Monthly Archives: December 2012

I really don’t want to write about guns . . .

Posted by on December 27, 2012 Comments Off on I really don’t want to write about guns . . .

Everyone has opinions on the subject, and few are indifferent.

The opinions are strongly held, not preferences. And everyone has recited the top 5 arguments for or against societal action, according to one’s opinion.

But how can anyone seriously write about health care in the United States without considering the impact of firearms?

I know that I am not interested in becoming one more activist in the debate—there are plenty of those on both sides. I also know that no opinion on any subject is without dissenters, including whether the sun will rise tomorrow morning.

Knowing that, I plan to point out some facts that might be generally agreed upon, no matter where one’s opinions lie.

First, firearm deaths are a public health concern. In 2010 there were 2,468,435 deaths in the United States from all causes, of which 31,328 were related to firearms. Deaths from firearms were 1.27 percent of all deaths, or one of every 78.8 deaths.

For purposes of comparison, there were 35,332 deaths from motor vehicle accidents that year, or 1.43 percent of all deaths, and one out of every 69.9 deaths. Source: National Vital Statistics Report, October 12, 2012, Centers for Disease Control and Prevention

Second, while the rate of death from firearms has been steady for the past ten or more years at about 10.2 per 100,000 of population, it is not equally distributed among age groups.

The risk of homicide by firearm is greatest between ages 18 and 44, while the risk of suicide rises with age through life.

Firearm Deaths by age and intent, 2001-2009

More to follow, reluctantly.

If you don’t think this is a matter of national defense

Posted by on December 20, 2012 Comments Off on If you don’t think this is a matter of national defense

Well, the Department of Defense does.

During the period 1998-2010, discharges from the US Armed Forces for obesity have risen at a rate that should concern all of us.

Presumably, the military problem reflects the similar civilian problem; however, we expect soldiers to be more physically fit than civilians.

In this inter-service rivalry no one is winning:

AFHSC_obesitypct_201101

The entire report: Diagnoses of Overweight/Obesity, Active Component, U.S. Armed Forces, 1998-
2010

Fat old people have a problem. Fat old people are a problem.

Posted by on December 17, 2012 Comments Off on Fat old people have a problem. Fat old people are a problem.

Bette Davis famously said, “Old age is no place for sissies.” Growing old is challenge enough, so is being obese—but put them together and . . . .

Among the challenges:

1. Accelerated cognitive decline. A recent study found that cognitive decline was accelerated among the obese with any two of the four abnormalities:
a. High triglycerides or use of lipid-lowering medications
b. High low-density lipoproteins (LDL)
c. Elevated blood pressure or use of blood pressure medications
d. Elevated blood glucose

A 2009 Nursing World article added the following life-threatening illnesses:

2. Cardiovascular Disease. Over 80 percent of older Americans dies from this disease. Obesity seems to exacerbate the inflammatory process that underlies it.

3. Gallbladder Disease. Obesity is believed to effect a decrease in bile salts and increase in cholesterol.

4. Cancer. The evidence that obesity is a risk factor for cancer, particularly breast cancer, is growing.

5. Diabetes. Even relatively small weight gains can provoke a genetic tendency toward diabetes, so much the worse for the large weight gains that result in obesity.

As well as the nonfatal ailments:

6. Respiratory Problems. Lungs decrease in size, and the chest wall becomes heavier.

7. Arthritis and Osteo-arthritis. While arthritis is a general challenge for older adults, obesity puts weight on the knee and hip joints, resulting in damage to cartilage.

8. Skin conditions. Perspiration and friction can lead to persistent skin conditions.

The necessary emotional and financial burden of caring for the aged in our society, as well we should, is inflated by the unnecessary burdens of avoidable disease and disability. As we address the health needs of our population, we must lessen the burden of the aged on our society, not by decreasing available benefits but by decreasing needs. That goal requires improving health before and during old age.

Further reading:
Obesity Among Older Americans
National Blueprint: Increasing Physical Activity Among Adults Age 50 and Over
Effect of Obesity on Falls, Injury, and Disability

What to do about fat kids?

Posted by on December 14, 2012 Comments Off on What to do about fat kids?

Obese children tend to become obese adults.

