Month: April 2015
Doubletree Breakfast
Porridge, sultanas, blackberries and pineapple
Quote: The best way to predict the future is to create it
Predicated on one of my favorite quotations, variously attributed to Dennis Gabor, Buckminster Fuller (who gets credit for any quote of truly dubious origins, it seems), or perhaps most credibly, since I found it on the Internet, to a Tweet by Abraham Lincoln: the best way to predict the future is to create it.
Cited by David Katz in this LinkedIn Post
What’s Next for Health Promotion? Reflections, and Resurrections
My mission at the conference, as stipulated by Dr. O’Donnell, was to answer this question he posed: what’s next for health promotion?
The question seemed to invite a prediction, and in that context, my response was: I have no idea. My tea-leaf-literacy is no better than anyone else’s; and, predictably, I can’t seem to find my crystal ball.
But, I thought, there is another context for the question, predicated on one of my favorite quotations, variously attributed to Dennis Gabor, Buckminster Fuller (who gets credit for any quote of truly dubious origins, it seems), or perhaps most credibly, since I found it on the Internet, to a Tweet by Abraham Lincoln: the best way to predict the future is to create it.
Ah, that changes things. Because I do know what I would like to create next for health promotion: the actual promotion of health. What a novelty that would be.
We have known for more than 20 years virtually all we need to reduce prevailing rates of major chronic diseases- heart disease, cancer, stroke, diabetes, dementia, and so on- by as much as 80%. We have learned ever more about it with each passing year, but for the most part, the aggregation of evidence has changed little; serving, instead, to reaffirm what we already knew and append an exclamation mark. And Dan Buettner’s work has iced this well-baked cake with the evidence that what we thought we knew about lifestyle as medicine works exactly as hoped, and predicted, at the level of entire populations- not in the context of randomized trials, but living in the real world.
We could, simply by using what we have long known, add years to lives and life to years, all around the globe. We could, if we chose to turn what we know into what we do, bequeath to our children a future in which dreadful chronic diseases simply don’t happen eight times out of ten.
I am choosing to predict that future, because I have children, whom I predict will in turn have children. I am choosing to predict that future, because I am committing myself fully to help create it.
The effort is called the GLiMMER Initiative. There are many elements to the project, but the first step is the demonstration that there is a massive, global consensus among experts regarding the fundamentals of health-promoting living, including eating. Despite the endless parade of fad diet books; despite the constantly shifting preoccupations with gluten, GMO, meat, wheat, fats and carbs- there is a massive, overlooked consensus about what matters most.
I know this in part from doing my job, and studying the relevant evidence. But I know it from a rather intimate perspective as well. Working in preventive medicine for some 25 years now, I have come to know my highly regarded colleagues around the world. In instances too numerous to recall, I have shared a meal with them.
And we all eat more like one another than any of us eats like the ‘typical’ American. From vegan to Paleo, fat-focused to carb-conscious, the world’s experts eatwholesome foods in sensible combinations. They use common knowledge of fundamentals to care for themselves, and their own families. Meanwhile, the public- hearing only ever of the disagreements that serve to generate morning show segments, new varieties of camouflaged junk food, and the next great dietary fad– is left to languish in the misguided belief that the experts don’t agree.
I’ve heard it countless times. No two experts in nutrition agree about anything. Expert opinion in nutrition changes every 20 minutes.
It’s just not true, and I have proof. A global coalition of over 120 experts (and counting) from more than 16 countries has pledged public support for the same, fundamental principles of healthy eating and living.
More remarkable than the accomplishments and celebrity of those on this council is their diversity. There are, as predicted, devotees of a vegan diet, a Mediterranean diet, and a Paleo diet- willing to endorse the same fundamentals. Yes, they differ, too; but they (we) all have more uniting than dividing us. We agree more than we disagree. The council members are not endorsing one another. In some cases, they may not even like one another. But we have come together just the same- because we all know what’s what.
And what we agree about is all we need to slash rates of chronic disease. What we agree about and have long known is all we need to add years to lives, add life to years, and bequeath to our children a vastly better medical destiny- and life.
