Wednesday, December 31, 2008

Resolutions For 2009 - “Ten Things to do in 2009 to Improve Health”

As we welcome in 2009 a year filled with hope and promise I thought it would be a good time to make up a list of Ten Things to do in 2009 to Improve Health.

1. Make it the norm for everyone to have health insurance and access to care.

2. Pay health care providers to communicate with consumers in the language the consumer understands.

3. Give consumers information in a useful format; there are more people who can watch a DVD than there are persons who can read.

4. Give consumers questions they can ask and provide answers so they understand what they may be told.

5. Encourage each person to talk about the level of care they want and include end of life issues.

6. Develop solutions for long term care that include a mix of private, public, and home based alternatives.

7. Encourage the sale of fresh vegetables and fruits in all communities.

8. Work to increase opportunities for persons of all ages and sizes to engage in physical activity.

9. Have EPA enforce clean air and water standards so we can breathe freely and safely drink tap water.

10. Remember that health care is more than science and numbers it is about body, mind, and spirit.

And a healthy and happy New Year to you too!

Tuesday, December 30, 2008

Future Health Solutions - Part II (of many)

Health is full of “trendy” words or things that sound good until you look at it more closely and try to decipher what will be the real impact. For example, much is written about the need for evidence-based medicine. Sounds like a good idea but the implication is that either, before, medicine was not based on evidence, or that now we have a better way to analyze the evidence. Unfortunately, much of what is discussed today is evidence based on studies that are over a decade old and are based on research on non-Hispanic white males.

It is not surprising that existing evidence-based protocols fail us as individuals. Too often the data that define the evidence do not include the other 2/3 of the population that is female or something other than non-Hispanic white. The evidence fails to acknowledge what we have documented during the first part of the 21st century, i.e., that there are gender differences and that there are differences in how individuals metabolize medicines and everything else we ingest or absorb. The challenge remains to acknowledge that there are persons excluded from our current models of evidenced based medicine.

It is no wonder I shudder when I hear that future treatments, and of course the reimbursements to which they will be linked, will be based on the existing evidence.

Wednesday, November 5, 2008

Future Health Solutions - Part I (of many)

American politics offer a spectacular view of what makes our country great. While we had a major election and shift in government there were neither tanks in the street nor bullies to keep people away from the polls. We waited on long lines to exercise our American rights and show the world who we really are. Although some of us may take our comforts for granted we have much to be proud of and that will see us through the economic turmoil which is still to come.

The freefall in the investment community and the government bailout surely indicate that our capitalism needs to be tempered with decisions that take into account the greater good. What has that got to do with health? Absolutely everything. Ethics must guide decisions not only in the non-profit world but also in the for-profit sector. We can craft an uniquely American health solution that involves both the private and public sectors...but only if the greater good guides our decisions in both sectors. After an election it is our resolve as a nation to work together and solve problems that will lead to solutions which are totally American. The best is yet to come.

Wednesday, October 22, 2008

Uninsured ER Overcrowding . . . It’s a Myth

Perhaps the most frequent scapegoat for the crisis in our health system is the uninsured.  For decades the litany of attacks on the uninsured has been they are overcrowding emergency rooms and using scarce resources because they do not go in for regular ongoing care.  But buried in today’s newspapers, ensuring that it will get scant attention, was reporting on new research released by the Journal of the American Association (JAMA) that turns conventional wisdom on its head.

The study found that the uninsured are less likely than those with insurance to use emergency rooms.  In fact, while 17% of persons in our country are uninsured, they only represent between 10% to 15% of emergency room visits.

When you talk to people who are uninsured they tell you that they do everything they can to take care of themselves; after all not everyone gets sick leave.  They also avoid emergency rooms because they are already living at the edge and are concerned that the costs they incur from an emergency room visit will push them off the precipice to which they are clinging.

According to the JAMA study, insured patients represent the majority of increased use of emergency rooms over the past decade.   So while providing health insurance to those who cannot afford it is critical, it does not go far enough to make our health system what we know it should be.  Access is about more than having coverage.

