March 25th, 2015
It is estimated that 86 million Americans (more than 1 out of 3 adults) have prediabetes, a condition that puts them at high risk for developing diabetes and its complications. While some risk factors for developing diabetes cannot be changed, research studies have shown that preventing or delaying the onset of diabetes can be achieved through lifestyle interventions that help participants change their eating and exercise habits to lose weight.
But is there enough evidence that these interventions can work in community-based settings, especially for those at highest risk for diabetes such as racial and ethnic minorities? If community-based diabetes prevention programs do show promise for reducing participants’ risk of diabetes, how successful are these interventions in the long run? What are the program costs?
A University of Chicago report, supported by NYSHealth and the Robert Wood Johnson Foundation, identifies the full range of studies of existing community-based diabetes prevention programs; assesses the effectiveness of these programs for populations at highest risk for developing diabetes, including racial and ethnic minorities; and examines the implementation and ongoing costs of running these programs, especially compared with medication management programs.
Read the report and accompanying policy brief highlighting key findings.
In a new Health Affairs blog post, NYSHealth President and CEO James R. Knickman and Chief Program Learning Officer Kelly Hunt weigh in on the report’s findings, including the need for substantially more public and private investments in diabetes prevention research and demonstrations. Read the blog post.
HEALTHFIRST RENEWS ITS PRESENTING SPONSORSHIP OF THE AMERICAN DIABETES ASSOCIATION EXPO SATURDAY, MARCH 14th AT JACOB JAVITS CENTER
March 6th, 2015
HEALTHFIRST RENEWS ITS PRESENTING SPONSORSHIP OF
THE AMERICAN DIABETES ASSOCIATION EXPO
SATURDAY, MARCH 14th AT JACOB JAVITS CENTER
NEW YORK, NY-March, 2015 – The American Diabetes Association of Greater New York proudly announces the 2nd annual presenting sponsorship of Healthfirst for the American Diabetes Association’s 2015 EXPO. The FREE community event will be held in the North Wing of the Jacob Javits Convention Center on Saturday, March 14, 2015 from 10 a.m. – 4 p.m., beginning with an EXPO Kick-Off, featuring Borough Presidents, as well as ABC News and Univision media personalities. More than 11,000 attendees are expected from the Greater New York region, attracting both those families affected by diabetes, and all those interested in learning how to live healthier, active lifestyles, and change the future of diabetes.
This year also marks the American Diabetes Association’s 75th Anniversary. The Association will honor 75 years of progress in diabetes treatment, management and quality of life, and the Association’s role in these advancements. Learn more, by visiting http://www.diabetes.org/about-us/75th-anniversary, and by visiting the ADA experience booth at the EXPO.
“Healthfirst is dedicated to increasing the public’s awareness of diabetes and providing resources to help reduce the prevalence of this disease,” said George Hulse, Healthfirst VP of External Affairs. “We are proud to serve as a presenting sponsor of the American Diabetes Association EXPO for a second year to offer attendees important educational tools to lead a healthier life.”
Featuring complimentary health screenings and more than 80 prominent corporate exhibitors with the latest products, resources and educational information on diabetes, EXPO also highlights interactive events, celebrity and local chefs, professional industry speakers, access to health care providers, multilingual presentations and diabetes prevention information, as well as active exercise and healthy cooking demonstrations, a family fun zone, senior zone, multicultural community areas, and this year a new living with Type I and diabetes goes digital area. To register, visit: www.diabetes.org/newyorkexpo.
American Diabetes Association Executive Director of Greater New York Kevin Shippy said, “We once again welcome Healthfirst’s sponsorship and support in joining the movement to Stop Diabetes in the most populous and diverse market in the U.S. Those families most affected by diabetes mirror Healthfirst’s customers and demonstrates its commitment to the Greater New York communities served by increasing diabetes awareness, education, management and prevention, specifically to the high risk populations.”
Special mention to the EXPO sponsors: Presenting sponsor Healthfirst, and Sponsors:
New York Rx Card, Sanofi, Adlens, Novo Nordisk, Diabetic Watchers, Empire Blue Cross Blue Shield, Advanced Cardiovascular Diagnostics, Unimas Nueva York, Univision 41 Nueva York, ABC Channel 7, Lyfebulb, and Vitreous Retina Macula Consultants of New York, Healthplus Amerigroup, Walgreens/Duane Reade, Regeneron.
