Archive for March, 2006

Are Immigrants Living the American Dream or a Health Nightmare?

March 30th, 2006 by Melanie Matthews

As the adage goes, “When in Rome, do as the Romans.” But according to a March 2006 study by the Center for Disease Control and Prevention (CDC), immigrants to the U.S. will stay healthier by hanging on to their native eating habits instead of embracing American nutritional trends. As noted by Dr. Dean Ornish on Newsweek's Health website, the CDC study found that recent immigrants reported significantly better physical and mental health (such as lower rates of obesity and high blood pressure) than their U.S.-born counterparts, despite having limited access to healthcare and little or no health insurance.

However, extended stays in this country are proving hazardous to immigrants' health. The study found that people from other countries (African-American, Asian and Hispanic) who move to the United States become progressively less healthy the longer they stay in this country. Immigrants residing in the United States for five years or more were 54 percent more likely to have high blood pressure and 25 percent more likely to have cardiovascular diseases, for example, than those who lived here less than five years. Think about the impact on healthcare costs when those uninsured patients hit the healthcare system at that five-year juncture.

Dr. Ornish recommends that America begin to export healthier ways of eating. He's working with American companies who have a worldwide presence to improve the nutritional value of the foods they export to other countries so as to cut down on chronic illness, with record progress. That's a great idea for the countries on the receiving end, but many of those foreigners may never visit this country.

As a corollary to this corporate effort, Americans should be embarrassed enough by these findings to become walking ambassadors for health to the immigrants among us. Instead of embracing the latest diet craze (goodbye South Beach, hello Sonoma), we should shed sedentary lifestyles and follow the advice of the myriad of health experts at our fingertips. We should join workplace wellness initiatives launched by employers hoping to curb healthcare costs and raise productivity. We should log in to the healthcare information portals developed by our health plans, not just to check claim status but to benefit from the preventative care information that resides there. We should listen to our doctors when they tell us to lose weight, stop smoking, avoid stress and eat well. And maybe we should ask our newly arrived Asian and Mediterranean neighbors for a taste of their cuisines, which by all accounts are a lot healthier than ours.

We also must recruit our schools and our children in this effort. A healthy revamping of school lunches --- whether packed at home or bought in school---can teach the right nutritional lessons to school-age offspring of these ailing immigrants. It should also make a dent in those rising obesity rates that haunt us.

It's not likely that the CDC data will slow the flow of immigrants to our shores; the lure of the American dream is too potent. But a shift toward smarter eating and living will allow us to skim the unhealthy habits from this melting pot.

Another Signal that Healthcare Costs Are Too High

March 29th, 2006 by Melanie Matthews

In another example that healthcare costs are too high, six states, including Colorado, Illinois, New Jersey, New Mexico, South Dakota, Texas and Utah now require insurers to cover workers' dependent children into their twenties, in most cases even if they are no longer full-time students.

The latest state to pass such a law is my home state, New Jersey, which now covers "children" through age 30.

The rationale behind these state actions is to address the high uninsured rate among this age group. A 2004 report by the Institute of Medicine found that approximately one in three young adults lack health insurance, compared to one in six Americans overall. Nineteen to 24 year olds (34.9%) are most at risk among all ages of being uninsured.

While I applaud these state legislators for taking action to address this historically uninsured population, maybe the better answer is to control the costs of healthcare plans, as opposed to another mandate on coverage requirements.

What if health plans offered a no-frills package with some basic coverage to meet the needs of this population; or how about a state program like the State Children's Health Insurance Program, which provides low-cost health insurance for families and children.

Employers who are bearing most of the brunt of healthcare costs increases will now be faced with another increase – covering children into 30s. There just has to be some other answer than putting more onus on employers, because ultimately it will the employees and their “children” that suffer.

Physician Practice Recognizes Importance of Lifestyle Factors

March 21st, 2006 by Melanie Matthews

In the six years that I've been a patient at my OB/GYN practice, I've never been asked during a visit about any lifestyle conditions. Sure, I was giving a registration form to complete when I first joined the practice that asked some lifestyle questions, along with family history. But I've never updated this form and I've never been asked these types of questions again.

But at a recent annual visit, my doctor asked how often I exercise, how much fruit and vegetables I eat, if I'm still a non-smoker and if there are any high levels of stress in my life.