Thursday, October 16, 2008

Science Speaks and EPA Listens . . . Sometimes

Today, the EPA announced it was following the advice of its Clean Air Scientific Advisory Committee to set standards for lead in air that are 10 times stricter than we have today in order to protect children’s cognitive development. This follows on the heels of the decision by EPA in July to recommend the ban of carbofuran, one of the most toxic pesticides still in use.

Since EPA is being receptive to science click here to send EPA Administrator Johnson a letter calling on EPA to revisit its March decision on ozone standards. EPA ignored the very same committee's recommendation and set standards for ozone that were higher than recommended. According to published research that move is estimated to result in 5,650 unnecessary deaths annually. That’s not to mention the thousands of cases of cardiac events (heart attacks and respiratory illnesses) that could have been prevented.

Clearly, there’s still much work to be done to clean our air; following the scientific recommendations is a good place to begin.

Monday, October 6, 2008

And for this we have government?

The October 6, 2008 USA Today article “Sleuths go door to door to sniff out Medicare fraud” is a good example of how we can go so very wrong with how we focus on reducing costs. I do not know what other people read but for me it was a waste of government dollars to send out the sleuths. What did they discover? That an 86 year old man was able to go on walks and therefore was not eligible to get the home health care costs of having a nurse go to the house to give him his injection. Sounds odd?

While we all celebrate that the man could take a walk; walking involves being able to move your feet while injecting yourself involves your hands. It seems that Medicare only pays for the nurse to go to the home if the person is homebound. The sleuth who discovered the man commented that the man’s nervousness about giving himself an injection was not sufficient reason to qualify him for the nurse visit. Is it reasonable to expect that every 86 year old person should be able to inject themselves? Did anyone take into account the savings that Medicare accrued since the man was able to live at home because he had this help? Moreover, the reporter confused the work of the nurse and that of the health aide.

While the sleuth may have been using the Medicare standard; it is obvious that the standard has to change. We need to have more sanity in how we care for each individual. Blanket rules such as this do more damage than good— rather than cover they suffocate.

Wednesday, September 17, 2008

Our Future....Hispanic Students

Our future is tied to this generation of youth.  If you are the parent, grandparent, teacher, mentor or friend of a Hispanic college student looking to a future in a science, technology, engineering, or math (STEM) field please encourage them to visit

Yesterday the National Alliance for Hispanic Health (the Alliance) announced the opening of the Alliance/Merck Ciencia (Science) Hispanic Scholars Program. We are making two types of awards:
  • High School Seniors -- $42,500 Scholar Package.  Promising Hispanic high school students from Brownsville, TX; Elizabeth, NJ; and Los Angeles, CA are invited to apply to become one of ten Alliance/Merck Ciencia Scholars that will be selected in the Spring of 2009.  Scholars will receive up to $20,000 in scholarship (up to $5,000 each of four years of college) and up to $22,500 in summer internship stipends (up to $7,500 each of three summers).  Scholars will also receive mentorship and professional development support to complete a Bachelor's degree in a STEM field and pursue a STEM career.
  • College STEM Majors -- $2,000 Scholarship. Hispanic college students from all 50 states, the District of Columbia, U.S. territories and Puerto Rico pursuing a Bachelor’s degree in a STEM field major are invited to apply for a $2,000 one-time scholarship of which 25 will be awarded in the Spring of 2009.
This program of the Alliance and the Health Foundation for the Americas (HFA) is being conducted in partnership with the Merck Institute for Science Education (MISE) with support from The Merck Company Foundation.

Just this morning the Census Bureau released new data showing that there are 1.7 million recent Hispanic high school graduates enrolled in college.  Innovation in communication, genomics, and earth sciences all hold the prospect for a golden age of discovery....but only if our youth have the educational background to lead such discovery.   At the Alliance we are working to help secure that future of hope and prosperity for all.

Friday, September 12, 2008

The Consumer and Direct to Consumer Advertising

How consumers make health care decisions is complex. Consumers do not make health decisions in the same way that they make choices about objects they purchase.

For this reason and many other reasons I was surprised at the backlash that pharmaceutical companies met when they began to push for direct to consumer advertising. The outcry was that consumers would see their health care provider and demand a particular drug. Really? More than likely what happened was that the consumer would TiVo the ad (along with their favorite program) and then skip it because it was “simply advertising.”

