Archive for October, 2010

What Health Care Can Learn from a 200 Year Old Economics Lesson

Say you were in a different line of work – the prisoner relocation industry, for instance, and the year was 1790…what’s your most significant business challenge?  Well, if you were doing business out of England, transporting your cargo to Australia without killing them would likely be right up there.

Finding themselves with a homeland prison system bursting at the English seams in the 18th century, the British government began hiring ship captains to transport masses of prisoners to Australian penitentiaries.  Unfortunately, rough seas of the crossing and ineffective nutrition and medical care along the way took a fatal toll on the individuals being transported – 30% mortality rates per crossing not uncommon. 

Over time, the toll also cost the British government.  Yes, these were prisoners, but the public and church railed against the government’s morality failing in allowing the ongoing carnage – the government soon embroiled in scandal.

The British government responded with a host of new rules for prisoner transport – the requirement of medical care practitioners and onboard inspections, lemons to prevent scurvy, raising captains’ salaries, etc.  And although these reforms came with incentives for the captains, they weren’t aligned effectively with the sought-after result – captains finding more reward in selling the government-issued supplemental food at port rather than giving it to the prisoners to keep them alive.  The prisoner shipping program was costing the government even more money, and the high mortality rates continued.

But enter a smart economist of the time who proposed a better idea, and everything changed.  What was it?  Pretty simple really – only pay the sea captains for each prisoner that walked off the ship alive in Australia (not for how many boarded in England). 

Fairly immediately, survival rates shot up to 99%.

What’s the parallel lesson for today’s health behavior dilemma?  If we want to truly motivate real and lasting healthy behavior change, incentives must be directly aligned with the outcome we want to achieve.  The fierce tides of maintaining health and wellness can be foreboding and challenging.  But solutions that focus more on the journey, less on the desired outcome risk missing the harbor completely.  Incenting individuals to complete health assessments and screenings is a first step – it begins the engagement process.  But participants need to also be incented to follow through on healthy actions.

Beyond engagement, incenting individuals for health improvement follow-through and results is a game changer in the rough seas (and high stakes) of health improvement.  Isn’t it time we cross the ocean?

Just How Social is Health?

Remember one year ago when H1N1, the disease formerly known as swine flu, blew the global sale of surgical masks through the roof? Outbreak scares like that pound home the unavoidable fact illness is contagious. But how about healthy behavior – is it contagious too? Can the company we keep, our social networks, impact our individual health status? New research shows not only might our immediate social connections impact our healthy (or unhealthy) behavior, but the social networks connected to ours may as well. 

Health, it turns out, might be as contagious as illness.

The most notable new research, culled from several decades worth of quantifiable Framingham Heart Study health risk data (including social links between study participants) reveals that healthy behavior like quitting smoking, maintaining a healthy weight, even adapting a happy disposition, passes from friend to friend with Kevin Bacon-like agility. And the impact isn’t marginal – individuals are 57% more likely to become obese if their friends are obese and even 20% more likely to become obese if a friend of a friend becomes obese.

Behavior is contagious.

Enter the continually vastly expanding popularity of web-based social media and the opportunities to leverage social networks positively for health improvement become more than compelling – they become essential.

This summer’s “Biggest Loser Challenge” organized by the Alliance for a Healthier Minnesota proved online social media can be used to dramatically improve healthy behavior, from individual to individual – over 10,000 individuals engaged in improved exercise and nutrition habits, connected through an online platform, collectively shedding 37,000 pounds in three months.

Social media approaches to improved health can’t alone turn the tide on the unhealthy behavior consuming as much as 50% of current health care costs. More effective is a multi-dimensional approach that also includes a focus on shifting workplace culture and introducing onsite efforts, along with personalized coaching programs, healthy rewards and other elements. Collectively, these combined forces are having compelling positive results on improved employee health – leveraging the significant power of social networks.

You know the old saying, you can’t choose your family but you can choose your friends?  Well, apparently your friends (and their friends) can help choose your health.  As engagement in social media continues to re-define our expanding social networks, the time is right to leverage their power for healthy good.

- Eric Zimmerman, Chief Marketing Officer, RedBrick Health. To hear more, come see Eric at the 2010 Connected Health Symposium in Boston on Oct. 22. Also, read about RedBrick Health’s recent acquisition of Social Kinetics.

How Complicated is Health?

