"You can beam me up, Scotty, but I'd rather you bail me out."
- Captain Kirk
Based on initial feedback from a lively audience, What is Community: Voices and Choices for Sustainability on December 5 was a great success. In addition to two provocative and engaging presentations, participants interacted with each other in three hands-on sessions - design charrette, open space technology, and appreciative inquiry. All of it was captured in high-energy images by three talented graphic recorders. The images and recordings of the presentations will be available on our website soon.
Thanks to our partners - The Arizona Community Foundation, Local Initiatives Support Corporation (LISC) and the ASU Stardust Center for Affordable Homes and the Family - for helping to make it happen. 
Arizona Health Care Market Report 2008
For a comprehensive overview of Arizona's health care providers and plans, take a look at the Arizona Health Care Market Report 2008, now available at slhi.org. SLHI commissioned the report by Allan Baumgarten and Associates, who have done similar studies in other states, in order to capture trends in insurance coverage, hospital and health plan performance, and where Arizona's health care sector may be headed in the future.
The data are from 2006 (hospitals) and 2007 (health plans), with interpretation from more than 30 interviews with leaders in provider systems, health plans and government agencies. While hospitals and health plans were generally profitable in 2006 and 2007 (some were very profitable), the second half of 2008 may be the harbinger of a quite different picture in the immediate future.
But that's why SLHI has invested over the years in a data and analytical infrastructure (Arizona HealthQuery, Arizona Health Survey) to inform practice and policy decisions on the ground. Some things we can control and some things we can't, but without a solid understanding of where we've been, what is working and what isn't, we're flying blind.
Sight. Insight. That's what we need today.
Over 1.1. million Arizonans in the 18 to 64 year-old range almost 30 percent of that group reported one or more problems with medical debt in 2008. And here's the kicker: Almost 80 percent of them had health insurance.
Those stats are from the 2008 Arizona Health Survey, one of the largest and most comprehensive health surveys ever undertaken in the state. While health insurance coverage continues to be a major issue, it's clear that rising costs are now affecting the broader middle class and represent a growing threat to economic stability in the future. Considering that over 600,000 people lost jobs in the U.S. last month, prospects for making an appreciable dent in employer-based health insurance, at least in the near term, seem remote.
Other models are on the table, of course, ranging from single payer to individual product/tax credit approaches and variations in between. In 2004 SLHI did a cost/benefit analysis of increasing health insurance coverage in Arizona in our Arizona CAN report through a comparison of four approaches - two mandatory and two voluntary. In economic and coverage terms, the mandatory models performed better than the voluntary ones, and the expansion of public programs and/or some form of public utility, "universal" approach outperformed either an employer mandate or an individual tax credit approach. We would imagine getting similar results today.
But then, system efficiency and effectiveness have never been first order criteria for most Americans. If they were, we wouldn't have the fragmented, expensive and over-administered health care system we have in the U.S. today.
While you're out and about this Holiday season be on alert to these next three possible health threats:
According to the author Esther Dyson, mental diabetes among children is a growing concern, and bound to get worse in our media-saturated, technology-rich culture. Just as being fed too much processed, sugar rich food can lead to diabetes, "being fed so much processed information - video, audio, images, flashing screens, talking toys, simulated action games - can seriously mess up children's information metabolism and their ability to process information for themselves."
The children's response: What do adults know anyway? Read Dyson's take on all this over at edge.org.
Mental Diabetes - too much time spent in front of screens - can lead to NDD, or Nature Deficit Disorder, as laid out in Richard Louv's 2005 book, Last Child in the Woods. Less time spent out in the woods and fields, Louv argues, leads to more behavioral problems among children.
Besides the allure of mediated technology, other causes of NDD are sensationalist media coverage, paranoid parents, and a litigious culture that favors "safe" sports and activities over unstructured imaginative play.
Of course, some of us who came of age in the '50s and '60s, built forts and played cowboys and indians and GI Joe in the backyard aren't exactly paragons of imagination either.
If you think you or your children are immune to afflictions like mental diabetes and nature deficit disorder, you probably suffer from SPD, or Smart Person's Disease, which a psychologist of our acquaintance says is "rampant" among the allegedly educated class.
SPD is a fixation on being smart and able to figure out every problem, no matter how small or large. It starts with figuring out how to solve your own problems and then, when it becomes chronic, with solving other people's problems, as in "This is your problem, and I'm here to tell you how to fix it."
SPD is found in the lairs of foundations, universities, think tanks, government just about any place smart people hang out together and talk about how smart they are, and how stupid other people are. There's a cure a good dose of humility but apparently that drug is in short supply in some circles.
While the federal government bails out Wall Street and other institutions "too big to fail" in the current economic crisis, philanthropic organizations closer to the ground are faced with balancing their chosen mission, programs and strategies with meeting immediate and pressing charitable needs in their own communities.
The tension between 'charity' and 'philanthropy' is certainly not new in our nation's history, but it takes the dislocation of a major physical, social or economic crisis to bring it into sharp relief.
Charity relieving suffering and meeting immediate human needs is the older, downstream concept. Philanthropy addressing the root causes of suffering and need is the newer, upstream concept. It is a continuum, of course selfless charity at one end, "strategic" philanthropy at the other but there is a decided difference in intent and approach, depending on where along the continuum a philanthropic organization decides to spend its energy and resources.
Read the rest of this reflection on where philanthropy ought to be directing its resources in December's The Drift.
Probably not if youre a physician: In a recent survey of newly minted doctors, just four percent said they wanted to practice in a town with a population of 25,000 or less. With 20 percent of Americans living in rural areas and only 11 percent of docs practicing there, it's apparent there's a mismatch between demand and supply.
What to do? Increasing rural residencies is a good idea, but it's problematic with the closing of more rural hospitals 5,900 today compared to 8,000 in 1980. Putting together loan forgiveness programs, financial incentives and help with medical malpractice premiums is also helpful, but even that hasn't made an appreciable dent in the problem. The most successful strategy recruiting and training future physicians who grew up and like living in rural areas should be pursued, but it's a numbers problem with few nontraditional, rural students interested in pursuing careers in high-need areas like family medicine.
But necessity is the mother of invention. Look for changes in scope of practice and the use of more nurse practitioners and physician assistants to relieve the load in underserved and rural areas. Look for new ways of delivering care, such as the use of extended professional networks, health care cooperatives and distance technology (telemedicine, the internet).
And who knows? Life on the freeways and beltways of America might one day persuade more young professionals to get out of the fast lane and discover the pleasures of living in smaller towns. Depending on the future of cities, life in the country could look pretty good.
We received this from Mary Peterson, Executive Director of Maggie's Place, after reading our Weave the People report on building community. In the spirit of the Holiday Season, we pass it on. It says it all:
"I know you can't really talk about love without it starting to sound hokey...but love is the glue - and really the only glue - when you are talking about the creation of authentic community. Love allows the creation of community that can overcome fear, welcome all, and sacrifice for the good of the other. If you want community to grow, the starting place must be in the venues where people are already well-practiced at the messy and hard business of loving each other.
"And, love is an exercise in virtue...forgiveness, owning up to mistakes, being willing to sacrifice, exercising self-control, watching out for the good of the other. When a body of people can commit to common principles, common virtues...that's the stuff that has changed the world.
"Love is the deepest desire of our hearts and the biggest motivator in the hard work of making change in our lives.
"If you can tap into that...then you are REALLY onto something!"
December 2008