However, in some cases the consumer had new information and actually now had something to ask their health care provider about. For example, very few knew about ED and those that experienced it were reluctant to speak about it. This is no longer the case.

As consumers we do not ask enough questions. And while some health care providers bemoaned that they had to talk to their patient about why the medicine they were asking for was the wrong one for them, other providers saw it as an opportunity to engage the consumer in their own care. Conversations with a consumer are a good and essential part of health care. This needs to be encouraged and we need to reimburse providers for this one-to-one education. And of course in a multicultural world, the conversation must be in the language that the consumer speaks.

Thursday, September 11, 2008


My daughter goes to college 90 miles north of New York City. On her campus September 11 is remembered in a way to respect the lives that were lost. In Washington, D.C. there are variety of commemorations too including those personal ones…a moment of silence, a prayer…something to make us recall what time can make too easy to erase.

On September 11 we lost many precious lives. They deserve a moment of our time to reflect on how the events of that day changed every part of our lives.

Thursday, September 4, 2008

We are not Canada or Sweden

Having just visited Sweden and other countries in the region, and heard about their health system first-hand, I am reminded that our system is different because we as Americans have different expectations. We expect more from our health care system but paradoxically we do not want to pay higher taxes.

Think about your typical American; they want answers in real time. In Canada and Sweden consumers have to wait for everything from a visit to a specialist to test results. That same approach would be unacceptable in the U.S. and might even be considered malpractice in some instances.

More to the point is that in the United States we made the decision in 1965 to provide a level of health care to persons over 65 regardless of income that is unheard of in most other countries. We care for older folks. All this makes our American health care system, with all its flaws, operate under a different set of values and constraints; the comparison to some of these other national health plans is useless and too often misguided. And it’s an important distinction to make as a new Congress and Administration will take up health care reform and policy wonks start declaring that the grass is greener in Canada and Sweden.

Tuesday, September 2, 2008

Top 10 lessons I learned when I went to the hospital.

That most people say they are happy with their health care is not very meaningful when you consider that most people are healthy.

Like lots of other people, I have gotten to know the most about health care when I have been sick or have had to care for someone else.

Here are some key things I have learned:

1. Public or private insurance gets you in the door but not necessarily the care you need.

2. There is a shortage of health care providers.

3. Mistakes happen.

4. Patients and providers want answers immediately.

5. There is little time left for patients and providers to get to know each other.

6. There are communication problems even when everyone speaks the same language.

7. People have to take more responsibility for their own health records even when they do not want to or do not have the skills.

8. It is important to make clear what one wants.

9. While evidence based medicine is a factor to consider; clinical judgment must also be valued.

10. You need to have someone with you.

We have a lot of work to do to make our health care system better.

Monday, September 1, 2008

Economics does not apply to health.

Our biggest mistake has been to use economic models to explain consumer behavior towards the purchase of health care. The underlying economic assumptions of the “rational consumer” or “all things being equal” are not valid. When we purchase health care we make a decision that may not be seen by others as rational but to the individual represents a valid choice.

Even if there’s just a small chance a treatment may work, if you are in pain or suffering, any chance is better than none and you want access to that treatment. It may not be rational but it’s human nature.

The rules for how we make decisions about health are just not the same as when we buy a cell phone or any other item. Health is neither a brand nor a commodity. Each individual addresses health choices at a very personal level.

After all, it is about one’s life and you just can’t buy another one.

Finally, on another note, we're thinking of all the families who have been displaced and otherwise affected by hurricane Gustav today. And our prayers are with those who lost family members to the storm.

Friday, August 29, 2008

Trimming the Fat or Cutting Muscle?

Too often those who beat the drums of cutting out the fat in the health care system ignore the reality that at some point there’s just no more fat to cut. The enthusiasm for saving dollars is now cutting connecting tissue and muscle too!

I’ve seen it most in visiting friends who are taking care of older family members. Our health care system is not prepared to handle the increase in older patients and the support they need.

Families and friends are often surprised and too often overwhelmed by the amount of attention they must provide even in the best of health care settings to make sure their loved ones get the care they need. Cost cutting has created a shortage of nurses, social workers, and all the members of a health care team. It has put a stopwatch on the time our health care provider can talk to us making the profession more difficult to practice and frustrating patients who no longer feel cared for.