Pop quiz – what’s the leading cause of premature aging and death? According to a new article by Dr. Joseph Mercola, physician and New York Times bestselling author, increased insulin and leptin receptor resistance. Translated into common language – too much sugar and processed foods combined with insufficient exercise. Make lifestyle adjustments around these pitfalls and the author notes the reward would likely be a 90% elimination of high blood pressure, obesity, diabetes and high cholesterol conditions.

That’s it – less fructose, regular exercise. Simple.

 If health and longevity are that easy, why aren’t we all doing it? Probably because it’s more complicated than it sounds and few people are provided with the information they need to make the right choices. Do most people understand how to avoid corn-based sweeteners and processed foods? They likely know fresh fruit is healthy, but do they realize too much of it can actually be unhealthy (large amounts of fruit-based fructose worsening insulin resistance)? Do they understand how to identify and avoid foods laden with trans fats and harmful chemical additives?

And that’s just nutrition – we tend to believe the path to maximized health merely requires common sense, but most people don’t understand how healthy living skills – coping with stress, a balance of rest and physical activity, community and social network ties, factor significantly into our health and longevity. And if they do understand, they don’t always know where to obtain skills and information they need to do something about it. Even more challenged – those whose health status has already been impacted enough to result in a chronic condition.

Most individuals need a push to make healthy lifestyle changes. Employers can provide a financial push through an effective healthy rewards program. But the push needs to be followed by personalized support and guidance, helping all individuals gain the informed skills they need navigating the often complicated journey of health.

Kicking the Habit May Require More Kick

Glimpse any two minutes of the popular television series Mad Men, a compelling mirror of 1960’s American culture, and chances are you’ll see at least one of them smoldering between someone’s fingers or lips.  In the boardroom.  On the airplane.  In the living room, kitchen and family car.  Even primary physicians during patient visits are smoking them.  Cigarettes are so prevalent on the set of Mad Men, it wouldn’t be surprising to see the line item “Lucky Strikes” hover at the top of the production budget.

Did our culture really embrace smoking that handsomely a mere few decades ago?  Have we truly reversed the direction of this single tenet of unhealthy behavior?

The good news is our culture has made significant strides away from smoking prevalence since the Surgeon General’s Advisory Committee on Smoking and Health published its comprehensive report linking cancer risks to smoking in 1964 (and Congress passed the Cigarette Labeling and Advertising Act the following year.)  The bad news is, even with the multitude of new research indicating a full range of additional health risks and morbidity impacts of tobacco use (from the gamut of cancers to heart disease, stroke and a myriad of others), the declining trend line of smoking prevalence has flat-lined.  In 2005, 20.9% of adults were classified as smokers.  In 2009, 20.6% were. That’s a half decade of virtually unchanged tobacco use declines.

Kicking the habit has also lost its steam in teen communities, as well.  Between 1997 and 2003, teenage smoking dropped from 36% to 22%.  However, in 2009 it remained virtually the same as the 2003 level.

Even more alarming, the Centers of Disease Control and Prevention just released a study indicating more than half (54%) of children between the ages of 3 and 11 years old are being exposed to second hand smoke.

Have we reached an unmovable wall of smoking decline and prevention?  Is an 80% non-smoking population the best we can hope for?

Hardly.  If you compare state by state smoking prevalence rates and examine the different state-sponsored approaches to tobacco use, you’ll easily note the relative impact.  California, for instance, has implemented aggressive and long running tobacco control programs and realized smoking prevalence declines by 40% virtually the same time period (between 1998 and 2006) the nationwide prevalence declines stalled.  As a result, lung cancer is now declining in California four times faster than the rest of the nation.  Maine, New York, and Washington have experienced 45-60% youth smoking prevalence reductions in recent years as a result of their sustained efforts directed at this population.

Sustained engagement, once again, proves key.  A recent study by the Oregon Health Science University supports this theory, as well.  They studied smokers trying to quit over a 12 week period and discovered those who ultimately do quit fall into one of two camps – those who abstain and quit immediately and those who relapse during early weeks of treatment but eventually quit.  The study emphasized how delayed quitters account for as much as one third of smokers who successfully remain abstinent one year post intervention – a significant population achieving healthy behavior change not immediately but over time.

Mad Men’s Don Draper may remain a hopeless chain smoker the remainder of the series, his lungs ever pocked with Lucky Strikes char.  It was the 1960’s, afterall.  But today’s smokers fare a far better chance to reform.  The right balance of motivation, education, intervention and sustained engagement can get them (and keep them) tobacco-free.


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