Sunday, January 23, 2011

Bad-Mouthing Big Tobacco

This one definitely pulls on my public health heart strings. As part of the Tobacco Control Act and following the recent expansion of tobacco into FDA 'jurisdiction', cigarette packages and advertisements must now include color graphics depicting the negative health consequences of smoking. Travelers to Europe and Asia may be reminded of similar strategies, as several countries have had these requirements for years.

The regulations require that at least 50% of the real estate on the front and back of cigarette packs must be covered by the graphics, with 20% of the space reserved on other advertisements. The finals rules will be issued on June 22, and the new packages hit the shelf no more than 15 months after that date. Some health advocates are hesitant to pursue 'shock value' movements like this, but given the system-wide costs of addiction (in both personal health and health spending) and the industry's blatant targeting of vulnerable populations I can think of few more effective ways to both deter purchase and remind the populace of the severe repercussions tied to a product that cuts 443,000 lives short every year. Below are some of the better examples under consideration. What do you think?

Friday, January 7, 2011

Can the GOP repeal the Affordable Care Act?

The 112th House of Representatives has scheduled a vote to fully repeal health reform on January 12th. Could this actually happen?

Short answer: No.

Long answer: As many of the new members ran on the ‘Repeal ObamaCare’ mantra, the vote is little more than a political stunt to appease the base and reiterate the fact that Republicans did indeed gain the House majority in the 2010 midterm elections; the vote to repeal will pass the House and be killed in the Senate, where Dems still enjoy the majority.

The symbolic vote is only the start of the attacks on the new law, though. Over the following months, there will be numerous attempts to defund certain provisions in the law that are required to first be appropriated by Congress in the annual budget. Every year, Congress must approve the federal spending package, and numerous pieces of health reform face this second hurdle. Provisions that could be threatened include the new long-term care insurance program (CLASS Act), the new Public Health and Prevention Fund, and some of the funds needed for expanded federal regulatory personnel to implement the law.

That being said, the central pillars of the ACA are more or less protected from Congressional action and enjoy permanent funding authority. These include all the funds related to insurance expansion like the insurance exchange subsidies and Medicaid expansion, investments in primary care and community clinics and payment/delivery reform pilot programs (Pay for Performance, reducing hospital readmissions, etc). Interestingly, the law provides expanded authority to the Department of Health and Human Services (HHS) allowing for the Department’s independent funding of ‘related provisions’ without seeking appropriations through Congress, essentially creating a backdoor to funding streams that may not survive the appropriation process. And of course, the individual mandate is facing it's own battle in the courts

Curious as to what the effects of repeal would be? Here are just a few of the more immediate effects:

-Allows insurance companies to drop children under 26 from their parents’ plan
-Adds $230 Billion to the federal deficit
-Increases drug prices for seniors, and removes their ability to receive free preventive screenings
-Allows insurance companies to deny coverage to individuals with pre-existing conditions

To be clear, there are a number of things that do need to be tweaked in the law. Until the politically-driven nowhere-votes cease, though, these adult legitimate conversations can never happen.

Tuesday, January 4, 2011

Prevention & Wellness

I was interviewed for a men's health piece a few months back, and the article was recently published on the website HealthDay. Below is the full text of the article, which exhibits the two topics that must be incentivized and invested into in order to foster a new high-value, primary-care focused health care delivery system.

For One Man, It's All About Prevention and Wellness

Weight, sleep, exercise and more can all play a role in keeping mind and body healthy

By Dennis Thompson
HealthDay Reporter
WEDNESDAY, Dec. 22 (HealthDay News) -- Adam Dougherty is laying the groundwork for a long and healthy life.

Dougherty, 25, is a health policy analyst living in Los Angeles with a master's degree in public health from the University of Southern California. He's applying the lessons learned for his career to his own health. He's in pretty good shape, 5-feet-9 and 160 pounds, and he wants to maintain his shape and his health.

"Coming from my public-health background, I'm a really strong believer in prevention and wellness," Dougherty said.

That means keeping both the mind and the body healthy. "I really think physical health and mental health are important counterbalances for the stresses we endure during the week," he explained.

Part of Dougherty's wellness routine includes taking some time each day to do something that relaxes him. "I play guitar," he said. "That's a good way to decompress and detach and calm my nerves."

Dougherty also eats a balanced diet, eating complete meals at breakfast, lunch and dinner. But he's aware of total calorie intake, adding that a person needs to burn as many calories as they eat in a day if they hope to maintain their weight, and burn more and eat less for weight loss.

"I'll try not to keep a lot of snack foods around, and limit my food intake to meals only," he added.
That's helped him maintain a healthy weight. "I've shed a few pounds since my college days, and that's associated to my beer intake," he said, laughing. "Liquid calories are definitely ones you should stay away from."

Sleep is another health factor that Dougherty pays attention to, trying to get seven to eight hours of sleep each night. "It's really important to get enough sleep on a night-to-night basis," he pointed out. "Sleeplessness contributes to stress, which is a major factor in many health problems."

Exercise is another key component to pursuing a healthy lifestyle, he noted. "I do a lot of cardio," Dougherty said. "I'll run a lot, bike and the like. A lot of my friends will focus on strength building, but I think cardio is more important."

He admits, though, that it's not always easy to get enough exercise day after day. "Just going to work every day, it's hard to find time," he said. "When you get home, you're tired and want to relax."
Dougherty's solution is to not give himself a chance to relax. When he comes home, for instance, he doesn't sit down. Instead, he said, "I'll come in and throw on running shoes or head out to play basketball."

Dougherty gets regular physical checkups -- trying to see his doctor at least once a year -- and also pays attention to health problems that he's at risk for because of his family history. He comes from a very Irish, fair-skinned family, he explained, and is particularly concerned about skin health.

"My dad has had skin cancer a couple of times," he said. "I'll go and get a mole checked out if it looks suspect."

More information
A companion article on men's health offers more on what men can do to improve their health.
SOURCE: Adam Dougherty, Los Angeles
Last Updated: Dec. 22, 2010
Copyright © 2010 HealthDay. All rights reserved.