We just can’t trim more from health care expenditures when the number of older people (and by definition sicker people) is getting larger.

Tax credits and insurance pools will only take us so far…we need to accept that health will be a larger portion of our country’s GDP. That is inevitable. The challenge is to create a system that is better and covers many more lives. That will take more and new dollars.

What do you think?

Thursday, August 21, 2008

The fat in our bodies

When I was growing up women were always looking to see how much fat they had on their bodies. Times have changed - today men and women are monitoring the fat on their bodies. Yet recent research shows that when we are looking we are not seeing what is most important.

All we see is bumps on our bodies but that does not tell us what makes up those bumps.

Those bumps or excesses are made up of two kinds of fat cells. The brown fat cells burn energy and keep us warm us while the white fat cells store energy. It seems highly likely that each person will vary in the amount and distribution of these two kinds of fat cells. This latest discovery means that we now have to better understand what kind of fat people have and where it is located. Could it be that all those comments about storing fat in your thighs is true for some because that is where some people have more white (storage) fat cells? For certain fat is more than just globs on our bodies to suck out or cut out; they are part of our delicately balanced endocrine system.

While research progresses, the best course of action to be healthy is still the same Spectacular Seven: do not smoke (and if you do stop), eat as healthy as possible, exercise, nurture healthy relationships, see your health care provider on a regular basis, take any medicines as prescribed, and be patient.

Wednesday, August 20, 2008

Dateline Minneapolis: Hospice is part of life.

As I was eating dinner at the restaurant in the hotel today in Minneapolis, a gentleman from Oklahoma and his wife were being seated at the next table. He said how much he enjoyed my morning keynote address at the National Hospice and Palliative Care Organization's 2nd National Conference on Access to Hospice and Palliative Care. After he sat down he turned around and looked at me and said, “Let me be accurate. I didn’t enjoy it but I felt challenged. You stepped on my toes. Thank you.”

I put my fork down and asked him how I could help. He wanted to know what was the best way to reach people who were not like him. What could he do? I reminded him that his greatest strength in reaching out to others was his deep sense of humanity and that reaching out to different communities is difficult because there is no cookie cutter. Although people may want to sell a single method to reach any group the fact is that there is no magic way to reach every person with a message about hospice.

Later in the day I spoke to another person who was pleased that they now had brochures about hospice in 20 languages. I couldn’t help but grin at their belief that somehow a brochure was going to be the bridge for discussions of life and death. Years of work on all sorts of health topics documents that brochures even when properly translated will not accomplish what needs to happen. Brochures are a tool; in and of themselves they accomplish nothing.

What do we need? We need conversation. End of life issues are difficult and the conversations difficult. We need trained and trusted advocates that can help us decide what our wishes are, have the conversation with those we love, and write it all down. It’s a loving step that gives us decision making authority and gives the comfort of clear directives to those we love in the most difficult of times. But it’s a step that requires more than a brochure, it requires one-to-one support. Making clear one’s preferences and planning for our own end of life care is a way to celebrate the full cycle of life.

You can call us at the National Alliance for Hispanic Health for support and speak to a trained health advocate in Spanish or English at 1-866-783-2645.

Philanthropy and the Hispanic Community

As we consider the impact of our evolving demographics one thing is certain; the philanthropic community must step up to the plate and respond to the needs of the Hispanic community in a meaningful way.

For too long Hispanic oriented programs were at best an appendage to ongoing foundation programs. In the best of instances Hispanic initiatives were placeholders for future programs. More often than not, however, in the absence of data about the Hispanic community the response of the philanthropic sector was to apply the lessons learned from other segments of the population to Hispanics and thus further diminish the unique Hispanic experience. In some instances foundations spent their resources on tasks to help them study and think. Throughout all of these exercises time passed and today the Hispanic population has grown to a level that is not adequately reflected by today’s funding priorities.

Looking at the foundations in California, Texas, and New York it is evident that only a negligible amount of the dollars actually ends up addressing the concerns of Hispanics. Moreover, there is a reluctance to fund Hispanic programs unless they are cloaked in conceptual frameworks that provide a comfort level to the funder. For example, endowment campaigns for Hispanic organizations may need to be rethought and many of the rules about fundraising principles may need to be retooled.