Diabetes affects nearly 29.1 million children and adults in the United States, and more than one million adults in New York alone.
An additional 86 million have prediabetes and by year 2050, if current trends continue, 1 in 3 adults will be diagnosed with diabetes. Type 2 diabetes is more prevalent in African-Americans, Latinos, Native Americans, Asian-Americans, Native Hawaiians and other Pacific Islanders, and are considered higher risk populations. (Source of Statistics: June 2014 Centers for Disease Control and Prevention)
Make sure you join the movement and visit the American Diabetes Association EXPO, presented by Healthfirst, to learn how to live healthy, be more active and help change the future of diabetes. For a Schedule of Events or to pre-register, visit www.diabetes.org/newyorkexpo.
About the American Diabetes Association
The American Diabetes Association is leading the fight to Stop Diabetes and its deadly consequences, and fighting for those affected by diabetes. The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. Founded in 1940, our mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. For more information please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit www.diabetes.org. Information from both these sources is available in Spanish as well as English.
Healthfirst is a not-for-profit health plan serving more than one million members in downstate New York. Created in 1993 by a consortium of the region’s health systems, Healthfirst’s operating model strives to achieve quality outcomes and member satisfaction through collaboration with its extensive provider network and community organizations.
Healthfirst offers a comprehensive selection of free and low-cost health insurance options for individuals and families at every stage of life, including government-sponsored health plans such as Child Health Plus, Medicaid Managed Care, Medicare Advantage, and Managed Long Term Care, as well as commercial plans such as Healthfirst Leaf Plans. We treat our members with the same care and attention we give our own families.
For more information on Healthfirst, visit www.healthfirst.org.
April 29th, 2014
by Dr. Rob van Dam
Assistant Professor in the Department of Nutrition, Harvard School of Public Health
1. The latest Harvard study on coffee and health seems to offer good news for coffee drinkers. What did the research find?
We looked at the relationship between coffee consumption and overall mortality in the Nurses’ Health Study and the Health Professionals Follow-Up Study, which together included about 130,000 study volunteers. (1) At the start of the study, these healthy men and women were in their 40s and 50s. We followed them for 18 to 24 years, to see who died during that period, and to track their diet and lifestyle habits, including coffee consumption. We did not find any relationship between coffee consumption and increased risk of death from any cause, death from cancer, or death from cardiovascular disease. Even people who drank up to six cups of coffee per day were at no higher risk of death. This finding fits into the research picture that has been emerging over the past few years. For the general population, the evidence suggests that coffee drinking doesn’t have any serious detrimental health effects.
2. So for coffee drinkers, no news is good news? Why is this finding so important?
It’s an important message because people have seen coffee drinking as an unhealthy habit, along the lines of smoking and excessive drinking, and they may make a lot of effort to reduce their coffee consumption or quit drinking it altogether, even if they really enjoy it. Our findings suggest that if you want to improve your health, it’s better to focus on other lifestyle factors, such as increasing your physical activity, quitting smoking, or eating more whole grains.
3. Is there an upper limit for the amount of coffee that is healthy to drink each day?
If you’re drinking so much coffee that you get tremors, have sleeping problems, or feel stressed and uncomfortable, then obviously you’re drinking too much coffee. But in terms of effects on mortality or other health factors, for example, we don’t see any negative effects of consuming up to six cups of coffee a day. Keep in mind that our study and in most studies of coffee, a “cup” of coffee is an 8-ounce cup with 100 mg of caffeine, not the 16 ounces you would get in a grande coffee at a Starbucks, which has about 330 mg of caffeine.
Also keep in mind that the research is typically based on coffee that’s black or with a little milk or sugar, but not with the kind of high-calorie coffeehouse beverages that have become popular over the past few years. A 24-ounce mocha Frappachino at Starbucks with whipped cream has almost 500 calories—that’s 25 percent of the daily calorie intake for someone who requires 2,000 calories a day. People may not realize that having a beverage like that adds so much to their energy intake, and they may not compensate adequately by eating less over the course of the day. This could lead to weight gain over time, which could in turn increase the risk of type 2 diabetes, and that’s a major concern.
