"Once you have a mission, you can't go back to having a job."
- Shai Agassi, CEO
Better Place
What's Health Got to Do With It?
Did you know there are more choreographers (16,340) than metal casters (14,880) in the U.S.? Or more card dealers in casinos (82,960) than lathe operators (65,840)?
We’re not sure what this has to do with health, except that the world has changed, and many of us are still in yesterday’s time-warp when it comes to thinking about the economy.
In that vein, we’d bet good money that tomorrow’s jobs in health and health care aren’t necessarily the ones we’re cranking out today.
I generally try not to add to the din on specific political matters or pending legislation, but Arizona Proposition 101, the Freedom of Choice in Health Care Initiative, is peculiar enough – and perhaps perverse enough – to warrant this exception.
I admit that I’m not sure I fully understand the ramifications of this proposed initiative in actual practice. Health care lawyers tell me it is poorly worded and constructed, and has the potential for all sorts of “mischief” that will generate legal challenges for years to come – in other words, a “lawyer’s dream.”
I also admit that while I find Prop. 101 to be unnecessary and even a potential detriment to providing access to quality, affordable health care, I share its framer’s concern with the heavy and occasionally inept hand of government in trying to cram physicians and patients into some type of monolithic public insurance scheme. There should be as few barriers as possible between physicians and patients, and on that score I would include private as well as public insurance plans. But that’s a subject for another time.
So what’s wrong with Prop. 101? Read one person’s view in this month’s The Drift.
Healthy foods like whole grain bread, fresh fruit and vegetables are by definition becoming luxury goods – available only to people who can afford them.
The prices of some healthy foods have jumped by as much as 16% between 2004-2006, while less nutritious items like potato chips have gone up less dramatically, according to the University of Washington’s Center for Obesity Research. This is hardly good news for low-income people with diabetes and other serious illnesses, nor for the children of families who can’t always afford to set the table with fresh, healthy food.
Several Health in a New Key communities in the Phoenix metro area are working on community gardens, but that’s not enough to combat the industrialization of our entire food chain, which distorts nutrition access and equity with its singular focus on profit. It’s no accident that when you drive through some Valley neighborhoods, you see plenty of fast food outlets but few, if any, natural food markets.
Fostering healthy communities is as much about economics and infrastructure as it is about education, self-responsibility and choice. You can’t make healthy choices if you don’t have the means – or the opportunity – to do so.
Is worth a pound of cure, as Ben Franklin said well over two centuries ago. A recent report from the Trust for America’s Health proves it: investing just $10 per person per year in programs to increase physical activity, improve nutrition and prevent tobacco use would save the country more than $16 billion in annual health care costs within five years.
But, as we pointed out in the item above on healthy foods as luxury goods, it’s hard to invest in prevention if you don’t have the infrastructure to deliver it. If we’re ever going to move from health care to health, it will be the focus on population-based or public health, that will get us there.
The HUGE hurdle to getting this done: Disease prevention does not earn the large profits associated with disease treatments. It pays to be sick – literally. The pay just doesn’t accrue to the patient!
"Services with no measurable health benefit consume 30% of Medicare dollars."
- Journal of the American Medical Association
May 28, 2008, p.2439
Or at least when it comes to running nursing homes. According to a panel survey of over 14,000 nursing homes reported in the Spring 2008 issue of the Journal of Policy Analysis and Management, public nursing homes not only provide better care than their for-profit and nonprofit counterparts, but serve more impoverished patients to boot.
It's all in the incentives: "Maximizing quality and access is a zero-sum game for nonprofits and for-profit nursing homes. For-profit 'Medicaid mills' have an incentive to offer worse care to more patients," whereas nonprofit homes offer better care to fewer patients. "But public sector nursing homes seem to maximize both quality and access."
Who among the readers of Outloud is not up to their eyeballs in program and organizational evaluation schemes?
If we’re not careful, evaluation can become a prison – a straightjacket – of metrics, forms and community indicators that we ask our community partners to adopt in assessing their performance. Time and again, we hear from community agencies, advocates and volunteers who say they spend as much time filling out some funder’s evaluation "matrix" as they do working with people in their community. People end up counting and accounting, rather than doing and learning.
Instead, evaluation should be a prism – a means of dispersing light into its constituent spectral colors, or a rainbow of perspectives. Prisms are also used to reflect light so we can study its components with different polarizations and determine how they interact, or even how to reorient and reposition them. We should reflect on the light of evaluation together, weaving the language of counting and accounting with the language of local knowledge, stories, history and shared cultural mores and rituals.
We’ll have more on evaluation and learning in Weave the People: Threading Healthy Communities, to be released this November.
It won’t be long before we’ll be able to read other people’s minds if researchers at the University of California-Irvine have anything to say about it.
They just received a $4 million grant from the U.S. Army Research Office to study synthetic telepathy – basically developing a brain-computer interface that would use a “non-invasive brain imaging technology like electroencephalography to let people communicate thoughts to each other.”
Oh Brave New World! Board meetings will never be the same, not to mention marriage and torture techniques. Not that the last two are related to each other, by the way.
You could make a good argument that one is on the horizon. In 2006, for the first time in U.S. history, a majority of all births to women under 30 – 50.5% -- were out of wedlock. For white, non-Hispanic women, the figure was about 33%; for Hispanics, 51%; and for African-American women, almost 80%.
By comparison, in 1960 just 6% of all births were to unmarried women.
Economics and education are driving this demographic shift. AHCCCS now pays for over 50% of the births in Arizona. It’s harder for low-income persons – and especially young, low income males with insufficient education – to support a family, not to mention paying the taxes it will take to improve the educational, health and social infrastructure of this country. Add this trend to that of a graying population that is living longer, and you could paint a ruinous financial tsunami of epic proportions.
Is the two-parent, traditional nuclear family destined to become obsolete? If so, what are the alternatives for raising healthy, vital children and nurturing future generations? We’d like to hear your views.
September 2008