Yet the voice of the Hispanic community is not as strong as one would expect. Today Hispanics are 1 out of every 6 people in the United States; and yet that number is not reflected in the boards, staff, or programs of the philanthropic sector. We have a long way to go but with responsible leadership we will get there.

Thursday, August 14, 2008

2042 is the new 2050

For a while we heard that by 2050 whites would be less than 50% of the population in the U.S. Today’s announcement that by 2042 less than 50% of the U.S. population will be white documents that demographic changes are happening even faster.

By 2050 the four major groups in the U.S. will remain the same (whites 46 percent , Hispanics 30 percent, blacks 15 percent, and Asians 9 percent) although the growth in the different segments will vary.

These data provide an opportunity to prepare for the future of our country. At the very least we all need to work together to make sure that all segments of the population are as healthy as possible so that each individual can lead a full and productive life.

After all... life, liberty and the pursuit of happiness are fundamental to the American way...and of the three life is first. Clean air, clean water, safe food, and quality health care should be the first items on everyone’s agenda. offers a more detailed analysis of this Census Bureau announcement.

Wednesday, August 13, 2008

Hispanics Without Health Care Insurance; One Size Does Not Fit All

Data from the new study on Hispanics and health care released today by the Pew Hispanic Center and the Robert Wood Johnson Foundation are consistent with existing findings.

The critical part is that 1/3 of Hispanics have no health insurance but it seems that of those nearly 25% still manage to have a usual source of care.

One size fits all is a 20th century model of health care delivery -- it does not work for any body.

Here's an excerpt from the release:
More than one-fourth of Hispanic adults in the U.S. lack a usual health care provider, and a similar proportion report obtaining no health care information from medical personnel in the past year. At the same time, more than eight in ten report receiving health information from media sources, such as television and radio...

Tuesday, August 12, 2008

The Skinny on Weight

“Fat and healthy not an oxymoron” or “Fat and fit” were attempts to capture what was conveyed by recently published research in the Archives of Internal Medicine. Basically, over half of the overweight people turned out to be okay while nearly 25% of normal weight people were at risk for heart problems.

The more accurate headline would have stated metabolic health is linked to many factors and weight is only one of them. Moreover, whether a person is thin or has excess pounds is not the best way to determine a persons risk for heart problems. Your health is made up of many factors that include everything from your genetic package to the air you breathe. That being said this study is another reminder that as engaged health consumers we need to go for regular check-ups to see how our bodies are functioning, i.e, blood pressure, cholesterol levels, triglycerides, etc.

Narcissism aside, health is not about how we look but about how our body is working. has an AP story on this study.

Tuesday, August 5, 2008

Tuesday Health News

Tuesday is health news day for many daily newspapers and other news groups.  Here is a roundup of what's making news this Tuesday:
  • The Los Angeles Times reports on concerns that nanotechnology that imbeds miniscule silver particles into consumer products (from socks to plastic containers) to kill germs may make its way into human cells causing toxicity. 
  • An article in the New York Times reports that more than 11 million adults (18-64 years of age) in the U.S. with a chronic illness are also uninsured.
  • Reuters reports that the Food and Drug Administration (FDA) has cleared six flu vaccines for the 2008-2009 flu season with protection against additional strains of flu to make the approved vaccines more effective.
  • The Washington Post today reports on efforts of National Alliance for Hispanic Health member La Clinica del Pueblo in Washington, DC to support healthy diet and activity habits which Hispanic immigrants bring to the U.S. but lose as they adopt North American health norms.

Tuesday, July 29, 2008

Tuesday Health News

Tuesday is health news day for many daily newspapers and other news groups.  Here is a roundup of what's making news today:

Monday, July 28, 2008

HIV/AIDS Always a Priority

I worked in the U.S. Department of Health and Human Services (DHHS) Immediate Office of Secretary Margaret Heckler when she first announced the new health care crisis that we now know as AIDS.  Since the very beginning of the epidemic CDC tracked how many Hispanics had AIDS.  We have always been hard hit by AIDS' impact in our communities.  Recent coverage by the Washington Post missed the opportunity to describe the experience of our community.  I appreciated that the Post today tried to correct their reporting by including my Letter to the Editor in today’s editorial section.