So, despite my want of crystal ball or decipherable tea leaves, I predict that the future of health promotion involves the genuine promotion of health. I predict a culture that collectively rolls its eyes when the next fad diet book comes out, because nobody is buying. I predict a culture committed to using what it knows about disease prevention, because every child and parent, every grandparent and friend, recognizes they’ve got precious skin in the game. I predict that we will figure out how to reconcile legitimate academic debate and the relentless pursuit of what we don’t know, with the reliable use of what we do.
I predict it, because we are striving to create it.
These reflections come at a propitious time. Today is Easter, and Passover- celebrations of rebirth, and renewal. My predictions are thus fortified, and my hopes, resurrected.
Besides, anything is possible. Abraham Lincoln said so on his Facebook page.
-fin
David L. Katz, MD, MPH, FACPM, FACP
Director, Yale University Prevention Research Center; Griffin Hospital
President, American College of Lifestyle Medicine
Editor-in-Chief, Childhood Obesity
Follow at: LinkedIN; Twitter; Facebook
Read at: INfluencer Blog; Huffington Post; US News & World Report; About.com
Author: Disease Proof
Gallup-Healthways Well-Being Index
Potential way to measure changes in well-being and attribute them to particular interventions…
http://www.well-beingindex.com/2014-community-rankings
A new report from the Gallup-Healthways Well-Being Index® ranks the 100 largest communities in the United States by their comparative well-being. North-Port-Sarasota-Bradenton, Florida, has the nation’s highest well-being, followed by Urban Honolulu, Hawaii; Raleigh, North Carolina; Oxnard-Thousand Oaks-Ventura, California; and El Paso, Texas. El Paso also leads the nation in purpose and physical well-being.
Youngstown-Warren-Boardman, Ohio-Pennsylvania, has the lowest overall well-being in the country, as well as the lowest purpose and social well-being. The four communities rounding out the bottom five in terms of overall well-being are Toledo, Ohio; Knoxville, Tennessee; Dayton, Ohio; and Indianapolis-Carmel-Anderson, Indiana. The state of Ohio has five communities among the ten ranked for lowest overall well-being.
“State of American Well-Being: 2014 Community Well-Being Rankings” examines the comparative well-being of the largest 100 communities in the United States. You can read more about the rankings here and download all the reports here.
The Gallup-Healthways Well-Being Index uses a holistic definition of well-being and self-reported data from individuals across the globe to create a unique view of societies’ progress on the elements that matter most to well-being: purpose, social, financial, community and physical. It is the most proven, mature and comprehensive measure of well-being in populations. Previous Gallup and Healthways research shows that high well-being closely relates to key health outcomes such as lower rates of healthcare utilization, lower workplace absenteeism and better workplace performance, change in obesity status and new onset disease burden.
To discover where other communities — including yours — fall within the rankings, download a copy of the report today. You can also subscribe to content from the Well-Being Index; by subscribing, we’ll let you know when we release new reports and insights from the Well-Being Index.
Meeting : Policy Lab, Childrens’ Hospital of Philadelphia
Met with David and Eli at PolicyLab at The Children’s Hospital of Philadelphia.
- The pediatric health perspective provides an important prism as it differs from views of adult health in many significant ways:
- small improvements in child well-being can have significant, positive downstream impacts
- children are mostly very healthy and aren’t expected to die, so QALYs and DALYs aren’t as relevant
- social determinants (education, exposure to substance abuse) are significant
- News of Australia’s recent Cricket World Cup Victory has traveled far.
- Various US Federal and State government programs are starting to blur boundaries and be more flexible global budgeting so as to catch the less-well defined determinants of health, especially in Vermont, Oregon and Washington (Adverse Childhood Experience data sets and its relationship to toxic stress.
Resonating with Ike
There are two aspects of Presidency Eisenhower’s life and presidency that resonate with the key themes of my Eisenhower Fellowship: Chronic Disease and the consequences of ungoverned Institutional Power.
As a consequence of a life of smoking, President Eisenhower later suffered terribly from heart disease, culminating in the first of a number of heart attacks (see this NEJM book review) that inevitably led to a deterioration in his health.
