  1. Access to Health Services 

  2. Clinical Preventive Services 

  3. Environmental Quality 

  4. Injury and Violence 

  5. Maternal, Infant and Child Health 

  6. Mental Health 

  7. Nutrition, Physical Activity and Obesity 

  8. Oral Health 

  9. Reproductive and Sexual Health 

  10. Social Determinants 

  11. Substance Abuse 

  12. Tobacco 

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Is your office chair killing you? – The Globe and Mail

 

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Is your office chair killing you? – The Globe and Mail.

Excerpt from the article

…For decades, hundreds if not thousands of studies have examined the relationship between our activity levels and our health. Only recently have researchers turned their attention to the consequences of sitting at a desk all day and lying on the couch all evening.

 

MORE RELATED TO THIS STORY

• Can sitting too long really hurt my health? 

• Prolonged bouts of sitting increase cancer risk 

• Sedentary workers at risk for sleep apnea 

“We’re talking extensively and producing public health messages about what we don’t do. And we don’t talk at all about what we do do: We don’t move very much, but we do sit idle,” says Dr. Mark Tremblay, director of healthy active living and obesity research at the Children’s Hospital of Eastern Ontario Research Institute.

The average person now spends 9.3 hours a day sitting. People who sit for six or more hours per day are 40 per cent more likely to die within 15 years compared to someone who sits less than three hours a day, even if they exercise. Obese people sit 2½ hours more each day than people of normal weight, according to data compiled by Medical Billing and Coding, a U.S.-based organization….

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The rise of citizen scientists and patient initiated research

Emerging Patient-Driven Health Care Models: An Examination of Health Social Networks, Consumer Personalized Medicine and Quantified Self-Tracking, Int. J. Environ. Res. Public Health 2009, 6, 492-525; doi:10.3390/ijerph6020492

by KENT BOTTLES, MD in an article at KevinMD.com

Whether you call it Health 2.0, Medicine 2.0, or e-Health 2.0, the Internet is changing medicine in ways that challenge the status quo. This article explores how a group of amateurs who call themselves “health hackers” and “citizen scientists” are trying to use the Internet to connect with other patients, run experiments, and conduct clinical trials on their own diseases.

Dr. Gunther Eysenbach states “Medicine 2.0 applications, services and tools are Web-based services for health care consumers, caregivers, patients, health professionals, and biomedical researchers, that use Web 2.0 technologies as well as semantic web and virtual reality tools, to enable and facilitate specifically social networking, participation, apomediation, collaboration, and openness within and between these user groups.” One review examined 46 different definitions of Health 2.0, and Eysenbach’s definition does not emphasize a key component of the concept: amateurs can use these new Internet tools to do work that in the past was only done by professionals….

…

Charles Blanke, MD, Director of Gastrointestinal Oncology at the Oregon Cancer Institute summarizes the advantages and disadvantages of their patient-initiated approach:

This is powerful and compelling work! I remain incredibly impressed by the data-coordinating abilities of the Life Raft personnel. I see the major purpose of this sort of data as hypothesis generating. Unfortunately, it cannot be free of bias and thus cannot stand by itself, but it certainly can point investigators and the Company in the right direction and let us know what we need to be looking at more closely. Thus, its importance cannot be overstated….

,,,The tension between the traditional approach to medical research and patient-initiated research can only be resolved by cooperation and two-way communication between the two groups. The Mayo Clinic and PXE examples clearly show that both groups can benefit by meaningful and respectful partnership. The AIDS and ALS examples demonstrate that patients with few options and new Internet tools will continue to push the traditional research community to be open to new ideas, new approaches, and new possibilities. Gilles Frydman, founder of the Association of Cancer Online Resources, has stated, “Better-informed people are more willing to participate in the advancement of science. Those patients taking Gleevec do not consider themselves guinea pigs. They are recipients of experimental medicine.”…

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