Obese adults tend to get high blood pressure, diabetes, chronic back pain, heart attacks and strokes.

Some researchers in an article published in the August 13, 2012 edition of Pediatrics have a partial answer.

Competitive foods are those sold outside of the Federal meal program. The conclusion from the Full Report:

Laws that regulate competitive food nutrition content may
reduce adolescent BMI change if they are comprehensive, contain strong
language, and are enacted across grade levels. Pediatrics 2012;130:437–
444

What this means is that researchers have found something our state legislators and local school boards can do to slow the public health crisis of obesity among children.

But there is a problem—you knew that, right? Many school districts depend on the sales of snacks and sugary drinks to supplement the local school budget. Even if the wealthiest school districts could afford to remove the snack and drink machines, the poorer districts would face a Hobson’s choice: accept the machines and health risks or reject them at the expense of education.

Many states have been dealing with how to equitably share revenue among different school districts, allowing some redistribution of revenue in favor of the poorer districts without being confiscatory toward the wealthier districts. What is “equitable” is a highly charged political debate.

Even with the political caveat, it is reassuring to learn there may be things we can do, even without Federal intervention, to reverse the public health epidemic of obesity and its consequences.

There was a time when FAT City was something good.

Posted by on December 12, 2012 Comments Off on There was a time when FAT City was something good.

No more.

We are FAT City. It is bad. It is getting worse. Here’s what it looks like geographically:

Map of Obesity in the USA 2011

The map shows the problem in 2011, but it does not show the growth of the problem over time. Exploring that growth is part of the search for the cause and the solution.

If being overweight were just an aesthetic choice, no one would care. If being overweight were totally beyond the control of individuals, we would simply live with it as we do other things beyond our control, such as the limits of our life span.

But, the problem of obesity has an impact on our entire society and is at least in part modifiable. It makes finding soldiers who can pass basic physical exams scarcer than would otherwise be the case, and it puts a burden our health care system, both payers and providers, particularly public programs such as Medicare and Medicaid.

While we will want to consider diabetes, heart disease, and cancer, as well as other preventable causes of death and disability, in discussing the health of our nation, they are affected profoundly and substantially by the prevalence of obesity in the society. There are a considerable number of obesity-related illnesses,
and they impact our health, our longevity, our national budget, and our family budgets.

So, initially I may be writing a bit more about obesity than other health challenges, but we will get to them as well in the fullness of time.

What the health is this blog about anyway?

Posted by on December 10, 2012 Comments Off on What the health is this blog about anyway?

Murray Feshbach, Vladimir Treml, Barbara Anderson, Brian Silver

Who are these guys?

In the 1970’s and 1980’s these scholars documented the declining life expectancy in the Soviet Union. Ten to twenty years before its demise, they demonstrated that the USSR was drinking itself to death.

In the US we are eating ourselves into history’s dumpster—unless we stop the trends.

Obesity leads to diabetes, heart disease, back problems, cancer, and others. We are having an epidemic of obesity. It is a big problem. It is not the only problem—just a big one.

As our belt sizes grow, the health care needs of the baby boomers will grow beyond our ability to meet them. There will be neither enough dollars nor enough people to take care of those with chronic illness.

The problem is too big for a simple solution, like the latest diet or routine liposuction. The consequences are too great for the luxury of magical thinking—if we don’t think about it, it will go away. It won’t, as anyone who has tried to lose 10 pounds surely knows.

In order to manage, if not solve a problem, we need to:

1. Agree there is a problem
2. Define precisely what the problem is
3. Determine what tools we have to meet the problem
4. Agree on the best tools or remedies to use
5. Apply all appropriate remedies to reduce the uncertainty of the outcome

While this challenge is less dramatic than those we regularly see headlining news stories, it is my belief that it is the most serious threat to our nation. As such, it must be a national priority and must be addressed at the national, regional, state, local and personal levels, by both governmental and non-governmental organizations, including private businesses.

It is the purpose of this blog to address the American health crisis in the context of the five points of problem-solving mentioned, including the evidence of the problem, possible causes of the problem, and actions we might take. I plan to provide links to the latest research as well as the initiatives of others.

Let’s get started: Background of the Problem