The second aspect is highlighted in a warning he gave during his televised farewell address in 1961 where he airs his concern for the power granted to, and then held by the military-industrial complex in the wake of the World War II and then later the Cold War.
“A vital element in keeping the peace is our military establishment. Our arms must be might, ready for instant action, so that no potential aggressor may be tempted to risk his own destruction. . . . American makers of plowshares could, with time and as required, make swords as well. But now we can no longer risk emergency improvisation of national defense; we have been compelled to create a permanent armaments industry of vast proportions. . . . This conjunction of an immense military establishment and a large arms industry is new in the American experience. . . .Yet we must not fail to comprehend its grave implications. . . . In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.”
More analysis on this here.
Conversation with Constantijn
Had a good conversation with Constantijn about our Fellowship foci. In describing the new financing model, he asked an excellent question:
In what circumstances would an institution be able to get people to trust them to do the right thing with their data?
In other words, how much, and what kind of value does a company need to provide to the population to allow them to entrust them with their most personal and sensitive information?
Surely extending their vital, healthy life would qualify?
Day Zero
So the day is finally here and I’m about to embark on my 2015 Eisenhower Fellowship. I’m typing this on the plane from Sydney to Philadelphia via San Francisco.
I’m trying not to succumb to the American food environment, so hope to be more conscious about what I put in my mouth. Part of this will involve me taking photos of what I eat, to wit, my first meal of the trip (I didn’t eat the bread roll):
Transit Details:
- UA870: SYD > SFO 13hr 40mins
- UA267: SFO > PHL 5hrs 23 mins
- SYD>PHL door to door: 24hrs
- Meal: Omelet, smear of spinach, chicken sausage (photo).
- Movies: Gone Girl. Trading Places.
- Paid US$250 after boarding for an upgrade to premium economy.
I’m coming around to the view that with a few exceptions, there are generally no people, just bad incentives. However, I also contend that these bad incentives have resulted in the world’s healthcare systems letting down the populations they are bound to serve. Fixing doctors’ incentives, as the US is seeking to do, will only be just part of the fix, with hospitals, pharmaceutical companies, prosthesis manufacturers etc. also in time having to participate in value-based payment models.
In this context, my Fellowship will focus on two themes:
- A contemporary exploration of how data science can improve healthcare systems
- Measurement/Detection/Prediction of Fraud, Abuse, Waste and Errors
- Measurement/Detection/Prediction of Cost
- Measurement/Detection/Prediction of Quality of Care
- Measurement/Detection/Prediction of Value of Care
- Delivery of Transparency (Cost, Quality, Value Indicators) Metrics to legitimate health market stakeholders
- Data-driven, Behavioural Economic Health System Interventions focused on improved outcomes
- A blue sky thought experiment on how a novel financing model might support an enterprise market for population health
- Beneficiaries of Healthy Life Extension
- Data sets/statistical treatments/in vivo measures/predictors of wellness e.g. social determinants/health data
- Financial Models for Pooling Population Health Risk e.g. Life Insurance
- Potential Efficacy of Population Health Intervention
- Attribution of Interventions to Health Outcomes
- Priming the Wellness Market
After discussing the Fellowship with Australian Eisenhower Alumni, I’m persuaded that the experience will be transformative, but not for the reasons I had assumed. Despite the privilege, honour and compelling subject matter associated with the Fellowship, I’m reliably informed that I’ll get at least as much (if not more) from my fellow Eisenhower Fellows (who I’ll be meeting face to face in just a few hours) and the people and places I visit, as I will from the ideas we exchange and discuss. As such, I’m going to use this blog to support a discipline around the contemporaneous capture of the various experiences during and beyond the Fellowship.
I’ll be accompanied on the last three weeks of the Fellowship by my wife Yan Li, who has been in Singapore awaiting the arrival of her partner visa after our marriage last year. She’ll be returning to Sydney with me at the conclusion of the Fellowship which is very exciting.
Many people have provided inspiration and encouragement at various stages leading up to and including the fellowship – family, friends, soon to be fellow EF alumni, and my colleagues at work who are covering for me in my absence.