There is much that we still have to do to help all those in our communities who have HIV/AIDS as part of their daily lives.

Friday, July 25, 2008

Add to Your "Must Do" List and Save a Life

The EPA surprised health advocates yesterday by proposing to ban carbofuran on both domestic and imported food.  That's good news for all of us.  Carbofuran is one of the most toxic insecticides still in wide use and poisons our food supply and our drinking water.  EPA is accepting comments for 60 days on the proposed ban and needs to hear your voice that this is a good thing.  Carbofuran's manufacturer, FMC, has vowed to fight the ban.

Of course EPA is an agency run by lawyers and not known for making public comment an easy task.  So here's a sample letter with all of the relevant docket numbers and authority codes. Just click here to download the letter.

About 1 million pounds of carbofuran are used in the U.S. each year and it's even more widely used outside of the U.S.  What's more, studies showed that when birds wandered into a field sprayed with carbofuran, 84% of them died . . . yet we allow farm workers to be exposed to this same chemical as part of their work!

As health advocates, we need to raise the noise level on this issue.  The Washington Post did a half page story, but its gotten scant coverage elsewhere.  The New York Times today only did a small blurb.

So make this a "must do" and save a life.  Write today to the Environmental Protection Agency (EPA) and let them know you support the proposed ban of carbofuran.

Thursday, July 24, 2008

Scholarships in Science for Hispanic Youth

I am thrilled that over the next five years the National Alliance for Hispanic Health and our partners will award at least $475,000 every year in scholarships and internships. The new Alliance/Merck Ciencia (Science) Hispanic Scholars Program was featured yesterday in testimony at a U.S. House Education and Labor Committee hearing on innovative business-education partnerships to help keep America competitive.

As one school superintendent told us, “this is going to change my kids lives.” It is a change that is long overdue. You can help by letting students know that they can call the Alliance at 1-866-783-2645 to get a science scholarship guide including information on our new scholarship program. In a time of financial difficulties for so many of our families it’s a bit of good news and who knows the student you help could become the next Hispanic Nobel Prize winner!

In related news, Education Week published a terrific feature story today by reporter Scott J. Cech about SciTech Summer Camp, developed by HENAAC and partners, aiming to get Hispanic high school students excited about the STEM fields (science, technology, engineering, and mathematics) through hands-on projects.

Tuesday, July 22, 2008

Needle in a (Jalapeño) Stack

The Food and Drug Administration (FDA) has found the source of the salmonella outbreak in the U.S. that sickened hundreds of people.  FDA inspectors found a jalapeño pepper from a distribution center in McAllen, Texas that was a genetic match with the outbreak serotype, Salmonella Saintpaul.  Talk about finding a needle in a jalapeño stack!

There’s been a lot of frustration about the 15 weeks it took to examine tomato and pepper producers and to identify this outbreak source.   What has not been talked about is what a gargantuan task this was for the FDA.  There are over 10 million tons of tomatoes grown in the U.S. alone each year and over 125 million tons worldwide.

It’s time for lawmakers to give the FDA the budget it needs to do its job.  The Senate Appropriations Committee just last week approved a $325 million increase for the FDA after years of budgetary neglect and it needs to become law.  As consumers we also need to recognize that we can never be 100% protected.  However, we can reduce risk by making safe food practices, like safe storage and washing fresh fruits and vegetables, a part of our daily routine.

And as a lover of my salsa, I want to say a word of thanks to the FDA inspectors and scientists that rarely get thanks, but have dedicated their lives to protecting the public’s health and this week found a needle in a jalapeño stack.

Tuesday Health News

Tuesday is health news day for many of the major daily newspapers and their news websites. Here is a roundup of links for what's making news today and some Alliance news:

Sunday, July 20, 2008

EPA Devalues Worth of Human Life

The U.S. Environmental Protection Agency (EPA) earned front-page coverage after it was revealed that the government agency has lowered its official estimate of life's value!

Leave it to EPA to devalue the worth of a human life.  I guess that inflation missed having an impact on our human worth.  And this how we want to make our environmental decisions?  How do you factor in the costs of a compromised life because of the increasingly toxic environment in which we live?  The EPA has a mandate to protect the public health and yet continues to play a numerical shell game with our lives.