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.