4. Is there any research that suggests coffee may have some beneficial health effects?
Yes, research over the past few years suggests that coffee consumption may protect against type 2 diabetes, Parkinson’s disease, liver cancer, and liver cirrhosis. And our latest study on coffee and mortality found that people who regularly drank coffee actually had a somewhat lower risk of death from cardiovascular disease than those who rarely drank coffee; this result needs to be confirmed in further studies, however. This is a pretty active area of research right now, and it’s not at the stage where we would say, “Start drinking coffee to increase your health even if you don’t like it.” But I think the evidence is good that for people in general—outside of a few populations, such as pregnant women, or people who have trouble controlling their blood pressure or blood sugar—coffee is one of the good, healthy beverage choices.
5. Why does it seem like scientists keep flip-flopping on whether coffee is bad for you or good for you?
Often people think of coffee just as a vehicle for caffeine. But it’s actually a very complex beverage with hundreds and hundreds of different compounds in it. Since coffee contains so many different compounds, drinking coffee can lead to very diverse health outcomes. It can be good for some things and bad for some things, and that’s not necessarily flip-flopping or inconsistent. Few foods are good for everything. That’s why we do studies on very specific health effects—for example, studies of how coffee affects the risk of diabetes—but we also conduct studies such as this most recent one looking at coffee consumption and mortality over a long period of time, which better reflects the overall health effect.
Coffee is also a bit more complex to study than some other food items. Drinking coffee often goes along together with cigarette smoking, and with a lifestyle that’s not very health conscious. For example, people who drink lots of coffee tend to exercise less. They are less likely to use dietary supplements, and they tend to have a less healthful diet. So in the early studies on coffee and health, it was hard to separate the effects of coffee from the effects of smoking or other lifestyle choices.
Over the several decades that coffee has been studied, there have been some reports that coffee may increase the risk of certain cancers or the risk of heart disease. But in better conducted studies, such as the one we just published—larger studies that have a lot of information about all other lifestyle factors and make a real effort to control for these lifestyle factors—we do not find many of these health effects that people were afraid of.
6. What is the latest research on the risks of coffee or caffeine during pregnancy?
For pregnant women, there has been quite a bit of controversy over whether high intake of coffee or caffeine may increase the risk of miscarriage. The jury is still out. But we know that the caffeine goes through the placenta and reaches the fetus, and that the fetus is very sensitive to caffeine; it metabolizes it very slowly. So for pregnant women it seems prudent to reduce coffee consumption to a low level, for example one cup a day.
7. Should people with high blood pressure consider reducing their coffee or caffeine intake? What about people with diabetes?
We know that if people are not used to using any caffeine, and they start to use caffeine, their blood pressure goes up substantially. Within a week of caffeine consumption, however, we see that the effect is less pronounced—there is less of an increase in blood pressure. After several weeks of continued caffeine consumption, however, a little bit of increase in blood pressure remains. In studies that look at the incidence of hypertension in the general population, drinking caffeinated coffee is not associated with a substantial increase in risk. But if people have hypertension, and are having a hard time controlling their hypertension, they could try switching from caffeinated coffee to decaffeinated coffee, to see if it has a beneficial effect.
With diabetes, it’s a bit of a paradox. Studies around the world consistently show that high consumption of caffeinated or decaffeinated coffee is associated with low risk of type 2 diabetes. But if you look at acute studies that just give people caffeine or caffeinated coffee, and then have them eat something rich in glucose, their sensitivity to insulin drops and their blood glucose levels are higher than expected. There isn’t any long-term data on coffee consumption and glucose control. But if people have diabetes and have trouble controlling their blood glucose, it may be beneficial for them to try switching from caffeinated to decaffeinated coffee. Making the switch from caffeinated to decaf may be better than quitting coffee altogether, because some research suggests that decaffeinated coffee actually reduces the glucose response.
8. How do you explain the paradoxical findings on coffee and caffeine consumption and diabetes?
It’s possible that there are simply different effects for short-term and long-term intake of coffee and caffeine. And, as I mentioned before, it’s becoming increasingly clear that coffee is much more than caffeine, and the health effects that you see for caffeinated coffee are often different than what you would expect based on its caffeine content.
For example, if you look at exercise performance, it seems that caffeine can be somewhat beneficial, but caffeinated coffee is not. Or if you look at blood pressure and compare the effects of caffeinated coffee to the effects of caffeine, you’ll find that caffeinated coffee causes blood pressure increases that are substantially weaker than what one would expect for the amount of caffeine it contains. The same is true for the relationship between coffee, caffeine, and blood glucose after a meal. It’s possible that there are compounds in coffee that may counteract the effect of caffeine, but more research needs to be done.