I'm happy to report that I get at least 30 minutes of exercise each day, I eat more than my fair share of fruits and vegetables, I don't smoke and while I have some levels of stress in my life – I find that exercising helps ease it away. But, this isn't the good news – the good news is that this physician practice took the time out of a visit to ask these questions. They are putting the emphasis on making the right choices that can lead to a healthier lifestyle.

In an audio conference we sponsored this past November, Primary Care Physicians in Disease Management: An "Old" New Model of Care, Dr. Maureen Mangotich, medical director, provider and community outreach, McKesson Health Solutions, relayed how important physicians are in their disease management programs, even when McKesson doesn't contract with the physicians. Dr. Mangotich laid out a number of ways in which McKesson seeks to engage physicians to support their programs to ensure the success of their programs.

While physician support of healthy lifestyle choices and population health or disease management programs is not a panacea for people who choose unhealthy lifestyles, it can certainly add to the other efforts that the healthcare industry is taking to give consumers more responsibility for their health.

Undoing the Advances of American Medicine

March 10th, 2006 by Melanie Matthews

Researchers at the Albert Einstein College of Medicine of Yeshiva University released a report this week that warns of a possible end to the long-term trend of progressively fewer heart attacks and heart-attack deaths in the United States.

The reason -- a dramatic upsurge in diabetes-related deaths and illnesses in New York City, including a sharp increase in diabetic patients hospitalized with heart attacks.

The researchers looked at New York City Department of Health mortality records for two three-year periods—1989 through 1991 and 1999 through 2001.

They found that during the decade between these two three-year time spans, while the mortality rates due to stroke, cancer and all other diseases declined, the mortality rate due to diabetes over that period increased by 61 percent.

Even though we've been covering in our news articles the increase in diabetes, it still shocks me that we are seeing mortality increases in the United States in this day and age. We have access to more information than any other generation. We are more aware of the role of heredity in our own healthcare. We have technology in place to identify people at risk.

We've got to find a way to harness all of the technology and the information we have to reverse this trend.

In our report, Diabetes: Disease Management Strategies & Programs, Volume III, we examine some of the ways that health plans and disease management companies are tackling this issue from programs targeted at teens and people with low literacy skills; how primary care physicians can aid in the treatment and education of diabetic patients; and which education strategies are most effective in managing diabetic patients.

It's fantastic that mortality rates due to stroke, cancer and all other diseases have declined, but it is just unacceptable for diabetes-related deaths to have increased. Let's put the same emphasis on diabetes that we have for the diseases where we've made such progress.

10,000 Steps a Day

March 1st, 2006 by Melanie Matthews

As the obesity crisis continues to loom large (pun intended) in the United States, I am forced on an almost daily basis about the factors driving this crisis.

Each day that I drop my daughter off to school, I am amazed at the jockeying of cars that occurs as parents try to get the closest parking space to the school. Yesterday, while picking up my daughter from school, I literally could not drive down the street because parents were double-parked picking up their children.

Surely these parents (and children, too!) might benefit from a walk down the street on a lot of different levels, like having a chance to talk one-on-one without the distractions in the car.

These parents will never get to 10,000 steps in a day if they continue to seek the closest parking space at school. They are, I'm sure, the same people who jockey for the “best” parking space at the mall, the grocery store and in every other parking lot.

Maybe we need to re-define the “best” parking space. Take for instance, Wegmans' grocery stores, which have a designated parking spot at the far end of their lots with signs that read: "This space reserved for everyone that knows that a few extra steps every day can help them be healthy."

Wegmans' does not just pay lip service to this walking challenge; it also motivates its employees to lead healthier lifestyles through its eat well.live well program.

Wegmans' employees also participate in the Excellus Blue Cross Blue Shield Step Up program, which is an Internet-based program designed to help participants take small steps every day toward reaching goals like walking a little bit more and eating a little bit smarter. The program allows people to set healthy goals and shows easy ways to achieve them. The Excellus program even allows participants to challenge friends, family or entire organizations to be healthier with its Healthy Competition option. The Excellus program is one of the wellness case studies highlighted in our new report, Workplace Wellness Case Studies: Tactics To Promote Health and Reduce Risk.

Perhaps if I suggest it at the next PTA meeting, my daughter's school might just launch a 10,000 step program...