9. Is drinking coffee made with a paper filter healthier than drinking boiled coffee or other types of coffee?
Coffee contains a substance called cafestol that is a potent stimulator of LDL cholesterol levels. Cafestol is found in the oily fraction of coffee, and when you brew coffee with a paper filter, the cafestol gets left behind in the filter. Other methods of coffee preparation, such as the boiled coffee common in Scandinavian countries, French press coffee, or Turkish coffee, are much higher in cafestol. So for people who have high cholesterol levels or who want to prevent having high cholesterol levels, it is better to choose paper filtered coffee or instant coffee, since they have much lower levels of cafestol than boiled or French press coffee. Espresso is somewhere in the middle; it has less cafestol than boiled or French press coffee, but more than paper filtered coffee.
10. Do tea and coffee have similar beneficial effects?
One could expect some of the beneficial effects of coffee to be similar for tea, since some of the compounds are similar. A study in China has found that drinking large quantities of Oolongtea—a liter a day—is beneficial for glycemic control in people with diabetes. But research on tea in the U.S. has not shown the type of beneficial effect we see for coffee, probably because people in the U.S.tend to drink tea that is weaker in strength and tend to drink less of it.
April 17th, 2014
BY SABRINA TAVERNISE AND DENISE GRADY
Rates of heart attacks, strokes, kidney failure and amputations dropped over the past two decades, federal researchers said.
Federal researchers on Wednesday reported the first broad national picture of progress against some of the most devastating complications of diabetes, which affects millions of Americans, finding that rates of heart attacks, strokes, kidney failure and amputations fell sharply over the past two decades.
The biggest declines were in the rates of heart attacks and deaths from high blood sugar, which dropped by more than 60 percent from 1990 to 2010, the period studied. While researchers had had patchy indications that outcomes were improving for diabetic patients in recent years, the study, published in The New England Journal of Medicine, documents startling gains.
“This is the first really credible, reliable data that demonstrates that all of the efforts at reducing risk have paid off,” said Dr. David M. Nathan, director of the Diabetes Center at Massachusetts General Hospital, who was not involved in the study. “Given that diabetes is the chronic epidemic of this millennium, this is a very important finding.”
The number of Americans with diabetes more than tripled over the period of the study and is now nearly 26 million. Nearly all the increase came from Type 2 diabetes, which is often related to obesity and is the more common form of the disease. An additional 79 million Americans have pre-diabetes, which means they are at high risk of developing the disease.
Researchers from the Centers for Disease Control and Prevention, who wrote the study, estimate that diabetes and its complications account for about $176 billion in medical costs every year. The study measured outcomes for both Type 1 and Type 2.
Researchers said the declines were the fruit of years of efforts to improve the health of patients with Type 2 diabetes. Doctors are much better now at controlling the risk factors that can lead to complications — for example, using medications to control blood sugar, cholesterol and blood pressure — health experts said. What is more, a widespread push to educate patients has improved how they look after themselves. And a major effort among health care providers to track the progress of diabetes patients and help steer the ones who are getting off track has started to have an effect.
“These results are very impressive,” said Dr. K. M. Venkat Narayan, professor of medicine and epidemiology at Emory University, who specializes in diabetes and was not involved in the study. “There is strong evidence that we’re implementing better care for patients with diabetes. Awareness has increased tremendously, and there’s been a great deal of emphasis on coordinated care in health care settings.”
Edward W. Gregg, a senior epidemiologist at the Centers for Disease Control and Prevention and the lead author of the study, said researchers used four federal data sets — the National Health Interview Survey, the National Hospital Discharge Survey, the United States Renal Data System, and Vital Statistics — over a 20-year period to give a comprehensive picture of diabetes outcomes.
Dr. Gregg said the study relied on large sample sizes, including hundreds of thousands of diabetics who had heart attacks, and thousands who died from high blood sugar.
“This is the first time we’ve put the full spectrum together over a long period of time,” Dr. Gregg said. He pointed out that heart attacks, which used to be the most common complication by far, had dropped down to the level of stroke, which also fell.
“We were a bit surprised by the magnitude of the decrease in heart attack and stroke,” he said.
Continue reading the main story
Continue reading the main story
Beyond the declines in the rates of heart attacks and deaths from high blood sugar, the study found that the rates of strokes and lower extremity amputations — including upper and lower legs, ankles, feet, and toes — fell by about half. Rates for end-stage kidney failure dropped by about 30 percent. The study did not measure blindness, another critical diabetes complication.
Dr. Gregg cautioned, however, that the number of Americans with diabetes continued to rise. “We have to find a way to replicate these successes, to transfer that knowledge into preventing the disease to begin with,” he said.
The declines in rates of complications began around 1995 and continued gradually, but steadily, over time, the data show. What drove the outcomes varied by the complication, Dr. Gregg said. Improved blood sugar control has made a difference, especially in reducing the rate of amputations and end-stage kidney disease. Declines in smoking and the rising use of statins to lower cholesterol and of other medications to control blood pressure contributed to the declines in heart attacks and strokes.
Researchers noted that heart attacks had declined substantially for the general population as well, where the same factors were at work. But while people without diabetes saw a 31 percent decline since 1990, those with it experienced a 68 percent drop.
Dr. Joel Zonszein, director of the Clinical Diabetes Center at the Montefiore Medical Center in the Bronx, attributed much of the improvement to a change in the approach to treatment. Doctors are putting more emphasis on controlling blood pressure and cholesterol — major risk factors for heart disease and strokes — than on lowering blood sugar, he said.
Because cardiovascular disease is what kills most people with diabetes, this shifting priority seems to have paid off. Dr. Zonszein said that certain blood pressure drugs, not available in the past, help protect the kidneys and had helped prevent or at least postpone kidney failure for many patients.
And doctors are paying closer attention. Dr. Narayan ticked off questions about diabetes patients that are now routine in many health care settings: “What proportion of your patients turn up for regular appointments? What proportion of your patients has at least one eye exam a year? What proportion of your patients has good control of glucose, blood pressure and lipids?”
Despite the progress, experts said there were still too many people with severe complications, often because they do not take care of the disease. People with Type 2 need to check their blood sugar regularly, take medications and watch their diet.
“Really, we have two worlds,” said Dr. Zonszein, explaining that educated patients tend to manage diabetes well. “Then we have the other world,” which is far more likely to ignore diabetes until its devastating complications set in, “maybe because of social issues, language issues, access to health care, economic issues.”
Dr. Nathan said that though the study shows that the average person with diabetes faces far lower risks for complications, the broader society still confronts a growing epidemic.
“There’s nothing else in the world that’s increasing as fast as the rate of diabetes,” he said. “As a society, we are still facing an enormous burden.”
January 6th, 2014
On May 16th the Institute for Leadership and the Business and Labor Coalition of New York staged a 4-hour Labor Fights Diabetes Symposium in New York City. Health Care experts, religious leaders, labor union leaders, nurses, doctors, nutritionists, athletes, and diabetes patients all addressed the growing epidemic of diabetes.
Speakers warned that diabetes is approaching epidemic proportions in the United States as 1 in 3 people or 79 million Americans will be diagnosed as prediabetic if trends continue. In New York State, Diabetes costs $16.4 billion with more than 4.3 million residents considered as prediabetic and another 1.5 million New Yorkers having diabetes.
The goal of our symposium was to educate stakeholders on how to reverse the impact of type 2 diabetes in New York both in prevention as well as reducing costs through effective care and self management for those already diagnosed.
To view the video report of the entire May 16th Diabetes Symposium, featuring health care experts, religious leaders, labor union leaders, nurses, doctors, nutritionists, athletes, and diabetes patients who addressed the growing epidemic of diabetes, click HERE.
Posted under Diabetes Prevention
January 6th, 2014
The New York Diabetes Symposium
Dr. Ann Albright
Director, of the Division of Diabetes Translation,
Centers for Disease Control and Prevention
The New York Diabetes Symposium
Dr. Ann Albright
Director, of the Division of Diabetes Translation,
Centers for Disease Control and Prevention
Reverend Michel Faulkner
President, Institute for Leadership
On May 16th the Institute for Leadership and the Business and Labor Coalition of New York staged a 4-hour Labor Fights Diabetes Symposium in New York City.
Dr. Ann Albright, Director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention, gave the keynote address. Dr. Albright warned that diabetes is approaching epidemic proportions in the United States as 1 in 3 people will be diagnosed as prediabetic if trends continue.
In New York State, Diabetes costs $16.4 billion with more than 4.3 million residents considered as prediabetic and another 1.5 million New Yorkers having diabetes. The goal of our symposium was to educate stakeholders on how to reverse the impact of type 2 diabetes in New York both in prevention as well as reducing costs through effective care and self management for those already diagnosed.
To view the presentation by Dr. Albright and the Q&A session, click HERE.
Posted under Diabetes Prevention
The American Diabetes Association of Greater New York Announces Launch of American Diabetes Month 2013
November 8th, 2013
During American Diabetes Month®, this November, the American Diabetes Association, a new BALCONY member, is rallying New Yorkers to take action and Join the Millions® in the fight to Stop Diabetes®. The Association invites you and organizations to participate with us, by either hosting a health screening, handing out diabetes risk tests, hanging American Diabetes Month posters, playing PSA’s, or spreading diabetes awareness in support of American Diabetes Month, starting November 1st, through November 30th. You can also opt to participate in a combination of the above.
Read the full release: Diabetes
November 5th, 2013
Report from Northeast Business Group on Health highlights problems employers face in finding solutions and identifies program elements necessary for future success
NEW YORK, November 4, 2013 – Cost and prevalence make obesity one of the top health challenges for employers and they need help figuring out how to implement programs that work, says a report released today by Northeast Business Group on Health (NEBGH). The report, “Weight Control and the Workplace,” cites as key findings the need for individually-customized instead of generic programs, and the importance of including employees in designing and rolling out such programs. Findings are based on a collaborative examination of obesity’s toll on the workplace by 15 executives from large employers and health plans, facilitated by NEBGH.
“Overweight employees cost employers more than $73 billion each year and put themselves at risk for diabetes, heart disease, arthritis and other chronic illnesses,” said Laurel Pickering, President and CEO of NEBGH, an independent coalition of large national employers and other organizations working to improve healthcare value and reduce cost. “Employers, health plans and healthcare providers need to come up with coordinated, compelling approaches that engage employees in managing their weight in order to stem skyrocketing healthcare costs and improve public health.”
A majority of employers identified “employees’ poor health habits” as one of their top three challenges to maintaining affordable health coverage, and are trying strategies ranging from offering healthier cafeteria options and on-site exercise programs to comprehensive wellness programs. But they are running into trouble when it comes to dealing with obesity and weight management.
“One of the challenges employers face in engaging people in weight control efforts is the stigma attached to being overweight or obese,” said Jeremy Nobel, MD, MPH, Executive Director of the Solutions Center, NEBGH’s platform for researching approaches to healthcare issues of critical importance to employers. “Official recognition of obesity as a disease by the American Medical Association could increase physician engagement in identifying overweight and obese individuals for intervention, as well as help reduce the stigma and pave the way for increased participation in employer-sponsored efforts.”
The NEBGH report details current behavioral, pharmacological, surgical and provider-focused weight control intervention strategies, and identifies models that have demonstrated effectiveness as well as issues employers face in implementing various initiatives.
The report also highlights what roundtable participants identified as key elements of a successful weight control program:
Financial support for the NEBGH report and its related activities was provided by Vivus, Inc.
Copies of the report, “Weight Control and the Workplace” can be downloaded at http://www.nebgh.org/resources/NEBGH_SC_WeightControlFINAL10%2031%2013.pdf
For more information, contact Laurel Pickering at 212-252-7440 x224 or email at laurel@NEBGH.org
September 5th, 2013
JOIN THE THOUSANDS
American Diabetes Association, Institute for Leadership, BALCONY and CWA Local 1180
Are Stepping Out for DIABETES
September 28, 2013
Registration: 8 a.m.
Brookfield Place Plaza in Battery Park City
CLICK HERE FOR DETAILS AND TO REGISTER.
July 8th, 2013
By Nancy Shute
It’s much better to prevent illness than to treat it: less time, less money, less suffering. But prevention is a surprisingly hard sell with doctors and the public. That’s true even though preventable chronic diseases like diabetes and heart disease are the most common causes of disability and premature death in the U.S.
There are reasons we’re so bad at preventive medicine, says Dr. Harvey Fineberg, president of the Institute of Medicine at the National Academy of Sciences. He wrote about the issues in this week’s JAMA, the journal of the American Medical Association. Fineberg tells Shots why we often get preventive medicine so wrong and provides a prescription for doing better. Hint: It involves Febreze. Here are highlights from the conversation edited for length and clarity.
It’s been clear to public health types for many years that prevention is a hard sell. Why did you decide to finally write this down?
“It’s been puzzling me for so long. Everyone knows prevention is good and it’s the right thing to do, and we have such difficulty putting it into practice. Over time I would notice one reason or another that makes it hard. After I started accumulating these, I realized I hadn’t seen it put together.”
But not so very long ago, disease prevention didn’t seem so important. What changed?
“The experts have a fancy term for this — it’s called the epidemiological transition. We’ve gone from a preponderance of acute and infectious disease as a source of premature death to chronic diseases, which are the preponderance of the burden of illness in most of the world. That puts a much higher premium on the prevention of chronic disease than ever in history.”
We love medical dramas like House, where the doctor snatches the patient back from death’s door. But you’re saying what we really need from our doctors is to avoid the drama by not getting so sick in the first place. Is there any drama in preventive medicine?
6 Ways To Make Prevention Normal
“You certainly have a lot of acute drama in the prevention of infectious disease that can otherwise wipe out whole villages and populations. But it’s pretty hard to make drama out of the day in and day out consistent acts that transform our lives.”
Can you give us a few examples of how this can work?
“We don’t have spittoons on street corners any more. It’s no longer acceptable to spit on the street. When you visit friends’ houses today do you see ashtrays? When I was a child it was considered OK to smoke.
“Those are cultural changes that occurred in our lifetimes. When cultural change succeeds, it succeeds because it’s so embedded in what we do that we don’t have to think about. The reason that consumer products really succeed is when the manufacturer can find a way to embed it in your daily life. When Procter & Gamble introduced Febreze, it made it a part of your daily cleaning ritual. It’s a way to affirm you’ve finished cleaning the house. I think we can use the same marketing techniques for health.”
What would be your version of Febreze?
“It would probably be around eating and diet choice. We’re often stymied by the growing amount of obesity, but actually a very small daily change in the number of calories and the amount of exercise you get would make a huge difference over time. That’s how we got into the problem, by tilting calorie intake and exercise in the wrong direction. That’s how we can tilt it in reverse.”
I hope you’re not saying that this is all up to individuals.
“Absolutely not. Employers have so much to offer in this. They are the place where most of us spend our days, and they have an interest in a healthier, more productive workforce.
“Government of course has its role in setting policies to make this easier. In New York, Mike Bloomberg has taken incredible leadership on tobacco, banning smoking in public places. And he’s gotten the trans fats out of restaurants.
“Obviously it comes down to the individual and individual resolve and desire. But that’s only going to succeed when it’s reinforced and made part of the culture.”
You say one of the simplest ways to get people to adopt more healthful behavior is to pay them to do it. How would that work?
“I’d pay people to get their child immunized. I’d pay people to make healthier food choices. I’d pay people at work in terms of reduced insurance premiums if they demonstrate absence of tobacco. Weight loss? I’d make that financially rewarding, too. And there companies that are already doing that.
“The point is that a lot of these solutions actually exist somewhere, but we haven’t made them the norm. That’s what I’m calling for. We need to make the right simple and healthful choices the norm.”
You list more than a dozen reasons why preventive health fails. One is that “avoidable harm is accepted as normal.” What do you mean?
“Automobile injuries are a very good example. The very word accident makes it seem like there was nothing we could do about it. But in fact automobile injury is reducible. It’s reducible by changes that we’ve done a lot of — seat belts, air bags, anti-lock brakes and the elevation of rear lights. Those are all based on evidence that they would reduce the likelihood of injuries. Changes in the highways, barriers that absorb impact, better lighting, better marking, clearer signage that don’t take as much time to read. Changes in driver education and ages for driver’s licenses. All of these aren’t an accident. They are part of a systematic approach to reducing the likelihood of injury to yourself and others. Sweden has adopted the right norm, which is zero fatalities in traffic accidents. Why isn’t the right norm for homicide zero? Defining injuries and harm as normal is our problem. We need to see them as abnormal and reducible.”
Where would you like to see more disease prevention in your life?
“I spend so much of my day at work. I would like to have the workplace be part of a healthier strategy. Reminding me more about walking the steps rather than taking that elevator. Not just promoting healthier food in the cafeteria, but providing information on healthier choices. I use it when I look at the alternatives.
“We know that there are not going to be short-term solutions for any of these problems. It’s got to be persistence that will enable the payoffs to be realized. That’s what it’s going to take. It will take time, but it will happen.”